제93차 대한이비인후과학회 학술대회 2019년 춘계 대한 ...

2019년 4월 25일(목)~28일(일)

그랜드 힐튼 호텔

제93차 대한이비인후과학회 학술대회 2019년 춘계대한이비인후과의사회 학술대회in conjunction withInternational Congress of ORL-HNS 2019

http://www.koreaorlmeeting.org/workshop/2019spring

Connecting the ENT World: Future of Science, Innovation, and Profession

제93차 대한이비인후과학회 학술대회2019년 춘계 대한이비인후과의사회 학술대회

in Conjunction with International Congress of ORL-HNS 2019

02 • www.korl.or.kr

April 26(Fri)

44 Program at a Glance

46 Otology Keynote Lecture I

46 Otology Symposium 1

48 Otology Keynote Lecture II

49 Otology Meet The Professor 1

50 Otology Masters of Surgery 2

51 Otology Masters of Surgery 1

53 Otology Symposium 2

56 Rhinology Keynote Lecture 1

56 Rhinology Symposium 1

57 Rhinology Keynote Lecture 2

58 Rhinology Round Table 1


61 Rhinology Masters of Surgery 1


66 Head & Neck Surgery Keynote Lecture 1

66 Head & Neck Surgery Masters of Surgery 1

68 Head & Neck Surgery Symposium 1



71 Head & Neck Surgery Meet The Professor 1


75 Head & Neck Surgery 3D Printing


77 Head & Neck Surgery Masters of Surgery 2



84 Instruction Course 1~4

87 Video Lecture 1~3

90 Plenary Session

92 Otology Oral Presentation 1~6

112 Rhinology Oral Presentation 1~5

127 Head & Neck Surgery Oral Presentation 1, 2

132 Otology Poster Exhibition

141 Otology Teaser Poster Presentation 1~5

174 Rhinology Teaser Poster Presentation

179 Head & Neck Surgery Teaser Poster Presentation 1, 2

04 Welcome Message

06 Organization

09 Congress Information

11 Win the Grand Slam (IC MTP MOS)

12 학술대회 평점 유의사항 안내

13 Award Winners

15 CODE Guideline

15 Highlight Programs hosted by KORL-HNS

16 Official Program

17 Scientific Program

34 의사회 프로그램

36 Instruction Course

37 Video Lecture

38 Plenary Session

38 Hands-on Course

39 기타 안내

40 Floor Plan

April 25(Thu)


Contents

International Congress of ORL-HNS 2019 in conjunction with 93rd Annual Congress of Korean Society of Otorhinolaryngology-Head and Neck Surgery

2019 Spring Meeting of Korean Association of Otorhinolaryngologists

03www.korl.or.kr •



ContentsApril 27(Sat)


196 OT-Grand Debate 1

198 OT-Symposium 3

200 OT-Keynote Lecture 3

200 OT-Symposium 4

202 OT-Symposium 5

203 OT-Meet The Professor 2

205 OT-Keynote Lecture 4

206 RH-Meet The Professor 1

207 RH-Symposium 4

209 RH-Keynote Lecture 3

210 RH-Masters of Surgery2

212 RH-Symposium 5

213 RH-Meet The Professor 2

215 RH-Keynote Lecture 4

216 HN-Symposium 6

218 HN-Keynote Lecture 4~6

220 HN-Round Table 1

222 HN-Grand Debate 1

223 HN-Symposium 7

225 HN-Meet The Professor 2

227 HN-Keynote Lecture 7

228 HN-Meet The Professor 3

228 2019 ICORL Head and Neck Ultrasound International Joint Symposium

231 HN-Symposium 8

234 ORLSP Audiologist

236 ORLSP Nurse 1, 2

241 ORLSP SLP

245 Instruction Course 5~15

250 Otology Oral Presentation 7~12

276 Rhinology Oral Presentation 6~11

297 Resident Paper Award

298 Head & Neck Surgery Oral Presentation 3~7

317 ORLOP Audiologist

319 ORLOP SLP

323 Rhinology Poster Exhibition

April 28(Sun)


334 Otology Symposium 6~10

345 Rhinology Grand Debate 1




352 Head & Neck Surgery Grand Debate 2

355 Head & Neck Surgery Symposium 9~11

361 Otology Oral Presentation 13

365 Rhinology Oral Presentation 12

369 Head & Neck Surgery Oral Presentation 8~13

392 Head & Neck Surgery Poster Exhibition

403 윤리특강

409 Author's Index

427 Sponsors

428 Exhibitors & Ads

429 Exhibition




Welcome message

Young-Mo Kim, M.D., Ph.D.President, International Congress of ORL-HNS 2019

Honorable members of the Korean Society of Otorhinolaryngology-Head and Neck Surgery and participants

from overseas,

As the president of the Congress, it is my honor to welcome you to the 2019 International Congress of ORL-

HNS in conjunction with the 93rd Annual Congress of Korean Society of Otorhinolaryngology-Head and

Neck Surgery / 2019 Spring Meeting of Korean Association of Otorhinolaryngologists (2019 KORL-HNS).

I think that the academic level and the development of medical experiences of Otorhinolaryngologists in

Korea have made remarkable progress. Internally, the Korean Society of Otorhinolaryngology-Head and

Neck Surgery has made the foundation stronger for the past 70 years. Externally, we have successfully held

a variety of international conferences, and we are also creating many achievements in clinical and basic

science in this field. Of course, I believe that these developments are the result of many members' hard work

with the former presidents and directors of the Korean Society of Otorhinolaryngology.

This year, The Korean Society of Otorhinolaryngology-Head and Neck Surgery, which celebrated its 70th-

anniversary last year, is on a new starting line for the 100th anniversary. I think we should establish a new

future strategy and devote ourselves by looking back on the steps of the past 70 years and make greater

efforts to become a leader of the international society. In recent years, we have tried to change due to the

rapidly advancing medical technologies. In order to adapt to these medical environments, the Congress has

also created a more active environment for learning the latest knowledge and skills and diversified the topics

of presentations and lectures to maximize the capacity of its members to a higher level. I sincerely hope that

this Congress will become another opportunity to open the hearts and minds of our members to medical care

and research. I also believe it become a beautiful festival where all the members participate and get united.

I would like to express my gratitude and respect with all my heart to Chae-Seo Rhee, the chairman of

the board of directors of the Korean Society of Otorhinolaryngology-Head and Neck Surgery, who made

considerable efforts in the preparation of this Congress, Byeong-Ho Song, the president of the Korean

Association of Otorhinolaryngologists, and the directors and members of committees of both societies. I

want to thank all the members for your devotion and participation.

I hope that this Congress can meet the academic expectations of all the members and become a festival that

all of you can enjoy again.

Thank you.




Welcome message

Byeong Ho Song, M.D., Ph.D.President, Korean Association of Otorhinolaryngologists

Distinguished members of Korean Society of Otorhinolaryngology-Head and Neck Surgery and Korean

Association of Otorhinolaryngologists, and those who came afar across the globe,

It is our pleasure to have our distinguished members and excellent guests from around the world for our

93rd Annual Congress of Korean Society of Otorhinolaryngology-Head and Neck Surgery and 2019 Spring

Meeting of Korean Association of Otorhinolaryngologists in conjunction with International Congress

of ORL-HNS(ICORL 2019). Our spring meeting has become an international academic meeting since

2014. We are delighted as the size of the meeting is growing and the number of participants registered is

increasing each year.

Since it was transformed to an international seminar, there have been some members who felt awkward

for the programs provided in English and the number of registration tended to drop, but it has been on the

rise again for the recent years. The Sunday program of Korean Association of Otorhinolaryngologists will

provide various lectures and symposiums useful in the primary health care setting as well as a lecture on

the latest controversial inspection process of hearing aids and the required course on inspection control and

ethics. To look at the schedule that starts from Thursday, you can see that it is made up of the instruction

course on the cutting-edge medical knowledge, symposium, and a wide range of lectures and free paper

presentations across the otorhinolaryngology fields. We expect that this will be an opportunity for the

participants to learn new knowledge with this program and make active academic exchanges.

I would like to express my gratitude to Yeong-Mo Kim, chairman of congress, chairman of board of

directors Chae-seo Rhee, academic director Yun-woo Goh and the members of the academic committee,

and vice-chairman of academic department Jae-jin Choi and the members of the Korean Association of

Otorhinolaryngologists who spared no pains to prepare this event. I wish you could enjoy the time of

harmonies and exchanges with our distinguished guests in this April when spring become ripe. Thank you.




Organization

President, International Congress of ORL-HNS 2019

Chairman, Board of Directors, KORL-HNS

The Board of Directors/Organizing Committee KORL-HNS

KOO, Ja-WOn CHO, KWang-Jae CHOI, Seung-HO PaRK, KyOung HO KOH, yOOn WOO Lee, IL WOO Lee, Seung HOOn Lee, SeI yOung

general Secretary Director, Board exam Committee

Director, Resident Training Committee

editor Director, Scientific Committee

Director, Treasure Committee

Director, Medical Insurance Committee

Director, Medical Insurance Committee

KIM, JIn KOOK ye, MI Kyung Lee, Jun HO SHIn, gWang CHeOL LIM, Sang CHuL CHae, Sung WOn PaRK, SHI nae PaRK, IL SeOK

Director, Medical affairs Committee

Director, Public Relations

Director, Planning Committee

Director, Medical Practitioner Committee

Director, Legislation Committee

Director, education Research Committee

Director, International affairs

Director, Social Responsibility

KIM, yOung-MOCongress President

RHee, CHae-SeOChairman

Jung, KWang-yOOnVice Chairman

HOng, IL HeeVice Chairman

CHO, yang-SunChairman-elect




auditorPaRK, CHang SIKKIM, gI HWan

Vice president, general Secretary Committee Han, CHang JOOnDirector, general Secretary KIM, Byung CHuLDirector, Treasury Lee, yOun KyuDirector, Corporate Relations PaRK, DOng SunDirector, Project RHIM, gu ILDirector, Policy PaRK, Sang HO

Director, Medical affairsHOng, DOng KyunRHO, yOng Hun

Director, Social Council yOOn, Sun OKDirector, Legislation SHIn, JOOng WOOKVice president, Scientific Committee CHOI, Jae JInDirector, education HWang, CHan HO

Director, Scientific Lee, Hyun JOngOH, Jae KOOKCHO, WOO JIn

Vice president, Public Relations Committee PaRK, SeOn Tae

Director, Public Relations

SHIn, gWang CHeOLLee, JOng SunKIM, Jun HeeCHO, yOung Ju

Vice president, Medical Insurance Committee KIM, Que CHIC

Director, Medical Insurance

Han, DOng HyuKKIM, JOng BInKIM, JOO HWanaHn, yOung JIn

Korean Association of Otorhinolaryngologists

SOng, ByeOng HOPresident

Associated Societies

CHae, Sung WOn KIM, Sung Wan KIM, Se-HeOn Lee, Seung HWan KIM, KWHanMIen Lee, Byung-JOO KIM, Jung SOO CHung, yOO-SaM

PresidentKorean Otological

Society

PresidentKorean

Rhinologic Society

PresidentKorean Society of Head and neck

Surgery

PresidentThe Korean audiological

Society

PresidentThe Korean

Bronchoesophagological Society

PresidentKorean Society of Laryngology, Phoniatrics and

Logopedics

PresidentKorean academy of Facial Plastic

and Reconstructive Surgery

PresidentKorean Society

of Pediatric Otorhinolaryngology




Scientific Committee Members

KOO, Ja-WOnKIM, DOng-yOungKIM, Sung WOnKIM, CHang-HOOnKIM, CHuL-HOKIM, Tae HOOnByun, Jae yOngPaRK, Jung JeBaeK, Seung KuKLee, Kun HeeLee, Kyu-yuPLee, Sang HyuKLee, JOng DaeCHung, Man KICHO, Kyu-SuPJOO, yOung HOOnCHOI, Byung yOOnHOng, Hyun JunHWang, CHan HO

Scientific Committee

Korean Association of Otorhinolaryngologists Scientific Committee

KOH, yOOn WOODirector, Scientific Committee

KIM, Sung HuHn Lee, SO-yOOn

Vice-Director, Scientific Committee

Vice-Director, Scientific Committee

Scientific Committee Members

LIM, JeOng TaeKMOOn, IL HaMOOn, Tae Hyun Bae, SeOng CHeOn SeO, In SeOKCHu, HOSuKKang, JeOng MInKIM, JOOnHOPaRK, KuK JIn Lee, KI ILLee, Seung SIn PaRK, Sun KILee, JIn SeOK Lee, CHuL HeeCHu, Hyung RO HaH, JeOng Hun CHOI, yOOn SeOK

Organization




Congress InformationCongress Venue- Grand Hilton Hotel & Convention Center, Seoul, Korea

- Please refer to the floor plan in the program book.

Registration DeskCongress Registration- Location: Convention Center (3F)

- Operating Hour: April 26 (Fri) : 07:00~18:00

April 27 (Sat) : 07:00~18:00

April 28 (Sun) : 07:00~17:00

Opening Ceremony- Date & Time: April 26 (Fri), 09:00~09:20

- Location: Convention Hall B, Convention Center (4F)

Congress BanquetDinner Coupon is attached on the name tag. Please submit your coupon when you enter room.

- Date & Time: April 27 (Sat), 18:00~

- Location: Convention Hall A - C, Convention Center (4F)

- Coupon is available at registration desk until sold out (price: 40,000 KRW)

LuncheonLunch Coupon is attached on the name tag. Please keep in mind that the name tag & Coupons cannot be re-issued.

- Date & Time: April 26 (Fri), 12:30~13:30

- Location: Convention Hall A, B, C

- Date & Time: April 27 (Sat), 12:40~13:30 - Location: Convention Hall A, B, C

- Date & Time: April 28 (Sun), 12:40~13:30

- Location: Emerald Hall A, B

- Location: Diamond Hall

- Location: Flamingo, White Heron, Peacock, Hotel (2F)

Closing Ceremony- Date & Time: April 28 (Sun), 17:00~17:30

- Location: Diamond Hall, Convention Center (3F)




Award CeremonyOpening Ceremony: Academic Achievement Award, DAIN Leading Research Award, Seok Dang Best Research Paper

Award, Resident Paper Award, Award for Humanitarian Service, Excellent Branch Award, International

Fellow Scholarship beneficiary

Closing Ceremony: Best Oral & Poster Presentation, Travel Grant Awards

Special Notices at the ICORL 2019It is strictly prohibited to take a photo or video for the lecture contents.

Please turn off or switch to vibrate your cell phone within the session room.

Special Information For Pray Room, Lunch Box, and Photo Zone

1. Pray room for Muslim : Residence in Grand Hilton Hotel : majelis (1st floor)

If you cannot find the room, please inquire at the residence front desk.

2. Lunch box for vegetarians is also available near the room entrance.

3. Information of photo zone :

1) lobby (4F), 2) next to the Medel booth (1F) (with “Hanbok” Korean Traditional Costume experience)

Enjoy wearing beautiful “Hanbok” and take a picture for overseas attendees.




Please put the stickers on Lottery ticket in your name card. You can get the stickers from the chairperson and speakers of

IC, MTP, MOS sessions.

Lottery Day & Place April 28 (Sun) 17:00~ Closing Ceremony

Diamond Hall, Convention 3F

How to apply for LotteryIf you receive 1~10 stickers and submit the Lottery ticket to Registration Desk by 15:40 on April 28 (Sun), GALAXY WATCH

ACTIVE, STARBUCKS GIFT CARD(KRW 50,000) will be given through the lottery at the Closing Ceremony.

If you receive 11~20 stickers and submit the Lottery ticket to Registration Desk by 15:40 on April 28 (Sun), SAMSUNG

GALAXY TAB S4 (LTE), LG LOBOKING TURBO, DYSON SUPERSONIC will be given through the lottery at the Closing

Ceremony.

GALAXY WATCH ACTIVE STARBUCKS GIFT CARD (KRW 50,000)

SAMSUNG GALAXY TAB S4 (LTE) LG LOBOKING TURBO DYSON SUPERSONIC

Win the Grand Slam (IC MTP MOS)




학술대회 평점 유의사항 안내

대한의사협회의 연수교육 관리 방침 변경(대의학 제2016-1호)에 따라 학술대회 출결관리 강화를 위하여 학술대회 시작과 종료를 확인할 수 있

도록 일 2회의 출결 확인을 하고, 체류 시간에 따라 부분평점을 발급합니다. 반드시 명찰을 발급 받으시고 금요일, 토요일, 일요일 매일 일 2회 출

결 확인을 하여 주시기 바랍니다.

또한 대리출석 방지를 위해 신분증 제시 요구에 적극 협조하여 주시기 바랍니다.

출결 확인 방법

컨벤션센터 3층 등록데스크에 비치된 바코드 리더기에 명찰에 출력되어 있는 바코드를 접촉.

※ 금요일, 토요일, 일요일 매일 일 2회의 접촉(1일 여러번 접촉할 경우 최초 접촉시간과 마지막 접촉시간으로 계산함.)

※ 일 1회의 접촉 또는 일 2회의 접촉 시간이 2시간 미만일 경우 연수 평점이 부여되지 않음.

부분평점 인정 기준(6평점 기준)

일 2회의 접촉 시간이

· 2시간 초과 ~ 3시간 이하 ⇒ 3평점 인정



· 5시간 초과 ~ ⇒ 6평점 인정

※ 금요일, 토요일, 일요일 각각 5시간 초과로 매일 2회씩 총 6회의 바코드를 접촉하셔야 최대18평점 인정(일요일 필수평점 2평점 포함)

필수평점 출결 확인 방법

· 필수과목 참석자는 해당 강의실 입장 및 퇴실 시 출입구 앞에서 바코드 리더기에 명찰의 바코드를 접촉하여 별도로 출결 확인 필수(체류시간

60분 이상)

· 필수과목 출결확인 바코드 리더기는 강의시간 10분 이내 철수하오니 이점 양지하시기 바랍니다.

· 면허신고자는 직전 3년간의 24평점 중 2평점을 필수평점으로 이수해야 함.




Award WinnersAcademic Achievement Award (학술상)

Professor Chang-Hoon Kim graduated from Yonsei University in 1992. He works for Yonsei University as a Rhinologist and also head of The Airway Mucus Institute. He is endowed with Academic Achievement Award at ICORL 2019, in recognition of his consistent and enthusiastic dedications for the development of the KORL-HNS in administrative as well as academic field for last 5 years.

CHANG-HOON KIM (Yonsei Univ.)

Recognition Award for Senior Members (원로회원 특별상)

Honorary professor of Keimyung University School of MedicineFormer chairman of Korean Society of Otorhino-laryngology-Head and Neck SurgeryFormer head of Institute of Hearing Loss at Keimyung University Dongsan Medical Center Former visiting professor of University of Iowa College of Medicine, USAAward for Humanitarian Service by Korean Society of Otorhinolaryngology-Head and Neck Surgery(2005)

Professor Joong-gahng KIM has been relieving the pain and keeping the health of many patients with medical treatments and operations taking it as an opportunity for research into student education, medical development and medical specialist training, and, furthermore, medical development. Particularly, he has been serving for research and community service with the scholarly interest and passion for about 30 years for the prevention and rehabilitation of a hearing impairment at the time when there was little understanding of the people with disabilities.

JOONG-GAHNG KIM (Keimyung Univ.)

Best Resident Paper Awards (전공의 우수연제상)

Paradoxical Response to Cold Dry Air Provocation

According to the Season in Allergic Rhinitis Patients

Rhinology: KI IK PARK (Inha Univ.)

DAIN Leading Research Award (다인 선도연구자상)

Professor Seung Hoon Woo is working for Dankook University hospital. He graduated from Dankook University in the year of 2000. In recognition of his excellency in academic achievement, he is endowed with Leading Research Award at ICOLR 2019. For last 5 years, as many as 33 scientific papers have been published under his major authorship in SCI(E) journals, corresponding of a total Impact Factor of 87.52.

SEUNG HOON WOO (DanKook Univ.)

Seok Dang Best Research Paper Awards (석당우수논문상)

Comparison of Clinical Usefulness of Program-Assisted and Real Ear Measurement-Assisted Hearing Aids Fitting

The 2nd PrizeYANG-SUN CHO (Sungkyunkwan Univ.)

Role of Interleukin-10-Expressing B Cells on the Pathophysiology of Chronic Sinusitis

The 3rd PrizeYONG MIN KIM (Chungnam National Univ.)

The 1st Prize

Number of Metastatic Lymph Nodes and Ratio of Metastatic Lymph Nodes to Total Number of Retrieved Lymph Nodes Are Risk Factors for Recurrence in Patients With Clinically Node Negative Papillary Thyroid Carcinom.

KYUNG TAE (Hanyang Univ.) The 1st Prize




Excellent Branch Award (우수지부상)

대전 · 세종 · 충남지부(Daejeon · Sejong · Chungnam Branch)

International Fellow Scholarship beneficiary (해외 장학금 수상자)

Best Oral Presentation Award

Six winners, two persons per specialty will be selected

throgh a rigorous review in oral presentation session.

Best Poster Award

Six winners in each specialty will be selected through a

rigorous review in poster presentation session.

Travel Grant Award

For young colleagues from overseas who submit outstanding abstracts as decided by the scientific committee. (<40 years of age)

Otology: BIBEK GYANWALI (Department of Pharmacology, National University of Singapore, Singapore)Hearing Handicap in Asian Demented Patients

Rhinology: ASTI WIDURI (Department of Otorhinolaryngology Universitas Muhammadiyah Yogyakarta Univ. Faculty of Medicine and Health Science, Indonesia)Correlation between IL-4 levels and Anxiety Score in Allergic Rhinitis Patients.

Head and Neck Surgery: MD I SAFIULLAH (Department of Otolaryngo logy, Abdul Malek Ukil Medical College, Bangladesh)Thyroid surgery under local anesthesia in selected group of patients my Experience

Award for Humanitarian Service (사회 봉사상)

Director Uh Suk Lee graduated from Seoul National University College of Medicine in 1979 and has been donating the units and chairs to the service places of the Association including Youngbo Jaaewon, Boys Town, and Eunpyong Maeul since 1990 and helping open a medical clinic otolaryngological clinic for free medical treatment and surgery and financial aid for orphans, people with disabilities, and homeless people. He also has been doing voluntary work on weekends more than 10 times a year until now for over 20 years, contributing significantly to pioneer and expand the community service area. Moreover, he participated in the otolaryngological medical service at Boy's and girl's town, the school operated by Sisters of Mary for orphans and poor children in Manila and Cebu in the Philippines, enhancing the status of the otolaryngologist in Korea.

UH SUK LEE (Seoul Union ENT)

Leonita Pinto Jeronimo (Hospital Nacional Guido Valladares Dili, East Timor

Chungnam National University School of Medicine, Korea)

Nguyen Nguyen (Hue University of Medicine and Pharmacy, Hue University Hospital, Vietnam

Inha University Hospital, Korea)




CODE GuidelineSpecialties

OT Otology

RH Rhinology

HN Head & neck Surgery

ORL Society Program & Combined Program

SLP Speech and Language Pathologists

CL Clinicians

KL Keynote Lecture

SL Special Lecture

SP Symposium

IC Instruction Course

VL Video Lecture

HO Hands-on Course

IM Interest group Meeting

OP Free Paper (Oral Presentation)

PP Free Paper (Poster Presentation)

PX Free Paper (Poster exhibition)

OTSP Otology Symposium

RHOP Rhinology Oral Presentation

HNHO Head & neck Surgery Hands-on Course

OTIC Otology Instruction Course

Scientific Committee

How to Understand the AbbreviationConnect the letters of Specialties and Session Abbreviations

& Types mentioned above. For example,

April 25 (Thu)

Welcome Reception 18:00 ~ 20:00

Room 3-3 (Diamond), Convention Center (3F)

※For all members & International attendees

April 26 (Fri)

Opening Ceremony 09:00 ~ 09:20

Room 4-2 (Convention B), Convention Center (4F)

※For all members & International attendees

April 27 (Sat)

general assembly 12:40 ~ 13:30


※KORL-HnS Regular Members Only

Congress Banquet 18:00 ~

Room 4-1, 4-2, 4-3 (Convention Hall a-C), Convention Center (4F)

※Pre-registered/paid for Banquet Only

April 28 (Sun)

Closing Ceremony 17:00 ~


※all members & International attendees

Highlight Programs hosted by KORL-HNS




April 25 (Thu)

지도전문의교육 14:00 ~ 18:00

Room 3-1 (emerald a), Convention Center (3F)

Welcome Reception 18:00 ~ 20:00


April 26 (Fri)

Opening Ceremony 09:00 ~ 09:20


Plenary Session 09:20 ~ 10:00


Chair: YOUNG MO KIM (Inha Univ.)

THe WORLD In 2019 anD THe KORean PenInSuLa

JOON OH (KYUNGHee UNIv.)

Congress Photo 10:00 ~ 10:10


Senior Member Luncheon 12:30 ~ 13:30

Room 2-6 (Peacock), Hotel 2F

exhibition Ribbon Cutting 10:30 ~ 10:40

Room 2-6 (exhibition Hall B), Convention Center (1F)

Official Program

April 27 (Sat)

조교수 이하 젊은 스텝을 위한 학회사업 오리엔테이션

09:20-10:20 *Korean Session Room 2-4 (Swan), Hotel 2F

09:20-09:25 인사말: 이재서 이사장, 정광윤 미래인재육성사업단장

09:25-09:35 대한이비인후과학회의 조직 (총무부)

09:35-09:45 고시위원회의 역할과 업무 (고시부)

09:45-09:55 수련위원회의 역할과 업무 (수련부)

09:55-10:05 보험위원회의 역할과 업무 (보험부)

10:05-10:15 사회공헌위원회의 역할과 업무 (사회공헌부)

10:15-10:20 맺음말: 정광윤 미래인재육성사업단장

general assembly 12:40 ~ 13:30


Congress Banquet 18:00 ~

Room 4-1, 4-2, 4-3 (Convention Hall a-C), Convention Center (4F)

April 28 (Sun)

[윤리특강]

13:30~14:30 *Korean Session Room 3-3 (Diamond)좌장 : 임상철 (전남의대)

13:30-14:00

삶과 죽음의 문제들: 미래사회에서 의사의 새로운 역할과 과제

김양현 (전남대 철학과)

14:00-14:30임상윤리의 이론과 실제

유상호 (한양대 의료윤리학)

Closing Ceremony 17:00 ~





April 26 (Fri) Otology

[OT-KL 1] Keynote Lecture I

10:30-11:00 Room 4-1 (Convention a)

Chair : YONG BeOM CHO (CHONNaM NatIONal UNIv.)

LOOKIng aT TInnITuS THeRaPy FROM a DIFFeRenT angLe

tIeN-CHeN lIU (NatIONal taIwaN UNIv., taIwaN)

[OT-SP 1] endoscopic approach for Middle ear Disease

11:00~12:30 Room 4-1 (Convention a)

Chair : Il-wOO lee (PUsaN NatIONal UNIv.), MICHael tONG (CHINese UNIversItY Of HONG KONG, HONG KONG)

enDOSCOPIC MIDDLe eaR anaTOMy anD PHySIOL-Ogy

MICHael CHI faI tONG (CHINese UNIversItY Of HONG KONG, HONG KONG)

TRanSCanaL enDOSCOPIC TyMPanOPLaSTy

Il JOON MOON (sUNGKYUNKwaN UNIv.)

enDOSCOPIC OSSICuLOPLaSTy

KaDr serKaN OrHaN (UNIversItY Of IstaNBUl, tUrKeY)

enDOSCOPIC aPPROaCH FOR aTTIC CHOLeSTeaTO-Ma

Il-wOO lee (PUsaN NatIONal UNIv.)

TRanSCanaL enDOSCOPIC eaR SuRgeRy FOR COngenITaL CHOLeSTeaTOMa

TSUKASA ITO (YAmAgATA UnIv., JApAn)

[OT-KL 2] Keynote Lecture II


Chair : JONG wOO CHUNG (UNIv. Of UlsaN)

THe euROPean BOaRD exaM In OTORHInOLaRyn-gOLOgy-HeaD anD neCK SuRgeRy(eBeORL-HnS).PReSenT STaTuS anD FuTuRe aSPeCTS

UlrIK PeDerseN (aarHUs UNIversItY HOsPItal, DeNMarK)

[OT-MTP 1] Management of Difficult or Intractable Recurrent Vertigo


Chair : OZGUr YIGIt (IstaNBUl traINING aND researCH HOsPItal, tUrKeY),

Moderator : wON-HO CHUNG (sUNGKYUNKwaN UNIv.)

SuPeRIOR CanaL DeHISCenCe SynDROMe

Ja-wON KOO (seOUl NatIONal UNIv.)

unILaTeRaL POSTeRIOR CanaL-PLuggIng SuR-geRy FOR InTRaCTaBLe BILaTeRaL POSTeRIOR CanaL-TyPe BenIgn PaROxySMaL POSITIOnaL VeR-TIgO

taKaO IMaI (OsaKa UNIv., JaPaN)

aPPROaCH TO InTRaCTaBLe MenIeRe’S DISeaSe; WHaT We WOuLD DO?

KYU sUNG KIM (INHa UNIv.)

[OT-MOS 2] Management of external ear Malformations

14:00~15:30 Room 3-1 (emerald a)

Chair : MICHael tONG (CHINese UNIv., HONG KONG), Moderator : GYU CHeOl HaN (GaCHON UNIv.)

SuRgICaL TIPS In MInOR auRICuLaR MaLFORMa-TIOn

JeONG-HOON OH (tHe CatHOlIC UNIv. Of KOrea)

BaSIC SKILLS FOR MICROTIa SuRgeRy

sUNG HUHN KIM (YONseI UNIv.)

IMPLanTaBLe HeaRIng aIDS FOR COngenITaL ex-TeRnaL & MIDDLe eaR MaLFORMaTIOnS

MICHael CHI faI tONG (CHINese UNIv., HONG KONG)

SKIn gRaFTIng In OTOLOgIC SuRgeRy

lOKMaN BIN saIM (KPJ HealtHCare UNIv.,MalaYsIa)

Scientific Program



Scientific Program


April 26 (Fri) Rhinology

[RH-KL 1] Keynote Lecture I

10:30~11:00 Room 4-2 (Convention B)

Chair : saM HYUN KwON (CHONBUK NatIONal UNIv.)

enDOSCOPIC VeRSuS exTeRnaL FROnTaL SInuS SuRgeRy: WHen & HOW

JaNNIs CONstaNtINIDIs (arIstOtle UNIversItY, GreeCe)

[RH-SP 1] Recent Perspectives on CRS


Chair : saNG HaG lee (KOrea UNIv.), KOrNKIat sNIDvONGs (CHUlalONGKOM UNIv., tHaIlaND)

CHaLLengeS In TReaTIng CRS: HOW WILL Re-SeaRCH DeVeLOPMenT OF enDOTyPeS anD CLInI-CaL BIOMaRKeRS LeaD uS

PONtUs stIerNa (HUDDINGe UNIversItY HOsPItal, sweDeN)

eOSInOPHILIC CRS In JaPan

KIYOsHI YaNaGI (st. lUKe’s INterNatIONal HOsP., JaPaN)

nOn-eOSInOPHILIC CRS In KORea

Dae wOO KIM (seOUl NatIONal UNIv.)

DIFFICuLT FeSS a SuRgICaL CHaLLenge

alI ZaHeer al-aMIN (IMPUlse HOsPItal, BaNGlaDesH)

[RH-KL 2] Keynote Lecture II


Chair : HwaN JUNG rOH (PUsaN NatIONal UNIv.)

THe SHIFTIng PaRaDIgM In SnORIng anD aPnea

MetIN ONerCI (HaCettePe UNIversItY, faCUltY Of MeDICINe, tUrKeY)

April 26 (Fri) Otology

[OT-MOS 1] My Favorite approach in Skull Base Surgery


Chair : JONG wOO CHUNG (UNIv. Of UlsaN), Moderator : KI-HONG CHaNG (tHe CatHOlIC UNIv. Of KOrea)

enDOSCOPIC LaTeRaL SKuLL BaSe SuRgeRy

IN seOK MOON (YONseI UNIv.)

InFRaTeMPORaL FOSSa aPPROaCH FOR JuguLaR FORaMen TuMORS

YaNG-sUN CHO (sUNGKYUNKwaN UNIv)

ManageMenT STRaTegy OF FaCIaL neRVe Tu-MORS

ZHaOYaN waNG (sHaNGHaI JIaO tONG UNIv., CHINa)

TRanSLaByRInTHIne aPPROaCH FOR VeSTIBuLaR SCHWannOMa

JONG Dae lee (sOONCHUNHYaNG UNIv.)

MIDDLe FOSSa aPPROaCH FOR VeSTIBuLaR SCHWannOMa

BeOMCHO JUN (tHe CatHOlIC UNIv. Of KOrea)

[OT-SP 2] eustachian Tube Disorders

15:50~17:50 Room 3-1 (emerald a)

Chair : HONG JU ParK (UlsaN UNIv.)YUN-HOON CHOUNG (aJOU UNIv.)

PaST, PReSenT, anD FuTuRe: BaLLOOn euSTa-CHIan TuBe DILaTaTIOn

HOlGer sUDHOff (BIelefelD aCaDeMIC teaCHING HOsP., GerMaNY)

DIagnOSTIC CRITeRIa FOR PaTuLOuS euSTaCHIan TuBe

rYOUKICHI IKeDa (tOHOKU UNIv., JaPaN)

VaRIOuS SuRgICaL ManageMenT OF PaTuLOuS euSTaCHIan TuBe

sOO-KeUN KONG (PUsaN NatIONal UNIv.)

COMBIneD FLuOROSCOPIC anD enDOSCOPIC eu-STaCHIan TuBe BaLLOOn DILaTIOn SySTeM

HONG JU ParK (UlsaN UNIv.)

CLInICaL aSSeSSMenT OF euSTaCHIan TuBe FunC-TIOn

HO YUN lee (eUlJI UNIv.)




[RH-MOS 1] My Philosophy of Rhinoplasty


Chair : CeMal CINGI (esKIseHIr OsMaNGaZI UNIv., tUrKeY), Moderator : CHase laY (saN JOse., Usa)

enDOnaSaL aeSTHeTIC anD FunCTIOnaL STRuC-TuRe RHInOPLaSTy

CHIH-weN twU (taICHUNG veteraNs GeNeral HOsPItal, taIwaN)

enDOnaSaL RHInOPLaSTy

CeMal CINGI (esKIseHIr OsMaNGaZI UNIv., tUrKeY)

My PHILOSOPHy In PRIMaRy aeSTHeTIC RHInO-PLaSTy OF aSIan

HONG rYUl JIN (Dr JINs PreMIUM NOse ClINIC)

CReaTIng a PROMInenT TIP anD naSaL BRIDge

YONG JU JaNG (UNIv. Of UlsaN)

WHaT aM I DOIng TODay In RHInOPLaSTy anD WHy?

KUN Hee lee (KYUNGHee UNIv.)

[RH-SP 3] Recent updates on allergic Rhinitis

15:50~17:50 Room 3-2 (emerald B)

Chair : JIN Hee CHO (tHe CatHOlIC UNIv.), KIMIHIrO OKUBO (NIPPON MeDICal sCHOOl, JaPaN)

ROLe OF VITaMIn D In aLLeRgIC RHInITIS

sUNG-wOO CHO (seOUl NatIONal UNIv.)

ROLe OF MICROBIOMe In PaTHOPHySIOLOgy OF aR

seOK-HYUN CHO (HaNYaNG UNIv.)

CLInICaL TRIaL FOR aLLeRgIC RHInITIS WITH OHIO CHaMBeR

KIMIHIrO OKUBO (NIPPON MeDICal sCHOOl, JaPaN)

neW HORIzOnS FOR TReaTMenT OF aR: BIOLOgICS, COMBInaTIOn DRugS

BeNJaMIN saN aGUstIN CaMPOMaNes (st. lUKes MeDICal CeNter, PHIlIPPINes)

[RH-RT 1] Olfaction and Taste Dysfunction: Diagnosis, Treatment and Prognosis


Chair : raMIZa raMZa raMlI (MalaYsIa), Moderator : seOK CHaN HONG (KONKUK UNIv.)

DIagnOSIS OF OLFaCTORy DISORDeRS

KYU BO KIM (HallYM UNIv.)

eVIDenCe FOR OLFaCTORy TRaInIng In THe TReaTMenT OF PaTIenTS WITH OLFaCTORy LOSS

seUNG-NO HONG (seOUl NatIONal UNIv.)

OLFaCTORy DySFunCTIOn anD auTOIMMunITy

YOUNG HYO KIM (INHa UNIv.)

TISSue InFLaMMaTIOn anD OLFaCTORy DySFunC-TIOn

DO-YeON CHO (UNIv. Of alaBaMa at BIrMINGHaM, Usa)

OLFaCTORy TeSTIngPeter sIMON JarIN (tHe MeDICal CItY, PHIlIPPINes)

DISCuSSIOn

[RH-SP 2] Challenges in Sphenoid Sinus Surgery

14:00~15:30 Room 3-2 (emerald B)

Chair : HUN-JONG DHONG (sUNGKYUNKwaN UNIv.), te-HUeI YeH (NatIONal taIwaN UNIv.,taIwaN)

BaSICS OF SPHenOID SInuS SuRgeRy: anaTOMy SuRROunDIng SPHenOID SInuS

YONG GI JUNG (sUNGKYUNKwaN UNIv.)

PITFaLLS anD TIPS FOR SPHenOIDOTOMy

BeNJaMIN saN aGUstIN CaMPOMaNes (st. lUKes MeDICal CeNter, PHIlIPPINes)

ISOLaTeD SPHenOID SInuS LeSIOnS

JI-HUN MO (DaNKOOK UNIv.)

COMPLICaTIOnS OF SPHenOID SInuS SuRgeRy anD ITS ManageMenT

te-HUeI YeH (NatIONal taIwaN UNIv., taIwaN)

exTenDeD aPPROaCHeS BeyOnD SPHenOID SInuS

JI HeUI KIM (UNIv. Of UlsaN)



Scientific Program


[Hn-SP 4] IgReHnS Panel: Innovation in Robotics and Head and neck Surgery

11:00~12:30 Room 2-3 (White Heron)

Chair : sI YOUN sONG (YeUNGNaM UNIv.), Moderator : CHrIs HOlsINGer

(staNfOrD UNIversItY UNIv., Usa)

FuTuRe OF ROBOTICS anD VIRTuaL ReaLITy In SuRgeRy

tHOMas PatrICK lOw (srI INterNatIONal, Usa)

TRanSORaL THyROIDeCTOMy: HeRe TO STay? OR JuST THe LaTeST FaD?

JON rUssell (JOHNs HOPKINs sCHOOl Of MeDICINe, Usa)

SeMI-auTOnOMy In ROBOTIC SuRgICaL SySTeMS

rYaN K OrOsCO (UNIversItY Of CalIfOrNIa saN DIeGO, Usa)

MeaSuRIng OuTCOMeS In TORS FOR OROPHaRynx CanCeR BeyOnD THe MDaDI

rYaN P GOePfert (UNIversItY Of texas MD aNDersON CaNCer CeNter, Usa)

[Hn-KL 2] Keynote Lecture II

13:30~14:00 Room 4-3 (Convention C)

Chair : YOUNG sOO rHO (DaIN ear NOse tHrOat HOsP.)

aPPROPRIaTe ManageMenT OF CeRVICaL neCK nODeS In ORaL CanCeR

raJeNDra B tOPraNI (HCG CaNCer CeNtre, INDIa)

[Hn-MTP 1] a road less traveled: Reconstructive surgery in HnC


Chair : MIN sIK KIM (tHe CatHOlIC UNIv. Of KOrea), Moderator : sOON-HYUN aHN (seOUl NatIONal UNIv.)

a JOuRney TO THe HeaD anD neCK SuRgeRy aS a ReCOnSTRuCTIVe SuRgeOn

MIN sIK KIM (tHe CatHOlIC UNIv. Of KOrea)

COnFROnTeD ISSueS In HeaD neCK ReCOnSTRuC-TIOn

CHUNG-HwaN BaeK (sUNGKYUNKwaN UNIv.)

ManDIBuLaR ReCOnSTRuCTIOn By uSIng COM-PuTeR-aSSISTeD anD 3D PRInTIng aSSISTeD.

PHaKDee saNNIKOrN (raJavItHI HOsPItal, BaNGKOK, taIlaND)

HOW TO aVOID COMPLICaTIOnS In FRee FLaP Re-COnSTRuCTIVe SuRgeRy In HeaD anD neCK

wOJCIeCH GOlUsIŃsKI (POZNaN UNIv., POlaND)

April 26 (Fri) Head & Neck Surgery

[Hn-KL 1] Keynote Lecture I


Chair : eUN CHaNG CHOI (YONseI UNIv.)

HPV In HeaD anD neCK CanCeR euROPean PeR-SPeCTIVeS

wOJCIeCH GOlUsINsKI (POZNaN UNIv., POlaND)

[Hn-MOS 1] Tips and Pitfalls in Surgical Management for Laryngopharyngeal Cancer


Chair : sOON YUHl NaM (asaN MeDICal CeNter), Moderator : se-HeON KIM (YONseI UNIv.)

TRanSORaL ROBOTIC SuRgeRy FOR OROPHaRyn-geaL CanCeR

se-HeON KIM (YONseI UNIv.)OPen COnSeRVaTIOn SuRgeRy FOR LaRyngeaL CanCeR

KwaNG-Jae CHO (tHe CatHOlIC UNIv. Of KOrea)enDOSCOPICaLLy-aSSOCIaTeD SuRgICaL TReaTMenT OF CHROnIC ODOnTOgenIC MaxILLaRy SInuSITIS

aNDreI I. IareMeNKO (PavlOv fIrst saINt PetersBUrG state MeDICal UNIv., rUssIa)

ReCOnSTRuCTIVe SuRgeRy FOR PHaRyn-gOeSOPHageaL DeFeCTS

sOON-HYUN aHN (seOUl NatIONal UNIv.)

[Hn-SP 1] evidence-based Management of Oral Cancer

11:00~12:30 Room 3-3 (Diamond)

Chair : sHeNG-PO HaO (sHIN KONG wU HO-sU MeMOrIal HOsP., taIwaN),

sOON YOUNG KwON (KOrea UNIversItY),

WHICH aPPROaCH IS aPPROPRIaTe FOR ORaL CanCeR

sHeNG-PO HaO (sHIN KONG wU HO-sU MeMOrIal HOsP., taIwaN)

WHaT IS THe aDeQuaTe ReSeCTIOn MaRgIn FOR ORaL CanCeR

HYUN JUN HONG (CatHOlIC KwaNDONG UNIv.)aPPROPRIaTe ManageMenT OF neCK nODeS In ORaL CanCeR

raJeNDra B tOPraNI (HCG CaNCer CeNtre, INDIa)WHaT aRe THe aPPROPRIaTe ReCOnSTRuCTIOn MeTHODS FOR ORaL CanCeR DeFeCT

PHaKDee saNNIKOrN (raJavItHI HOsP., MINIstrY Of PUBlIC HealtH, tHaIlaND)

COMPaRTMenTaL SuRgeRy FOR CanCeR OF THe MOBILe TOngue anD FLOOR OF MOuTH OnCOLOg-IC anD FunCTIOnaL ReSuLTS

PIerO NICOlaI (UNIversItY Of BresCIa., ItalY)




[Hn-KL 3] Keynote Lecture III


Chair : sUNG MIN JIN (sUNGKYUNKwaN UNIv.)

WHy aSSeSSMenT OF VOCaL FunCTIOn SHOuLD MaTTeR TO LaRyngOLOgISTS

DIaNe M Bless (UNIversItY Of wIsCONsIN sCHOOl Of MeDICINe aND PUBlIC HealtH, Usa)

[Hn-MOS 2] Technical nuances for endoscopic/Robotic Thyroidectomy


Chair : KwaNG YOON JUNG (KOrea UNIv.), Moderator : CHrIs HOlsINGer (staNfOrD UNIv., Usa)

SuRgICaL InDICaTIOnS ReVISITeD FOR THe ReTRO-auRICuLaR aPPROaCH OF ROBOTIC SuRgeRy FOR THyROID anD PaRaTHyROID DISeaSeS

tsUNG-lIN YaNG (NatIONal taIwaN UNIv., taIwaN)

TRanSORaL enDOSCOPIC THyROID SuRgeRy

JUN-OOK ParK (tHe CatHOlIC UNIv. Of KOrea)

TRanSORaL ROBOTIC THyROID SuRgeRy

KYUNG tae (HaNYaNG UNIv.)

[Hn-SP 3] Reconstructive Surgery update

16:20~17:50 Room 3-3 (Diamond)

Chair : CHUNG-HwaN BaeK (sUNGKYUNKwaN UNIv.), PHaKDee saNNIKOrN (raJavItHI HOsP., MINIstrY Of PUBlIC HealtH, tHaIlaND)

3D PRInTIng anD VIRTuaL SuRgICaL PLannIng FOR HeaD anD neCK ReCOnSTRuCTIVe SuRgeRy

rICHarD CHaN wOO ParK (rUtGers New JerseY MeDICal sCHOOl, Usa)

ReCOnSTRuCTIOn FOR HeaD anD neCK DeFeCT WITH SuBMenTaL FLaP

YOUNG-HOON JOO (tHe CatHOlIC UNIv. Of KOrea)

COMBIneD MaxILLaRy anD ManDIBuLaR ReCOn-STRuCTIOn COnSIDeRaTIOnS OF THe MaSTICaTOR SPaCe

freD M BaIK (staNfOrD UNIv., Usa)

DeVeLOPMenT anD IMPLeMenTaTIOn OF HanDS-On TRaInIng PROgRaM OF MICROVaSCuLaR SuRgeRy anD FRee FLaP RaISIng

MaN KI CHUNG (sUNGKYUNKwaN UNIv.)

PROPeR InDICaTIOn FOR ReCOnSTRuCTIOn; WHen FRee FLaP IS ReQuIReD

sOON-HYUN aHN (seOUl NatIONal UNIv.)

[Hn-SP 2] Cutting edges in Head and neck Cancer Research

14:00~15:30 Room 3-3 (Diamond)

Chair : CHUl-HO KIM (aJOU UNIv.), JasON CHaN (tHe CHINese UNIversItY Of HONG KONG, HONG KONG)

PLaSMa MeDICIne aS nOVeL THeRaPeuTIC STRaT-egy In HeaD anD neCK CanCeR : In aSPeCT OF MODuLaTIOn OF MITOCHOnDRIaL e3 uBIQuITIn PROTeIn LIgaSe 1

CHUl-HO KIM (aJOU UNIv.)

THe MIROBIOMe In HeaD anD neCK SQuaMOuS CeLL CaRCInOMa

JasON CHaN (tHe CHINese UNIversItY Of HONG KONG, HONG KONG)

unDeRSTanDIng THe LaRyngeaL MICROBIOMe IM-PLICaTIOnS FOR HeaLTH anD DISeaSe

sUsaN l tHIBeaUlt (UNIversItY Of wIsCONsIN MaDIsON, Usa)

ReSISTanCe TO TaRgeTeD THeRaPy anD COMBI-naTIOn exPLORaTIOn OF nOVeL MOLeCuLaR TaR-geTS anD IMMunOTHeRaPy In HnSCC

Hee KYUNG aHN (GaCHON UNIv.)

PReCISIOn SuRgeRy FOR HeaD anD neCK CanCeR

HaN-sIN JeONG (sUNGKYUNKwaN UNIv.)

[Hn-3D Printing] 3D Printing Course of “The Korean Society of 3D Printing in Medicine”


Chair : CHUNG-HwaN BaeK (sUNGKYUNKwaN UNIv.)

aPPLICaTIOn OF 3D PRInTIng In enT FIeLD

CHUNG-HwaN BaeK (sUNGKYUNKwaN UNIv.)

aPPLICaTIOn OF 3D PRInTIng In MeDICIne

GUK Bae KIM (aNYMeDI INC)

3D PRInTIng TeCHnOLOgy FOR HeaD & neCK ReCOnSTRuC TIOn

JONG-wOO CHOI (UNIv. Of UlsaN)

aPPLICaTIOn OF VaRIOuS 3D PRInTIng IMPLanTS COnSIDeRIng DeFeCT aReaS

JUNG-HwaN BaeK (H PlastIC sUrGerY)



Scientific Program


April 27 (Sat) Otology

[OT-gD 1] Implantable Hearing Devices


Chair : leveNt OlGUN (BaKeNt UNIv.ZUBeYDe HaNM researCH CeNter, tUrKeY),

Moderator : sUNG Hwa HONG (sUNGKYUNKwaN UNIv.)

ManageMenT OF FaR aDVanCeD OTOSCLeROSIS : STaPeS SuRgeRy

Ja-wON KOO (seOUl NatIONal UNIv.)

ManageMenT OF FaR aDVanCeD OTOSCLeROSIS: COCHLeaR IMPLanTaTIOn

eUNa HwaNG (UNIv. Of CalGarY, CaNaDa)

MIxeD HeaRIng LOSS : aCTIVe MIDDLe eaR IM-PLanT

leveNt OlGUN (BaKeNt UNIv.ZUBeYDe HaNM researCH CeNtet, tUrKeY)

MIxeD HeaRIng LOSS : BOne COnDuCTIOn IM-PLanTaBLe HeaRIng aIDS

eUNa HwaNG (UNIv. Of CalGarY, CaNaDa)

POSTLInguaL HeaRIng LOSS (nF2) : auDITORy BRaInSTeM IMPLanT


POSTLInguaL HeaRIng LOSS (nF2) : COCHLeaR IM-PLanTaTIOn

Jae-JIN sONG (seOUl NatIONal UNIv.)

SIngLe SIDeD DeaFneSS: COCHLeaR IMPLanTa-TIOn

BarrIe taN YaU BOON (sINGaPOre GeNeral HOsPItal., sINGaPOre)

SIngLe SIDeD DeaFneSS: BOne COnDuCTIOn HeaRIng aIDS

YOUNG JOON seO (YONseI wONJU UNIv.)

April 26 (Fri) Head & Neck Surgery

[Hn-SP 5] CeORL-KORean Joint Symposium : Best Practices and Optimizing Outcomes in Well Differentiated Thyroid Cancer


Chair : KYUNG tae (HaNYaNG UNIv.), JaN PlZÁK (CHarles UNIv., CZeCH rePUBlIC)

KORean THyROID IMagIng RePORTIng anD DaTa SySTeM

sUNG-HYe YOU (KOrea UNIv.)

neCK ManageMenT In THyROID CanCeR

JaN PlZaK (MOtOl UNIversItY HOsP., CZeCH rePUBlIC).

ManageMenT OF ReCuRRenT WeLL DIFFeRenTIaT-eD THyROID CaRCInOMa (WDTC)

IlaNa DOweCK (CarMel MeDICal CeNter, Israel)

InTRaOPeRaTIVe neuROMOnITORIng FOR THyROID SuRgeRy

BYUNG-JOO lee (PUsaN NatIONal UNIv.)

uSeFuLneSS OF aDHeSIVe SKIn eLeCTRODeS FOR IOnM OF RLn

HYOUNG sHIN lee (KOsIN UNIv.)




[OT-SP 5] genetic Hearing Loss


Chair : KeNNetH H. lee (UNIversItY Of texas sOUtHwesterN MeDICal CeNter, Usa),

KYU-YUP lee (KYUNGPOOK NatIONal UNIv.)

COCHLeaR gene THeRaPy FOR SenSORIneuRaL HeaRIng LOSS


geneTIC eTIOLOgy OF MILD TO MODeRaTe SenSO-RIneuRaL HeaRIng LOSS: IS IT geneTIC?

BONG JIK KIM (CHUNGNaM NatIONal UNIv.)

geRMLIne MuTaTIOnS CauSIng auTOInFLaMMaTO-Ry InneR eaR DISeaSe:CLInICaL IMPLICaTIOnS

BYUNG YOON CHOI (seOUl NatIONal UNIv.)

THe PaTHOMeCHanISM OF DFna9 anD THe PHySIO-LOgICaL ROLe OF COCHLIn

JINseI JUNG (YONseI UNIv.)

[OT-MTP 2] Chronic Otitis Media Surgery

13:30~15:00 Room 3-1 (emerald a)

Chair : see OK sHIN (CHUNGBUK NatIONal UNIv.), Moderator : HYeONG JONG KIM (HallYM UNIv.)

TyMPanOPLaSTy

JUN HO lee (seOUl NatIONal UNIv.)

ManageMenT OF MaSTOID CaVITy In CHROnIC OTI-TIS MeDIa

wON-HO CHUNG (sUNGKYUNKwaN UNIv.)

ManageMenT OF FaCIaL neRVe InJuRIeS In THe eaR SuRgeRy

sOeKIrMaN sOeKIN (sOeKIrMaN sOeKIN eNt HNs PrOKlaMasI HOsP., INDONesIa)

OSSICuLaR CHaIn ReCOnSTRuCTIOn unDeR OTO-SCOPe

YU ZHaO (west CHINa HOsPItal,sICHUaN UNIv., CHINa)

[OT-KL 4] Keynote Lecture IV


Chair : YaNG-sUN CHO (sUNGKYUNKwaN UNIv.)

eVIDenCe BaSeD TReaTMenT OF VeSTIBuLaR SCHWannOMaS

Per CaYe-tHOMaseN (COPeNHaGeN UNIv.,DeNMarK)

[OT-SP 3] Basic Research in Vestibular Science

09:00~10:20 Room 3-1 (emerald a)

Chair : KYU-sUNG KIM (INHa UNIv.), GYU-CHeOl HaN (GaCHON UNIv.)

IOn HOMeOSTaSIS In enDOLyMPHaTIC SaC anD Me-nIeReS DISeaSe

taKeNOrI MIYasHIta (KaGawa UNIv.,JaPaN)

eFFeCT OF SuPRagRaVITy STIMuLaTIOn On VeS-TIBuLaR enD ORganS

GYU CHeOl HaN (GaCHeON UNIv.)

THe ROLe OF VaSOPReSSIn-aQuaPORIn2 SySTeM In THe anIMaL MODeL OF enDOLyMPHaTIC Hy-DROPS

MINBUM KIM (CatHOlIC KwaNDONG UNIv.)

THe ROLe OF aSTROCyTe - neuROn LaCTaTe SHuT-TLe In VeSTIBuLaR nuCLeaR aCTIVITy anD VeSTIB-uLaR FunCTIOn

MIN sUN KIM (wON KwaNG UNIv.)

[OT-KL 3] Keynote Lecture III


Chair : seUNG Ha OH (seOUl NatIONal UNIv.)

CuRRenT HeaRIng HeaLTH STaTuS OF KORea

sUNGwON CHae (KOrea UNIv.)

[OT-SP 4] Tinnitus


Chair : tIeN-CHeN lIU (NatIONal taIwaN UNIv., taIwaN), eUI-CHeOl NaM (KaNGwON NatIONal UNIv.)

TOWaRD a TInnITuS IMPLanT VIa LIgHT-DRIVen PROMOnTORy eLeCTRICaL STIMuLaTIOn a PReLIMI-naRy RePORT

tIeN-CHeN lIU (NatIONal taIwaN UNIv., taIwaN)

COCHLeaR MIgRaIne anD TInnITuS

JeN tsUNG laI (KUaNG-tIeN GeNeral HOsPItal, taIwaN)

eFFeCT OF SOunD geneRaTOR On TInnITuS & Hy-PeRaCuSIS

sHI Nae ParK (tHe CatHOlIC UNIv. Of KOrea)

ePIDeMIOLOgy, eTIOLOgIeS, anD TReaTMenT OP-TIOnS FOR PeDIaTRIC TInnITuS

KeNNetH H lee (UNIversItY Of texas sOUtHwesterN MeDICal CeNter, Usa)



Scientific Program


[RH-KL 3] Keynote Lecture III


Chair : HUN-JONG DHONG (sUNGKYUNKwaN UNIv.)

enDOSCOPIC ManageMenT OF FROnTaL SInuS FRaCTuReS anD CSF LeaKS

BraDfOrD a. wOODwOrtH (UNIversItY Of alaBaMa at BIrMINGHaM (UaB) sCHOOl Of MeDICINe, Usa)

[RH-MOS 2] How I Do It: Palatal Surgery for OSa Patients


Chair : MetIN ONerCI (HaCettePe UNIversItY, faCUltY Of MeDICINe, tUrKeY),

Moderator : sUNG waN KIM (KYUNGHee UNIv.)

HOW I DO IT: COnCePT OF PaLaTaL SuRgeRy

sUNG waN KIM (KYUNGHee UNIv.)

SLeeP SuRgeRy: HOW I DO IT

HYUNG JU CHO (YONseI UNIv.)

H O W I D O T H e P a L a T a L S u R g e R y : uVuLOPaLaTOPHaRyngO PLaSTy WITH uVuLa SaVIng

seUNG HOON lee (KOrea UNIv.)

aLTeRnaTIVe PaLaTaL SuRgeRIeS In OBSTRuCTIVe SLeeP aPnea BeyOnD uPPP

HYUN JIK KIM (seOUl NatIONal UNIv.)

My PaLaTaL SuRgeRy - LIMITeD PaLaTaL MuSCLe ReSeCTIOn

KYU sUP CHO (PUsaN NatIONal UNIv.)

April 27 (Sat) Rhinology

[RH-MTP 1] My experiences in allergen-specific Immuno-therapy (aIT)


Chair : seON tae KIM (GaCHeON UNIv.), Moderator : DO-YeON CHO (UNIv. Of alaBaMa at

BIrMINGHaM, Usa)

TaBLeT SuBLInguaL IMMunOTHeRaPy FOR JaPa-neSe CeDaR POLLInOSIS - eFFeCTS anD ITS MeCH-anISM

KIMIHIrO OKUBO (NIPPON MeDICal sCHOOl, JaPaN)

eFFICaCy OF aIT FOR MOnO- anD POLy-aLLeRgen SenSITIza TIOn

DONG-YOUNG KIM (seOUl NatIONal UNIv.)

aLLeRgen-SPeCIFIC IMMunOTHeRaPy (aIT) In unIT-eD STaTeS

DO-YeON CHO (UNIv. Of alaBaMa at BIrMINGHaM, Usa)

[RH-SP 4] extended Surgical approach for Skullbase Tumors

08:40~10:20 Room 3-2 (emerald B)

Chair : HwaN JUNG rOH (PUsaN NatIONal UNIv.), CeM MeCO (aNKara UNIversItY, tUrKeY aND salZBUrG ParaCelsUs UNIversItY, aUstrIa)

uSe OF MODeRn IMMunOLOgICaL MaRKeRS In CSF LeaK DeTeCTIOn anD IMPLeMenTaTIOn In a COM-PReHenSIVe DIagnOSTIC aLgORITHM

CeM MeCO (aNKara UNIversItY, tUrKeY aND salZBUrG ParaCelsUs UNIversItY, aUstrIa)

COMPReHenSIVe ManageMenT OF SInOnaSaL Ma-LIgnanCy

tae BIN wON (seOUl NatIONal UNIv.)

enDOSCOPIC ReSeCTIOn anD ReCOnSTRuCTIOn OF anTeRIOR SKuLL BaSe

sHUHO taNaKa (UNIv. Of tsUKUBa, JaPaN)

enDOSCOPIC enDOnaSaL TRanSPTeRygOID aP-PROaCH

sUNG wON KIM (tHe CatHOlIC UNIv. Of KOrea)

enDOSCOPIC aPPROaCH TO THe naSOPHaRynx

saNG DUK HONG (sUNGKYUNKwaN UNIv.)

enDOSCOPIC enDOnaSaL ManageMenT OF CSF RHInORRHea

sHeIKH HasaNUr raHMaN (BaNGaBaNDHU sHeIKH MUJIB MeDICal UNIv., BaNGlaDesH)




April 27 (Sat) Head & Neck Surgery

[Hn-SP 6] Laryngology update and Opinion for Future Directions

08:30~10:20 Room 3-3 (Diamond)

Chair : BYUNG-JOO lee (PUsaN NatIONal UNIv.), sUsaN tHIBeaUlt

(UNIversItY Of wIsCONsIN MaDIsON, Usa)

TOWaRDS CLInICaL RegeneRaTIVe MeDICIne OF THe LaRynx

sUsaN l tHIBeaUlt (UNIversItY Of wIsCONsIN MaDIsON, Usa)

InnOVaTIOn OF InJeCTIOn MaTeRIaLS FOR VOCaL FOLD RegeneRaTIOn

seONG KeUN KwON (seOUl NatIONal UNIv.)

uPDaTe In PeDIaTRIC aIRWay SuRgeRy

rOBert CHUN (MeDICal COlleGe Of wIsCONsIN, Usa)

LaRyngeaL ReInneRVaTIOn FOR unILaTeRaL VO-CaL FOLD PaRaLySIS

seUNGwON lee (sOONCHUNHYaNG UNIv.)

InTRODuCTIOn OF SIMuLTaneOuS MuLTIFunCTIOn-aL LaRyngeaL exaMInaTIOn SySTeM anD IT'S CLIn-ICaL uSeFuLneSS

JIN-CHOON lee (PUsaN NatIONal UNIv.)

VOCaL FOLD SCaR

ferHaN OZ (IstaNBUl UNIversItY CerraHPaşa sCHOOl Of MeDICINe, tUrKeY)

PeDIaTRIC LaRyngOTRaCHeaL STenOSIS SuR-geRy, STePS TO PReVenT COMPLICaTIOnS

MeHMet UMUt aKYOl (HaCettePe UNIversItY, aNKara, tUrKeY)

[Hn-KL 4] Keynote Lecture IV


Chair : KwaNG YOON JUNG (KOrea UNIv.)

eVOLuTIOn OF TRanSORaL ROBOTIC SuR-geRy(TORS) TO THe gaMe-CHangeR;InTRODuCIng THe SIngLe PORT ROBOTIC SuRgICaL SySTeM

se-HeON KIM (YONseI UNIv.)

[Hn-KL 5] Keynote Lecture V


Chair : MIN sIK KIM (tHe CatHOlIC UNIv. Of KOrea)

PReCISIOn HeaD anD neCK SuRgeRy nexT-gen-eRaTIOn ROBOTIC SuRgeRy anD BeyOnD

CHrIs HOlsINGer (staNfOrD UNIversItY, Usa)

[RH-SP 5] essentials of asian Facial Plastics: Comparison with Caucasians


Chair : JUNG sOO KIM (KYUNGPOOK NatIONal UNIv.), CHIH-weN twU (taICHUNG veteraNs

GeNeral HOsPItal., taIwaN)

DOS anD DOnTS In aSIan eyeLID SuRgeRy

CHase laY (saN JOse, Usa)

aSIan auRICuLaR ReCOnSTRuCTIOn: DIFFeRenC-eS FROM CauCaSIanS

JeONG-HOON OH (tHe CatHOlIC UNIv. Of KOrea)

naSaL VaLVe SuRgeRy ReVISITeD In aSIanS

CHIH-weN twU (taICHUNG veteraNs GeNeral HOsPItal, taIwaN)

THe neW MeTHOD OF CaP gRaFT In RHInOPLaSTy

BaKI YIlMaZ (PrIvate PraCtICe, IstaNBUl)

[RH-MTP 2] Tips and Pitfalls for Frontal Sinus Surgery

13:30~15:00 Room 3-2 (emerald B)

Chair : JaNNIs CONstaNtINIDIs (arIstOtle UNIversItY, GreeCe), Moderator : JOsePH K. HaN (easterN vIrGINIa

MeDICal sCHOOl, Usa)

OuTSIDe - In DRaF 3

JeffreY D. sUH (UCla, Usa)

FROnTaL SInuS InVOLVeMenT In PRIMeR anD ReVI-SIOn FeSS

sUat - tUrGUt (UNIv. Of HealtH sCIeNCes sIslI HaMIDIYe HOsP., tUrKeY)

aPPLICaTIOnS, OuTCOMeS anD MODIFICaTIOnS OF eMLP

YING PIaO waNG (MaCKaY MeMOrIal HOsPItal, taIwaN)

enDOSCOPIC FROnTaL SInuSOTOMy uSIng THe SuPRaInFunDIBuLaR PLaTe aS a Key LanDMaRK

CHaNG-HOON KIM (YONseI UNIv.)

[RH-KL 4] Keynote Lecture IV


Chair : JIN Hee CHO (tHe CatHOlIC UNIv. Of KOrea)

HOLISTIC aPPROaCH TO THe OSa PaTIenTS: PReCI-SIOn OR PeRSPeCTIVeS

sUNG waN KIM (KYUNG Hee UNIv.)



Scientific Program


[Hn-SP 7] new Horizons in Medicine in the era of 4th Industrial Revolution

13:30~15:00 Room 3-3 (Diamond)

Chair : YOON wOO KOH (YONseI UNIv., KOrea)

DIgITaL TRanSFORMaTIOn In HeaLTHCaRe: 3D ReV-OLuTIOn

saNG-JOON ParK (seOUl NatIONal UNIv.)

eVOLuTIOn OF ROBOTIC SuRgeRy: FuTuRe PROS-PeCTS 2019

KOON HO rHa (YONseI UNIv.)

FLexIBLe enDOSCOPIC ROBOT FOR Hn SuRgeRy

DONG-sOO KwON (KaIst)

TROn - THe TeLeROBOTIC OPeRaTIng neTWORK

DaNIel J. GallaGHer (fOrt BelvOIr COMMUNItY HOsPItal, Usa)

[Hn-MTP 2] My Journey in the Management of Recurrent HnC

13:30~15:00 Room 2-5 (Crane)

Chair : YOUNG sOO rHO (DaIN ear NOse tHrOat HOsP.), Moderator : DONG Il sUN (tHe CatHOlIC UNIv. Of KOrea)

SaLVagIng ORaL CaVITy CanCeR

eUN CHaNG CHOI (YONseI UNIv.)

SuRgeRy FOR ReCuRRenT OROPHaRyngeaL Can-CeR

YOUNG-sOO rHO (DaIN eNt sPeCIal HOsPItal)

My JOuRney In THe ManageMenT OF ReCuRRenT nPC

sHeNG-PO HaO (sHIN KONG wU HO-sU MeMOrIal HOsP., taIwaN)

eVOLuTIOn OF SaLVage SuRgeRy In LaRyngeaL CanCeR

PIerO NICOlaI (UNIversItY Of BresCIa, ItalY)

[Hn-KL 7] Keynote Lecture VII


Chair : se-HeON KIM (YONseI UNIv.)

TRanSnaSaL enDOSCOPIC SuRgeRy FOR na-SO-eTHMOIDaL CanCeRS ReFLeCTIOnS On a 20-yeaR exPeRIenCe

PIerO NICOlaI (UNIversItY Of BresCIa, ItalY)

April 27 (Sat) Head & Neck Surgery

[Hn-KL 6] Keynote Lecture VI


Chair : KYUNG tae (HaNYaNG UNIv.)

TReaTMenT STRaTegy FOR PaPILLaRy THyROID CaRCInOMa

YasUHIrO ItO (ClINICal trIal aND MaNaGeMeNt CeNter, JaPaN)

[Hn-RT 1] Balancing between the Oncologic and Functional Outcomes in Oropharyngeal Cancer


Chair : YOUNG HaK ParK (tHe CatHOlIC UNIv. Of KOrea), Moderator : YOUNG-IK sON (sUNGKYUNKwaN UNIv)

OnCOLOgIC OuTCOMeS: SuRgeRy VS RaDIaTIOnJUNG Je ParK (GYeONGsaNG NatIONal UNIv.)

BaLanCIng BeTWeen THe OnCOLOgIC anD FunC-TIOnaL OuTCOMeS In OROPHaRyngeaL CanCeR: RaDIaTIOn OnCOLOgy PeRSPeCTIVe

sUNG HO MOON (NatIONal CaNCer CeNter)

BaLanCIng BeTWeen THe OnCOLOgIC anD FunC-TIOnaL OuTCOMeS In OROPHaRyngeaL CanCeR: PaTTeRnS OF FaILuRe

seUNG-KUK BaeK (KOrea UNIv.)

SaLVage STRaTegIeS FOR RaDIaTIOn FaILuReseIICHI YOsHIMOtO

(NatIONal CaNCer CeNter HOsP., JaPaN)

DISCuSSIOn

[Hn-gD 1] State of the art Management for Papillary Thyroid Carcinoma


Chair : YasUHIrO ItO (KUMa HOsPItal, JaPaN), Moderator : JeONG sOO wOO (KOrea UNIv.)

exTenT OF THyROIDeCTOMyJeONG-sOO wOO (KOrea UNIv.)

CenTRaL anD LaTeRaL neCK ManageMenTrICHarD CHaN wOO ParK

(rUtGers New JerseY MeDICal sCHOOl, Usa)

TuMOR TO TuMOR MeTaSTaSIS OF THyROID gLanDNaPaDON taNGJatUrONrasMe

(CHUlalONGKOrN UNIv., tHaIlaND)

THe DIFFeRenCe BeTWeen PRIMaRy VS SeCOnD-aRy MeTaSTaSIS OF WDTC- PaTTeRn anD OuTCOMe


SuRgICaL TeCHnIQue anD OuTCOMeS OF ReVI-SIOn THyROID SuRgeRy unDeR ReCuRRenT La-RyngeaL neRVe MOnITORIzaTIOn

KUrsat GOKCaN (aNKara UNIversItY MeDICal sCHOOl, tUrKeY)




[Hn-SP 8] aPTS Symposium: advances and Issues in Thyroid Surgery

16:20~17:50 Room 3-3 (Diamond)

Moderator : HIrOYa KItaNO (JaPaN), KwaNG YOON JUNG (KOrea UNIv.)

aCTIVe SuRVeILLanCe OF PTMC

YasUHIrO ItO (KUMa HOsPItal., JaPaN)

PaeDIaTRIC THyROID SuRgeRy In a TeRTIaRy Re-FeRRaL CenTRe

seaN lOUGHraN (MaNCHester rOYal INfIrMarY, UK)

aDVanCeS In IOnM

feNG YU CHIaNG (KaOHsIUNG MeDICal UNIv., taIwaN)

IOnM In ReMOTe aCCeSS THyROIDeCTOMy

KYUNG tae (HaNYaNG UNIv.)

PaRaTHyROID LOCaLIzaTIOn anD MaPPIng uSIng auTO FLuOReSCenCe

KaNG-Dae lee (KOsIN UNIv.)

aIRWay ManageMenT In anaPLaSTIC THyROID CanCeR

NavIN MaNI (MaNCHester rOYal INfIrMaeY., UK)

[Hn-MTP 3] Transoral endoscopic Thyroidectomy


Chair : GUK HaeNG lee (KOrea CaNCer CeNter HOsPItal),

Moderator : YOON wOO KOH (YONseI UNIv.)

PRInCIPLe anD uPDaTeD eVIDenCe OF TRanSORaL THyROIDeCTOMy

HOK NaM lI (PrINCe Of wales HOsPItal, tHe CHINese UNIv., HONG KONG)

gaSLeSS TRanSORaL ROBOTIC THyROIDeCTOMy uSIng DaVInCI SP SySTeM

YOON wOO KOH (YONseI UNIv.)

[2019 ICORL Head and neck ultrasound International Joint Symposium]

15:20~16:50 Room 2-5 (Crane)

Chair : JeONG KYU KIM (CatHOlIC UNIv. Of DaeGU), wOOJIN CHO (wItHsIM ClINIC)

aPPLICaTIOn OF uLTRaSOunD-guIDeD CORe BI-OPSy FOR an eLDeRLy InFIRM PaTIenT WITH Huge neCK MaSSeS

CHUN-NaN CHeN (NatIONal taIwaN UNIversItY HOsPItal, taIwaN)

uLTRaSOnOgRaPHIC eVaLuaTIOn OF uPPeR aIR-Way STRuCTuReS In CHILDRen

CHe YI lIN (NatIONal taIwaN UNIv. HOsP. aND CHIlDreN HOsP., taIwaN)

a CaSe OF PRIMaRy THyROID LyMPHOMa DIag-nOSeD By SuRgeOn-PeRFORMeD CORe neeDLe BIOPSy

IK JOON CHOI (KOrea CaNCer CeNter HOsPItal)

CLInICaL aPPLICaTIOn OF LaRyngeaL uLTRaSO-nOgRaPHy FOR THe TReaTMenT OF PaTIenTS WITH VOICe DISORDeR

YOON seOK CHOI (YeUNGNaM UNIv.)

exPanDeD uSe OF HeaD anD neCK uLTRaSOunD - a SIngLe SuRgeOn'S exPeRIenCe

DONG BIN aHN (KYUNGPOOK NatIONal UNIv)

OBJeCTIVe aSSeSSMenT OF POSTOPeRaTIVe SWaLLOWIng DIFFICuLTy THROugH uLTRaSOunD In PaTIenTS unDeRgOIng THyROIDeCTOMy

Jae-GU CHO (KOrea UNIv.)

CuRRenT TRenDS OF HeaD anD neCK uLTRaSOunD In HOng KOng

HOK NaM lI (PrINCe Of wales HOsPItal, tHe CHINese UNIv., HONG KONG)

THe IMPORTanCe OF uLTRaSOnOgRaPHIC DeTeC-TIOn OF MeTaSTaTIC LInguaL LyMPH nODe In ORaL CaVITy CanCeR

JUNG-Hae CHO (tHe CatHOlIC UNIv. Of KOrea)



Scientific Program


[ORLSP-nurse 2] Surgical Treatment and Postoperative Care for Otorhinolaryngological Disorders

13:30-14:50 *Korean Session Room 2-2 (Skylark)

Chair : seUNG-HO sHIN (ewHa wOMaNs UNIv.)

SuRgICaL TReaTMenT anD POSTOPeRaTIVe CaRe FOR CHROnIC eaR SuRgeRy

이현민 (부산의대)

SuRgICaL TReaTMenT anD POSTOP CaRe FOR COngenITaL auRaL aTReSIa

서명환 (서울의대)

SuRgICaL TReaTMenT anD POSTOP CaRe FOR La-RyngeaL DISORDeRS

조재구 (고려의대)

SuRgICaL TReaTMenT anD POSTOPeRaTIVe CaRe FOR OTORHInOLaRyngOLOgICaL DISORDeRS

최지윤 (조선의대)

[ORLSP-SLP] Special Lecture

10:40~11:10 Room 3-3 (Diamond)

Chair : seONG Hee CHOI (tHe CatHOlIC UNIv. Of DaeGU, KOrea)

HOW THe SLP Can enHanCe THe VOICe CaRe TeaM KnOWLeDge, aSSeSSMenT anD TReaTMenT

DIaNe M Bless (UNIversItY Of wIsCONsIN sCHOOl Of MeDICINe aND PUBlIC HealtH, Usa)

[ORLSP-SLP] State of the art Management for the Dysphonia Patients with normal Laryngoscopy

11:10~12:40 *Korean Session Room 3-3 (Diamond)

Chair : sUNG MIN CHUNG (ewHa wOMaNs UNIv., KOrea), JIN PYeONG KIM (GYeONGsaNG NatIONal UNIv., KOrea)

DySPHOnIa WITH nORMaL LaRyngOSCOPy: CLInI-CaL anD enDOSCOPIC FeaTuReS

Jae-YOl lIM (YONseI UNIv.)

CORReLaTIOn BeTWeen In PeRCePTuaL anD aCOuSTIC anaLySIS

JOO HYUN wOO (GaCHON UNIv.)

aPPLICaTIOn anD InTeRPReTaTIOn OF STROBOS-COPy & KyMOgRagPHy

JI wON KIM (INHa UNIv.)

무진동성대점막병변의 치료방법

GIlJOON lee (KYUNGPOOK NatIONal UNIv.)

April 27 (Sat) ORLSP

[ORLSP-audiologist] application of audiologic tests for auditory neuropathy spectrum disorder?

10:40-12:40 *Korean Session Room 3-1 (emerald a)

Chair : JUN HO lee (seOUl NatIONal UNIv.)

WHaT IS auDITORy neuROPaTHy SPeCTRuM DISOR-DeRS (InTRODuCTIOn)


TeOae 와 DPOae 검사의 해석과 임상 적용

JOONG HO aHN (UlsaN UNIv)

eLeCTROCOCHLeOgRaPHy

sUNG Il CHO (CHOsUN UNIv.)

aBR FOR auDITORy neuROPaTHy SPeCTRuM DIS-ORDeR

YONG-HO ParK (CHUNGNaM NatIONal UNIv.)

eaBR anD TRanS-TyMPanIC eeaBR PROCeDuReS anD CLInICaL exaMPLeS

MartIN walGer (UNIversItY Of COlOGNe, GerMaNY)

BeHaVIORaL TeST FInDIngS anD aIDeD PeRFOR-ManCe FOR anSD

eUN JIN sON (YONseI UNIv.)

[ORLSP-nurse 1] 외래에서 자주 접하는 이비인후과 질환의 진단과 치료

10:40-12:40 *Korean Session Room 3-2 (emerald B)

Chair : 홍현준 (가톨릭관동의대)

외래에서 흔히 접하는 어지럼

유명훈 (경북의대)

HOW TO uSe HeaRIng aIDS FOR HeaRIng IMPaIR-MenT PaTIenTS

송찬일 (연세의대)

음성질환

이도영 (서울의대)

갑상선 종물의 진단적 접근방법

이소윤 (차의과대)

DIagnOSIS anD TReaTMenT FOR OBSTRuCTIVe SLeeP aPnea

최지호 (순천향대)

만성 부비동염의 치료

신재민 (고려의대)




April 28 (Sun) Otology

[OT-SP 6] Recent advances in Otology (asian-Oceanian association of Otolaryngology-Head and neck Surgery Society Symposium)

09:00~10:40 Room 2-1 (Flamingo)

Moderator : sHeNG-PO HaO (fU JeN CatHOlIC UNIv., taIwaN),

seUNG-Ha OH (seOUl NatIONal UNIv.)

eaRLy HeaRIng LOSS DeTeCTIOn anD InTeRVen-TIOn

MOO KYUN ParK (seOUl NatIONal UNIv.)

IMPLanTaBLe HeaRIng DeVICe uPDaTe

BarrIe taN YaU BOON (sINGaPOre GeNeral HOsPItal. sINGaPOre)

enDOSCOPIC STaPeS SuRgeRy -IS IT COMPaRaBLe WITH MICROSCOPIC SuRgeRy

HsINGMeI wU (sHIN-KONG wU-HO-sU MeMOrIal HOsPItal, taIwaN)

COCHLeaR IMPLanT In aSean COunTRIeS an OVeRVIeW

lOKMaN BIN saIM (KPJ HealtHCare UNIv., MalaYsIa)

euSTaCHIan TuBOPLaSTy FOR POST RaDIaTeD naSOPHaRyn geaL CaRCInOMa anD TInnITuS Pa-TIenTS

weI-CHIeH CHaO (CHaNG GUNG MeMOrIal HOsPItal, KeelUNG, CHaNG GUNG UNIv., taIwaN)

[OT-SP 7] Basic Research in Hearing Loss

09:00~10:40 Room 2-2 (Skylark)

Chair : NOrIO YaMaMOtO (KYOtO UNIv., JaPaN), seUNG GeUN YeO (KYUNG Hee UNIv.),

a CuRRenT PeRSPeCTIVe HeaRIng PReSeRVaTIOn By InSuLIn-LIKe gROWTH FaCTOR 1

NOrIO YaMaMOtO (KYOtO UNIv., JaPaN)

InneR eaR CHangeS aFTeR COCHLeOSTOMy – an anIMaL STuDy anD CLInICaL IMPLICaTIOnS

YONG-HO ParK (CHUNGNaM NatIONal UNIv.)

neuRaL PLaSTICITy In THe CenTRaL auDITORy SySTeM

MIN-HYUN ParK (seOUl NatIONal UNIv.)

InneR eaR ORganOID, ReaDy?

MIN YOUNG lee (DaNKOOK UNIv.)

TLR7-TRPa1 InTeRaCTIOn DRIVeS HyPeRexCITaBIL-ITy CeLL DeaTH MODuLaTeD By MIRna LeT-7B In auDITORy CeLLS

KeN HaYasHI (KaMIO MeMOrIal HOsP., JaPaN)

April 27 (Sat)

[간행워크샵]

13:30~15:30 *Korean Session Room 2-4 (Swan)

좌장 : 황세환 (가톨릭의대)

13:30 ~ 13:40 인사말씀

이재서 (이사장)

13:40 ~ 13:50 우수 및 신속 심사자 시상

박경호 (간행이사)

13:50 ~ 14:20 의학일러스트 강의

류준선 (국립암센터)

14:20 ~ 14:50COMOn eRRORS By KORean Re-SeaRCHeRS

BasIl (KOrea eDItaGe)

14:50 ~ 15:20 SCOPuS 등재를 위한 학술지 준비

김형순 (인하대학교 공과대학)

15:20 ~ 15:30

한이인지 투고체계, 편집방침, 온라인투고 및 심사

시스템

황세환 (가톨릭의대)



Scientific Program


[OT-SP 10] Cochlear Implantation in Challenging Cases

13:30~15:30 Room 2-1 (Flamingo)

Chair : Jae YOUNG CHOI (YONseI UNIv.), seUNG HwaN lee (HaNYaNG UNIv.)

SeVeRe InneR eaR MaLFORMaTIOn CaSeS InCLuD-Ing COCHLeaR aPLaSIa

sUNG wOOK JeONG (DONG-a UNIv.)

auDITORy neuROPaTHy SPeCTRuM DISORDeR WITH an InTaCT Cn8

BYUNG YOON CHOI (seOUl NatIONal UNIv.)

aSyMMeTRICaL SenSORIneuRaL HeaRIng LOSS

JIN-wOONG CHOI (CHUNGNaM NatIONal UNIv.)

HeaRIng ReHaBILITaTIOn OF PaTIenTS WITH neuRO FIBROMaTOSIS TyPe II uSIng COCHLeaR IM-PLanTS

Jae YOUNG CHOI (YONseI UNIv.)

aBR ReCORDIngS PRe- anD POST CI IMPLanTaTIOn WHy anD HOW. a geRMan CLInICaL PeRSPeCTIVe


a LOngITuDInaL STuDy In SeQuenTIaL BILaTeRaL COCHLeaR IMPLanTaTIOn uSeRS On OuTCOMeS OF SPeeCH ReCOgnITIOn aFTeR PROLOngeD TIMe InTeRVaLS

YUHe lIU (PeKING UNIversItY fIrst HOsPItal, CHINa)

April 28 (Sun) Otology

[OT-SP 8] Vestibular Rehabilitation

11:00~12:40 Room 2-1 (Flamingo)

Chair : tOsHIaKI YaMaNaKa (Nara MeDICal UNIversItY HOsPItal, JaPaN), sUNG-wON CHae (KOrea UNIv.),

COnVenTIOnaL PeRSOnaLIzeD VeSTIBuLaR ReHa-BILITaTIOn FOR PeRIPHeRaL VeSTIBuLOPaTHy-OPTI-MaL TReaTMenT PeRIOD OF TRaInIng PROgRaM-

tOsHIaKI YaMaNaKa (Nara UNIv., JaPaN)

PILOT ReSuLT anD THe FaCTORS OF THe COMPLI-anCe TO THe CuSTOMIzeD VeSTIBuLaR exeRCISe

eUN-JU JeON (tHe CatHOlIC UNIv. Of KOrea)

VeSTIBuLaR PROSTHeSIS

seOK MIN HONG (HallYM UNIv.)

IS BenIgn PaROxySMaL POSITIOnaL VeRTIgO TReaTeD SuCCeSSFuLLy WITH THe TRV RePOSI-TIOn CHaIR?

DaN DUPONt HOUGaarD (aalBOrG UNIversItY HOsP., DeNMarK)

aR & VR In VeSTIBuLaR ReHaBILITaTIOn

sUNG KwaNG HONG (HallYM UNIv.)

[OT-SP 9] How to Maximize Convenience and Satisfaction of Hearing aids users?

11:00~12:40 Room 2-2 (Skylark)

Chair : JUN HO lee (seOUl NatIONal UNIv.), CHaNG HYUN CHO (GaCHeON UNIv.)

SeLeCTIng OPTIMaL HeaRIng aIDS anD ReLaTeD OPTIOnS SuITaBLe TO InDIVIDuaLS

GI JUNG IM (KOrea UNIv.)

aSSISTIVe LISTenIng DeVICeS

sUNG wOOK JeONG (DONG-a UNIv.)

COnneCTIng TO eLeCTROnIC DeVICeS & IOT TeCH-nOLOgy

eUN JIN sON (YONseI UNIv.)

auRaL ReHaBILITaTIOn

JIN-sOOK KIM (HallYM UNIv.)




[RH-SP 7] unique Role of Immune Cells in airway Mucosal Diseases


Chair : YONG wOO JUNG (KOrea UNIv.), taKesHI sHIMIZU (sHIGa UNIv., JaPaN)

HOMeOSTaSIS OF MeMORy T CeLL In aLLeRgy

YONG wOO JUNG (KOrea UNIv.)

eMeRgIng ROLe OF ePITHeLIaL-DeRIVeD CyTO-KIneS anD ITS ReguLaTIOn In THe PaTHOgeneSIS OF eOSInOPHILIC CHROnIC RHInOSInuSITIS

HIDeaKI KOUZaKI (sHIGa UNIv., JaPaN)

ROLe OF MaCROPHageS In aIRWay MuCOSaL MI-CROenVIROnMenT

seUNG Ja OH (KOrea INstItUte Of sCIeNCe aND teCHNOlOGY)

ROLe OF ReguLaTORy T CeLLS In PaTHOPHySIOLO-gy OF CHROnIC RHInOSInuSITIS

taKesHI sHIMIZU (sHIGa UNIversItY MeDICal sCIeNCe, JaPaN)

[RH-SP 8] Recent updates in Rhinology

11:00~12:40 Room 2-4 (Swan)

Chair : saM HYUN KwON (CHONBUK NatIONal UNIv.), Moderator: lOKMaN saIM (KPJ HealtHCare UNIv.,

MalaYsIa)

enDOTyPeS OF CHROnIC RHInOSInuSITIS aCROSS anCeSTRy anD geOgRaPHIC RegIOnS

wIraCH CHItsUtHIPaKOrN (raJavItHI HOsPItal, raNGsIt UNIversItY, tHaIlaND)

COnTROVeRSIeS On DIagnOSIS anD ManageMenT OF eOSInOPHILIC CRS

KOrNKIat sNIDvONGs (CHUlalONGKOM UNIv., tHaIlaND)

PReDICTIng PaTIenTS WITH CHROnIC RHInOSInuS-ITIS aS MaCROLIDe ReSPOnDeRS

KaCHOrN seresIrIKaCHOrN (CHUlalONGKOM UNIv., tHaIlaND)

aPPROaCH TO MIDDLe TuRBInaTe PaTHOLOgIeS

IBraHIM CUKUrOva (UNIversItY Of HealtH sCIeNCes IZMIr-tePeCIK traINING researCH HOsPItal, tUrKeY)

April 28 (Sun) Rhinology

[RH-gD 1] How to Diagnose and Treat Pediatric Rhinosinu-sitis


Chair : taKesHI sHIMIZU (sHIGa UNIv. MeDICal sCIeNCe, JaPaN), Moderator : YOO saM CHUNG (UNIv. Of UlsaN)

MeDICaL TReaTMenT OF PeDIaTRIC RHInOSInuS-ITIS

sOO wHaN KIM (tHe CatHOlIC UNIv. Of KOrea)

WHen & HOW TO STaRT SuRgICaL TReaTMenT OF PeDIaTRIC RHInOSInuSITIS

HYO YeOl KIM (sUNGKYUNKwaN UNIv.)

THe SuRgICaL TReaTMenT OF PeDIaTRIC RHInOSI-nuSITIS

tae HOON KIM (KOrea UNIv)

JaPaneSe guIDeLIne FOR ManageMenT OF PeDI-aTRIC RHInOSInuSITIS

taKesHI sHIMIZU (sHIGa UNIversItY MeDICal sCIeNCe, JaPaN)

[RH-SP 6] What’s new in Obstructive Sleep apnea Management

09:00~10:40 Room 2-4 (Swan)

Chair : sOO-KweON KOO (BUsaN saINt MarYs HOsP.), MetIN ÖNerCI (HaCettePe UNIversItY,

faCUltY Of MeDICINe, tUrKeY)

CPaP TReaTMenT unDeR neW KORean InSuRanCe SySTeM

JeONG-wHUN KIM (seOUl NatIONal UNIv.)

MuLTILeVeL SuRgeRy In aPnea

MetIN ÖNerCI (HaCettePe UNIversItY, faCUltY Of MeDICINe, tUrKeY)

OuTCOMe ReSuLTS OF uPPeR aIRWay STIMuLaTIOn FOR OBSTRuCTIVe SLeeP aPnea

CHaN sOON ParK (tHe CatHOlIC UNIv. Of KOrea)

WHaT ORTHODOnTISTS KnOW aBOuT SnORIng anD aPnea THaT enT SuRgeOnS DOn’T KnOW

seUNG-HaK BaeK (seOUl NatIONal UNIv.)



Scientific Program


[Hn-SP 10] Recent updates : Immunooncolgy in Head and neck Cancer

13:30~15:30 Room 2-5 (Crane)

Chair : YUH-seOG JUNG (NatIONal CaNCer CeNter), JasON CHaN (tHe CHINese UNIversItY Of HONG KONG,

HONG KONG)

DeVeLOPIng IMMunOOnCOLOgIC THeRaPy FOR HeaD anD neCK CanCeR

YUH-seOG JUNG (NatIONal CaNCer CeNter)

OVeRCOMIng ReSISTanCe TO IMMunOTHeRaPy

eUI-CHeOl sHIN (KaIst)

PaTHOLOgICaL FInDIngS In neCK DISSeCTIOn OF HnSCC


[Hn-SP 11] TSOHnS : Tentative Topic: application of uS for Otolaryngology and HnS by enT-Hn Surgeon

13:30~15:30 Room 2-6 (Peacock)

Chair : Kee HwaN KwON (HallYM UNIv.), tsUNG-lIN YaNG (NatIONal taIwaN UNIv., taIwaN)

CuRRenT DeVeLOPMenT OF uLTRaSOunD PeR-FORMeD By THe SPeCIaLISTS OF OTORHInOLaRyn-gOLOgy anD HeaD neCK

tsUNG-lIN YaNG (NatIONal taIwaN UNIv., taIwaN)

uLTRaSOunD-guIDeD CORe BIOPSy aS an exTenD-eD HanD OF enT-Hn SuRgeOn FOR MaKIng aCCu-RaTe DIagnOSeS

CHUN-NaN CHeN (NatIONal taIwaN UNIversItY HOsPItal, taIwaN)

aPPLICaTIOn OF HeaD anD neCK uLTRaSOunD In CHILDRen WITH OBSTRuCTIVe SLeeP aPnea

CHe YI lIN (NatIONal taIwaN UNIv. HOsP. aND CHIlDreN HOsP.,

taIwaN)

uLTRaSOnIC aSSeSSMenT OF THe OuTCOMe aF-TeR InJeCTIOn LaRyngOPLaSTy FOR PaTIenTS WITH unILaTeRaL VOCaL CORD PaRaLySIS

weN HsUaN tseNG (NatIONal taIwaN UNIv. HOsP., taIwaN)

SOnOgRaPHIC aSSeSSMenT OF SWaLLOWIng In POST-THyROIDeCTOMy PaTIenTS

YUNYING sHe (KaOHsIUNG veteraNs GeNeral HOsP., taIwaN)

April 28 (Sun) Head & Neck Surgery

[Hn-gD 2] Korean guideline for the Management of unilateral Vocal Fold Paralysis

09:00~10:40 Room 2-6 (Peacock)

Chair : YOUNG HaK ParK (tHe CatHOlIC UNIv. Of KOrea), MODeratOr: seUNG HO CHOI (UNIv. Of UlsaN)

ReCOMMenDaTIOn OF InJeCTIOn LaRyngOPLaSTy FOR unILaTeRaL VOCaL FOLD PaRaLySIS

Il-seOK ParK (HallYM UNIv.)

guIDeLIneS FOR VF PaRaLySIS-InJeCTIOn LaRyn-gOPLaSTy

taCK-KYUN KwON (seOUl NatIONal UNIv.)

aRyTenOID aDDuCTIOn anD ReCuRRenT LaRy-neaL ReInneRVaTIOn

seUNG-wON lee (sOONCHUNHYaNG UNIv.)

ROLe OF THe VOICe THeRaPy In PaTIenTS WITH unI-LaTeRaL VOCaL FOLD PaRaLySIS

HaN sU KIM (ewHa wOMaNs UNIv.)

WHaT IS THe ROLe OF eLeCTROMyOgRaPHy FOR eVaLuaTIng unILaTeRaL VFP PaTIenTS

saNG HYUK lee (sUNGKYUNKwaN UNIv.)

WHaT IS THe ROLe OF IMagIng STuDIeS In THe DI-agnOSIS OF unILaTeRaL PaRaLySIS?

Jae-YOl lIM (YONseI UNIv.)

WHaT IS THe ROLe OF THe VOICe aSSeSSMenTS In unILaTeRaL VFP?

JOO HYUN wOO (GaCHON UNIv.)

PROCeSS OF THe guIDeLIne DeVeLOPMenT

CHaNG HwaN rYU (NatIONal CaNCer CeNter)

[Hn-SP 9] aSHnO Symposium: update on the Management of nPC

11:00~12:40 Room 2-6 (Peacock)

Chair : eUN CHaNG CHOI (YONseI UNIv.), Moderator : sHeNG-PO HaO (sHIN KONG wU HO-sU

MeMOrIal HOsPItal, taIwaN)

DIagnOSIS OF rnPC IMagIng anD MOLeCuLaR

MarlINDa aDHaM (UNIversItas INDONesIa, INDONesIa)

CeLLuLaR BaSeD IMMunOTHeRaPy FOR rnPC

CHwee MING lIM (NatIONal UNIversItY Of sINGaPOre, sINGaPOre)

COnSIDeRaTIOnS anD POLICy OF SaLVage naSOPHaRyngeC TOMy

YU-tsaI lIN (KaOHsIUNG CHaNG GUNG MeMOrIal HOsP., taIwaN)

enDOSCOPIC VS ROBOTIC naSOPHaRyngeCTOMy

raYMOND KING YIN tsaNG (HONG KONG UNIv., HONG KONG)




April 28 (Sun)

[감정서 작성요령]

08:00~09:00 *Korean Session Room 2-1 (Flamingo)좌장 : 김진국 (건국의대)

08:00-09:00의료사안 감정서 작성 요령 및 의료법 질의 응답

성용배 변호사 (법무법인 태신)

[연구 활성화 심포지움]

09:00-10:40 *Korean Session Room 3-3 (Diamond)좌장 : 정영호 (서울의대)

09:00-09:30 정밀의료를 위한 병원정보시스템의 개발

이상헌 (고려대학교)

09:30-10:00 인공청각지능을 이용한 의료 솔루션

이교구 (서울대학교)

10:00-10:30 건강보험공단 자료분석을 위한 준비

한경도 (가톨릭대학교)

10:30-10:40 질문 및 토의

Korean Society of Thyroid-Head and neck Surgery endoscopic & Robotic Surgery Committee: update of Transoral Thyroidectomy

15:50~16:50 Room 2-5 (Crane)

KORean SOCIeTy OF THyROID-HeaD anD neCK SuRgeRy enDOSCOPIC & ROBOTIC SuRgeRy COM-MITTee: uPDaTe OF TRanSORaL THyROIDeCTOMy TRanSORaL THyROIDeCTOMy, PaST, nOW, anD neeDS

이동근 (동아의대)

anaTOMIC STuDy FOR TRanSORaL THyROIDeCTO-My aPPROaCH anD CLInICaL aPPLICaTIOn

우승훈 (연세대 해부학 교실 양헌무/단국의대)

LeSSOn LeaRneD FROM FauLTy TRanSORaL enDO-SCOPIC THyROIDeCTOMy

홍용태 (전북의대)

MaKIng a WORKIng SPaCe FOR TRanSORaL THy-ROIDeCTOMy

박준욱 (가톨릭의대)

CaRBOn DIOxIDe eMBOLISM DuRIng TRanSORaL ROBOTIC THyROIDeCTOMy

지용배 (한양의대)

DISCuSSIOn




April 28 (Sun)

[CL] 임상특강 I

08:40-09:10 Room 3-1, 2 (emerald a, B)좌장 : 최재진 (강동연세이비인후과)

발열성 피부 발진 환자의 감별진단 핵심

김태형 (순천향의대 감염내과)

[CL] 개회식 09:10-09:20

[CL] 전체특강 I

09:20-09:50 Room 3-1, 2 (emerald a, B)좌장 : 송병호 (미래이비인후과)

보청기 검수확인 과정에서 “음장검사”는 왜 필요한가

채성원 (고려의대)

[CL] 임상특강 II

09:50-10:20 Room 3-1, 2 (emerald a, B)좌장 : 신창식 (신창식이비인후과)

일차의료기관에서 경도인지장애와 치매환자 발견하기

나해리 (보바스기념병원 뇌건강센터)

[CL] 전체특강 II

10:20-10:40 Room 3-1, 2 (emerald a, B)좌장 : 한창준 (나래이비인후과)

국민연금공단이 알려드리는 청력 장애인 등록 심사

윤정순 (국민연금공단)

[CL] 필수특강 I

11:00-11:30 Room 3-1, 2 (emerald a, B)좌장 : 김익태 (메디서울이비인후과)

주사관련 감염의 예방과 관리

조선영 (삼성서울병원 감염내과)

의사회 프로그램

April 26 (Fri)

Lucheon Symposium - Intuitive SuRgICaL

12:30-13:30 Room 4-3 (Convention C)CHaIr : YOUNG HO JUNG (seOUl NatIONal UNIv.)

uPCOMIng THe neW HORIzOnS OF ROBOTIC-aS-SISTeD HeaD & neCK SuRgeRy WITH Da VInCI SP

YOON wOO KOH (YONseI UNIv.)

April 27 (Sat)

Lucheon Symposium – Oticon Korea

12:40-13:30 Room 4-1 (Convention a)

Lucheon Symposium - BuKWang Pharm.

12:40-13:30 Room 4-2 (Convention B)CHaIr : HUN JONG DHONG (sUNGKYUNKwaN UNIv.)

neW TReaTMenT OPTIOn FOR aLLeRgy RHInITIS, DyLaSTIne

Dae wOO KIM (seOUl UNIv.)

Lucheon Symposium – BORyung PHaRM.

12:40-13:30 Room 4-3 (Convention C)CHaIr : YOUNG-IK sON (sUNGKYUNKwaN UNIv.)

eFFICaCy OF n-aCeTyLCySTIne In ReLIeVIng THe SyMPTOMS OF LaRyngOPHaRyngeaL ReFLux DIS-eaSe

saNG HYUK lee (sUNGKYUNKwaN UNIv.)

April 28 (Sun)

Lucheon Symposium – VFC

12:30-13:20 Room 3-1, 3-2 (emerald a, B)

Sponsored Symposium




[CL] 필수특강 II

11:30-12:00 Room 3-1, 2 (emerald a, B)좌장 : 홍성수 (연세이비인후과)

언론에 비친 진찰실 (MOney Sex ReSPeCT)

이명진 (명이비인후과)

[CL] 정책특강

12:00-12:30 Room 3-1, 2 (emerald a, B)좌장 : 김규식 (코앤코김규식이비인후과)

심사평가체계 개편방향

이중규 (보건복지부 건강보험정책국 보험급여과장)

[CL] 교양세미나 - 와인, 자동차

13:20-14:20 Room 3-1 (emerald a)좌장 : 김현조 (밝고고운메디칼의원)

1) 와인강좌

이영주 (부띠끄림코 소믈리에)

2) 자동차 인문학

장진택 ((전)카미디어 대표)

[CL] 임상세미나 I - 청력검사법 비디오강의

13:20-14:20 Room 3-2 (emerald B)좌장 : 황찬호 (양천서울이비인후과)

1) MaSKIng & BOne COnDuCTIOn

정성욱 (동아의대)

2) SPeeCH auDIOgRaM

조창현 (가천의대)

[CL] 임상세미나 II - 소아이비인후과

14:20-15:20 Room 3-1 (emerald a)좌장 : 김기환 (김기환이비인후과)

1) 안전한 소아진정 및 진통

정재윤 (서울의대 응급의학과)

2) 2019년 예방접종 업데이트-소아를 중심으로

신광철 (미래이비인후과)

[CL] 임상세미나 III - 비부비동염

14:20-15:20 Room 3-2 (emerald B)좌장 : 유동희 (새롬이비인후과)

1) 치성 부비동염

정진혁 (한양의대)

2) 새로운 개념으로 접근하는 소아 만성 비부비동염의 치료 및 관리

이승훈 (고려의대)

[CL] 심포지움 I - LPR/GERD

15:40-17:00 Room 3-1 (emerald a)좌장 : 박선태 (코모키이비인후과)

1) geRD 치료의 최신지견 및 P-CaB의 역할

김도훈 (서울아산병원 소화기내과)

2) 식도운동질환의 진단과 치료

박정호 (성균관의대 소화기내과)

3) LPR 환자에서 투약을 종료하는 근거

이상혁 (성균관의대)

[CL] 심포지움 II - 알레르기 면역치료 패널토의

15:40-17:00 Room 3-2 (emerald B)좌장 : 박창식 (한사랑이비인후과)

Moderator : 이현종 (리앤홍이비인후과)

고수에게서 배운다 (MeeT THe exPeRT)

PaNelIst: 김수환 (가톨릭의대), 신유섭 (아주의대 알레르기내과)한만용 (차의대 소아청소년과), 홍석진 (한림의대)




April 27 (Sat)

[IC 5] 08:00-08:40 Room 2-6 (Peacock)

OSSICLe STaTuS BaSeD STagIng FOR COngenITaL CHOLeSTeaTOMa

CHaNG HO lee (CHa UNIversItY)

[IC 6] 08:40-09:20 Room 2-6 (Peacock)

PReOPeRaTIVe CI DIagnOSTICS WITH TRanSTyM-PanIC eCOg (anD eeaBR)


[IC 7] 09:20-10:20 Room 2-6 (Peacock)

LaTeRaL TeMPORaL BOne ReSeCTIOn In eaC Ma-LIgnanCy SuRgICaL LanDMaRK anD TIPS

KI-HONG CHaNG, BeOM-CHO JUN, JUN-wOOK ParK (DePt Of OtOlarYNGOlOGY HeaD aND NeCK sUrGerY,

st PaUls HOsPItal, tHe CatHOlIC UNIversItY Of KOrea)

[IC 8] 10:40-11:20 Room 2-6 (Peacock)

HOW TO uSe COSTaL CaRTILage In RHInOPLaSTy

YONG JU JaNG (DePt Of OtlarYNGOlOGY, asaN MeDICal CeNter, UNIv Of

UlsaN COlleGe Of MeDICINe)

[IC 9] 11:20-12:00 Room 2-6 (Peacock)

COMPuTeRIzeD DaTaBaSe FOR CHROnIC OTITIS MeDIa SuRgeRy 30-yeaR exPeRIenCeS

HYUNG-JONG KIM (HallYM UNIversItY)

[IC 10] 12:00-12:40 Room 2-6 (Peacock)

OFFICe LaRyngOLOgy InJeCTIOnS, angIOLyTIC La-SeRS anD MORe

MattHew stePHeN BrOaDHUrst (QUeeNslaND vOICe CeNtre)

April 26 (Fri)

[IC 1] 14:30-15:30 Room 2-6 (Peacock)

TRanSORaL enDOSCOPIC & ROBOTIC THyROIDeC-TOMy: SeT uP & BegInnIng

YOONwOO KOH, JUN-OOK ParK (YONseI UNIv., CatHOlIC UNIv.)

[IC 2] 15:50-16:30 Room 2-6 (Peacock)

ManageMenT OF FungaL SInuSITIS CHaLLengeS, DILeMMaS, FInDIngS anD SuggeSTIOnS

sOUraBHa KUMar PatrO (all INDIa INstItUte Of MeDICal sCIeNCes, JODHPUr, DePartMeNt Of OtOlarYNGOlOGY &

HeaD aND NeCK sUrGerY)

[IC 3] 16:30-17:10 Room 2-6 (Peacock)

WHaT KInDS OF LaRyngeaL DISeaSe COuLD Be TReaTeD WITH FIBeROPTIC LaRyngeaL LaSeR SuR-geRy (FLS) unDeR LOCaL aneSTHeSIa

seUNGwON lee (DePartMeNt Of OtOlarYNGOlOGY - HeaD aND NeCK sUrGerY, sOONCHUNHYaNG UNIversItY

COlleGe Of MeDICINe, BUCHeON)

[IC 4] 17:10-17:50 Room 2-6 (Peacock)

PROPeR aPPLICaTIOn OF CLInICaL PRaCTICaL guIDeLIne TO SuDDen HeaRIng LOSS

YONGHwI aN (DePt Of OtOrHINOlarYNGOlOGY, eUlJI UNIversItY sCHOOl Of MeDICINe,

eUlJI MeDICal CeNter, seOUl)

Instruction Course




April 26 (Fri)

[VL 1] 10:30-11:30 Room 2-5 (Crane)

auTOLOgOuS BOne-CaRTILage COMPOSITe gRaFT OSSICuLOPLaSTy

sHI Nae ParK (DePartMeNt Of OtOlarYNGOlOGY-HeaD aND NeCK sUrGerY, COlleGe Of MeDICINe,

tHe CatHOlIC UNIversItY Of KOrea)

SuRgeRy FOR SuPeRIOR CanaL DeHISCenCe Syn-DROMe

HONG JU ParK (Ulsan Univ.)

ReTROLaByRInTHIne VeSTIuLaR neuReCTOMy


FaCIaL ReanIMaTIOn uSIng HyPOgLOSSaL-FaCIaL neRVe anaSTOMOSIS aFTeR SCHWannOMa Re-MOVaL


[VL 2] 11:30-12:30 Room 2-5 (Crane)

InFeRIOR PaRTIaL MaxILLeCTOMy

KINaM ParK (sOONCHUNHYaNG UNIv.)

PaROTID SuRgeRy - HOW I DO By ReTRO-auRICu-LaR InCISIOn

DewaN MaHMUD HasaN (sarKarI KarMaCHarI HOsPItal)

MeDIaL SuRaL aRTeRy PeRFORaTOR FRee FLaP FOR HeaD anD neCK ReCOnSTRuCTIOnS

wOO-JIN JeONG (seOUl NatIONal UNIv.)

SuRgICaL TeCHnIQueS OF RaDIaL FOReaRM FRee-FLaP

YOO seOB sHIN (DePartMeNt Of OtOlarYNGOlOGY, sCHOOl Of MeDICINe, aJOU UNIversItY, sUwON, KOrea)

RaReLy uSeD BuT eFFICIenT aPPROaCHeS FOR FOReIgn BODy OR aBSCeSS ReMOVaL In HeaD anD neCK RegIOn

sO-YOON lee (CHa UNIv.)

[VL 3] 13:30-14:30 Room 2-5 (Crane)

TeMPORaLIS TenDOn TRanSFeR FOR SMILe ReS-TORaTIOn aFTeR FaCIaL neRVe PaRaLySIS

JI YUN CHOI (CHOsUN UNIversItY COlleGe Of MeDICINe)

uLTRaSOnIC RHInOPLaSTy neW TeCHnOLOgy LeaDS neW COnCePT

HONGrYUl JIN, JONGsOOK YI (DOCtOrJINs NOse ClINIC)

Video Lecture

[IC 11] 13:30-14:10 Room 2-6 (Peacock)

aSSeSSMenT OF VOCaL FOLD VIBRaTIOn

JIN-CHOON lee, sOO-GeUN waNG (BUsaN NatIONal UNIversItY)

[IC 12] 14:10-14:50 Room 2-6 (Peacock)

SuRgICaL anaTOMy OF CaVeRnOuS SInuS In en-DOSCOPIC enDOnaSaL SKuLL BaSe SuRgeRy

weIHsIN waNG (taIPeI veteraNs GeNeral HOsPItal, taIwaN)

[IC 13] 15:20-16:20 Room 2-6 (Peacock)

RHInOPLaSTy anD FaCIaL PLaSTIC SuRgeRy In PRIVaTe PRaCTICe

HONGrYUl JIN, JONGsOOK YI (Dr JINs PreMIUM NOse ClINIC)

[IC 14] 16:20-17:00 Room 2-6 (Peacock)

VIDeO HeaD IMPuLSe TeST FInDIngS FROM nOR-MaL SuBJeCTS anD PaTIenTS WITH VeSTIBuLaR DISORDeRS anD CLInICaL IMPLICaTIOnS

HONG JU ParK (DePartMeNt Of OtOrHINOlarYNGOlOGY-HeaD aND NeCK sUrGerY, asaN MeDICal CeNter,

UNIversItY Of UlsaN COlleGe Of MeDICINe, seOUl, KOrea)

[IC 15] 17:00-17:40 Room 2-6 (Peacock)

aLTeRnaTIVe PaLaTaL SuRgeRIeS In OBSTRuCTIVe SLeeP aPnea: PaTIenTS SeLeCTIOn, THeRaPeuTIC OPTIOnS anD SuRgICaL TeCHnIQueS

HYUN JIK KIM (seOUl NatIONal UNIversItY HOsPItal)




April 25 (Thu)

[OTHO] auditory Implants

07:30-17:30 Severance Hospital, Seoul, Korea

This workshop provides Otologist with a training platform to keep abreast of the recent surgical techniques in treatment of hearing loss, especially with auditory implant. Participants will have hands-on cadaveric dissection supervised.

[RHHO] endoscopic Sinus Surgery Cadaver Dissection

08:50-17:00 Research Institute, 1F, Seoul national university Biomedical

Planning the ideal nose workshop

[HnHO] endoscopic & Robotic Head and neck Surgery Dissection Course

07:00-17:00 Severance Robot & MIS Center, yonsei university Severance Hospital, Seoul, Korea

This course will cover all aspects of current minimally invasive robotic/endoscopic head and neck surgery, providing an opportunity to demonstrate and experience the advanced surgical techniques. The course will consist of detailed lectures, demonstrations and dissections on frozen corpses.

April 26 (Fri)

Rhinoplasty Hands on-Course

11:00~12:30 Room 2-2 (Skylark)

Study Phases on Large-nosed Clay Masks

Hands-on Course

April 26 (Fri)

[Plenary Session]

09:20-10:00 Room 4-2 (Convention B)

THe WORLD In 2019 anD THe KORean PenInSuLa

JOON OH (KYUNGHee UNIv.)

Oh Joon is a professor of united na-tions studies at Kyung Hee university in Seoul, Korea. He serves as an em-inent Person adviser to the un eco-nomic and Social Commission for asia and the Pacific (eSCaP). He is also the Chair of Save the Children Korea and a board member of Save the Children In-ternational. Previously he was ambas-sador and Permanent Representative of the Republic of Korea to the united nations in new york from 2013 to 2016. During this time, he also served as the 71st President of the economic and Social Council (eCOSOC) and as President of the Conference of States Parties to the Convention on the Rights of Persons with Disabilities (CRPD) in 2015 and 2016. Before that, he was Korean ambassador to Singapore from 2010-13 and Deputy Minister for Multi-lateral and global affairs in the Ministry of Foreign affairs and Trade in Seoul from 2008-10. The Korean government awarded him an Order of Service Merit twice, in 1996 and 2006. In 2018, he received a global Korea award from Michigan State university in the united Sates. Rehabilitation International (RI) gave him a global Presidential award in 2016 in acknowledgment of his achievements as President of the Con-vention on the Rights of Persons with Disabilities. He also received the 2014 youngsan Diplomat of the year award for his work on north Korean human rights issues. He published his first book in Korean “For Mica, Who Con-templates Life” in 2015.

Plenary Session




2019년 신입전공의 오리엔테이션 및 수련병원 과장회의

ㆍ일시 : 2019년 5월 17일(금)~18(토)

ㆍ장소 : 천안 상록리조트

전공의 자율평가고사

ㆍ일시 : 2019년 8월 31일(토)

ㆍ장소 : 전국 지정 고사장

The 11th Korean-american Satellite Symposium (KaSS)

ㆍ일시 : 2019년 9월 15일(일)~18일(수), 2019 AAO-HNSF Annual

Meeting & OTO Experience

ㆍ장소 : Ernest N. Morial Convention Center

900 Convention Center Blvd, New Orleans, Louisiana,

70130

제25차 이비인후과 종합학술대회

ㆍ일시 : 2019년 10월 17일(목)~18일(금)

ㆍ장소 : 여수엑스포컨벤션센터

기타 안내




Floor Plan

Floor Plan

Conn

ectio

n Bridge

2F

4F

Main HotelGrand Ballroom

7 Small Function Rooms

Room 2-1 (Flamingo)

Room 2-2 (Skylark)

Room 2-3 (White Heron)

Room 2-4 (Swan)

Room 2-5 (Crane)

Lotus Hill Garden

Lobby

Room 2-6 (Peacock)

Grand

Ballro

om

Board Room

Convention CenterRoom 4-1 (Convention A)

Room 4-2 (Convention B)

Room 4-3 (Convention C)

Room 4-1

(ConventionHall A)

Room 4-2

(ConventionHall B)

Room 4-3

(ConventionHall C)

Preview Room (April 26, 27)

Lobby




Floor Plan

Entrance

Conn

ectio

n Br

idge

MainHotelEntrance

1F

3F

Convention CenterExhibition Hall A

Room 1-1 (Exhibition Hall A)

Exhibition Hall B

Room 1-2 (Exhibition Hall B)

Convention CenterRoom 3-1 (Emerald A)

Room 3-2 (Emerald B)

Room 3-3 (Diamond)

Room 1-1 (Exhibition Hall A)Booth Exhibition

Room 1-2 (Exhibition Hall B)Poster Exhibition

Room 3-1

(EmeraldHall A)

Room 3-2

(EmeraldHall B)

Room 3-3

(DiamondHall)

Senior Members Lounge원로휴게실

bulle

tin b

oard

Registration Desk

Registration Desk

원로 휴게실(Senior Members Lounge)은컨벤션센터 3F에 위치해 있습니다.

Preview Room (April 28)




Program at a GlanceApril 25(Thu)

Time Convention 4F Convention 3F

Room Room 4-1 (Convention a) Room 4-1 (Convention B) Room 4-3 (Convention C) Room 3-1 (emerald a) Room 3-2 (emerald B) Room 3-3 (Diamond)

7:00

7:30

8:00

8:30

9:00

9:30

10:00

10:30

11:00

11:30

12:00

12:30

13:00

13:30

14:00

지도전문의 교육

Korean

14:30

15:00

15:30

16:00

16:30

17:00

17:30

18:00

Welcome Reception18:30

20:00




Time Hands-on Course Convention 1F

RoomSeverance Hospital,

Seoul, KoreaSeoul national university Biomedical Research Institute,

1FSeverance Robot & MIS center, yonsei university

Sevranse Hospital, Seoul, KoreaRoom 1-1 (exh. B)

7:00

Robotic & endoscopic Hn Surgery

Dissection Course in conjunction with 9th Hn

Surgery

Dissection Course of “Korean Society of

Head and neck Surgery”

7:30

8th yonsei Dissection Workshop for

auditory Implants in conjunction with

International Congressof ORL-HnS

8:00

8:30

9:00

The 27th SnuH International Course on

endoscopic Surgery of the nose and

Paranasal Sinuses in conjunction with

International Congress of ORL-HnS 2019

9:30

10:00

10:30

11:00

11:30

12:00

12:30

13:00

13:30

14:00

14:30

15:00

15:30

16:00

16:30

17:00

17:30

18:00

18:30

20:00




Program at a GlanceApril 26(Fri)


Room RM 4-1 (Convention a) RM 4-1 (Convention B) RM 4-3 (Convention C) RM 3-1 (emerald a) RM 3-2 (emerald B) RM 3-3 (Diamond)

7:00

7:30

8:00

OTOP 1 (Trauma & Tumor)

HnOP 1(Oral Cavity)

OTOP 2(Inner ear Basic II)

RHOP 1(Sleep Related Breathing

Disorders I)

HnOP 2(Salivary gland)8:30

9:00

Opening CeremonyPlenary Session

(The World in 2019 and the Korean Peninsula)

9:30

10:00Congress Photo

Coffee Break10:30

OT-KL 1(Looking at tinnitus therapy

from a different angle)

RH-KL 1(endoscopic versus external frontal sinus surgery: when

& how?)

Hn-KL 1(HPV in Head and

neck Cancer: european Perspectives)11:00

OT-SP 1 (endoscopic approach for

Middle ear Disease)

RH-SP 1 (Recent Perspectives on

CRS)

Hn-MOS1 (Tips and Pitfalls in

Surgical Management for Laryngopharyngeal Cancer)

Hn-SP 1 (evidence-based

Management of Oral Cancer)

11:30

OTOP 3(Inner ear Basic I)

RHOP 2(allergic Rhinitis)12:00

12:30

Luncheon Symposium(Intuitive SuRgICaLS KORea ISK)13:00

13:30 OT-KL 2(The european Board exam

in Otorhinolaryngology-Head

and neck Surgery)

RH-KL 2(Where are we in snoring

and sleep apnea surgery?)

Hn-KL 2(appropriate Management of Cervical neck nodes in

Oral Cancer)14:00

OT-MTP 1(Management of Difficult or Intractable Recurrent

Vertigo)

RH-RT 1(Olfaction and Taste

Dysfunction: Diagnosis, Treatment and Prognosis)

Hn-MTP 1(a Road Less Traveled:

Reconstructive Surgery in HnC)

OT-MOS 2(Management of external

ear Malformations)

RH-SP 2(Challenges in Sphenoid

Sinus Surgery)

Hn-SP 2(Cutting edges in Head and

neck Cancer Research)

14:30

15:00

15:30Coffee Break

16:00

OT-MOS 1(My Favorite approach in

Skull Base Surgery)

RH-MOS 1(My Philosophy of

Rhinoplasty)

Hn-KL 3(Why assessment of vocal function should matter to

laryngologists)

OT-SP 2(eustachian Tube Disorders)

RH-SP 3 (Recent updates on allergic

Rhinitis)

16:30

Hn-MOS 2(Technical nuances for

endoscopic/Robotic Thyroidectomy)

Hn-SP 3 (Reconstructive Surgery

update)

17:00

17:30

18:00

18:30

20:00




Time Hotel 2F Convention 1F

Room RM 2-1 (Flamingo) RM 2-2 (Skylark) RM 2-3 (White Heron) RM 2-5 (Crane) RM 2-4 (Swan) RM 2-6 (Peacock) RM 1-1 (exh. B)

Poster exhibition

7:00

7:30

8:00

8:30

9:00

9:30

10:00

10:30

VL1

exhibition Ribbon Cutting

Poster exhibition

11:00

Hands on Course(Turkey)

Hn-SP 4(IgReHnS Panel: Future of Robotics and Virtual

Reality in Surgery)

11:30

VL 212:00OTTPP 1

12:30

Senior Member Luncheon13:00

13:30

VL 3 OTTPP 214:00

14:30

OTOP 4(auditory System &

neuropathy)

RHOP 3(Sinonasal Tumors)

Hn-3D Printing(3D Printing Course of “The Korean Society of

3D Printing in Medicine”)

HnTPP 1 OTTPP 3

IC 1(Transoral endoscopic & Robotic Thyroidectomy:

Set up & Beginning)

15:00

15:30

16:00

OTOP 5 (auditory Rehabilitation I)

RHOP 4(Rhinosinusitis)

HnTPP 2

OTTPP 4

IC 2(Management of Fungal

Sinusitis Challenges, Dilemmas, Findings and

Suggestions)

Poster exhibition

16:30

Hn-SP 5(CeORL-KORean

JOInT SyMPOSIuM : Best Practices and

Optimizing Outcomes in Well Differentiated

Thyroid Cancer)

IC 3(What Kinds of Laryngeal

Disease Could Be Treated With Fiberoptic

Laryngeal Laser Surgery (Fls) under Local

anesthesi)

17:00

OTOP 6(auditory Rehabilitation

II)

RHOP 5(endoscopic Sinus

Surgery)OTTPP 5

RHTPP 1

IC 4(Proper application of Clinical Practical

guideline to Sudden Hearing Loss)

17:30

18:00

18:30

20:00

April26(Fri)




OT-KL 1Room 4-1 (Convention A)

Chair : YONG BEOM CHO

Keynote Lecture I

» 10:30-11:00

» LOOKINg AT TINNITUS THERAPY FROM A DIFFERENT ANgLE

DEPT. OF OTOLARYNGOLOGY,

NATIONAL TAIWAN UNIVERSITY HOSPITAL

TIEN-CHEN LIU

Tinnitus baffles patients and clinicians for long. This re-port provides a different perspective from the association of tinnitus with other diseases that are uncommonly men-tioned before and offers some therapeutic methods that may help certain patients distressed by tinnitus. Nation-wide, population-based, case controlled method was em-ployed to analyze the association of tinnitus with OSAS, menopause in women and history of migraine headache. Specific treatment such as CPAP, HRT and migraine prophylactic therapy were used in selective case series for tinnitus therapy The risk of tinnitus was higher in pa-tients with OSAS. We further performed PSG for 173 male patients with chronic tinnitus and found the inci-dence and severity of SDB is much higher. Also, associa-tion study demonstrated that menopausal women tend to have higher incidence of tinnitus. HRT has remarkable tinnitus relieving effects in our preliminary series. Finally, the history of migraine inflict a significant higher risk to develop tinnitus and we proposed that cochlear migraine may be a possible cause of tinnitus in some patients. The results of our association studies and clinical studies seem to be compatible with two major new concept of tinni-tus: 1, tinnitus is heterogenic; 2, a top-down mechanism is a significant etiological contributor.

OT-SP 1Room 4-1 (Convention A)

Chair : IL-WOO LEE, MICHAEL TONG

Endoscopic Approach for Middle Ear Disease

» 11:00~11:20

» ENDOSCOPIC MIDDLE EAR ANATOMY AND PHYSIOLOgY

DEPARTMENT OF OTORHINOLARYNGOLOGY,

HEAD AND NECK SURGERY, INSTITUTE OF

HUMAN COMMUNICATIVE RESEARCH,

THE CHINESE UNIVERSITY OF HONG KONG

MICHAEL CHI FAI TONG

Education objectives: In this presentation, the fundamen-tal middle ear anatomy and physiology with reference to endoscopic ear surgery will be presented. Content: The different perspectives including wide angled and close in-spection views of the middle ear will be illustrated with video clips and illustrations. Ventilation theories and variations in anatomy will also be outlined. Finally exten-sions to anatomy and physiology beyond the middle ear are discussed.

» 11:20~11:35

» TRANSCANAL ENDOSCOPIC TYMPANO-PLASTY

DEPARTMENT OF OTORHINOLARYNGOLOGY-

HEAD AND NECK SURGERY, SAMSUNG MEDICAL

CENTER, SUNGKYUNKWAN UNIVERSITY

SCHOOL OF MEDICINE

IL JOON MOON

Since the introduction of tympanoplasty, a variety of graft materials and surgical techniques have been developed and used to close perforations in the tympanic mem-brane. Regarding technique, conventional microscopic tympanoplasty with a postauricular incision remains the most effective procedure for patients with chronic otitis

April26(Fri)


International Congress of ORL-HNS 2019 in conjunction with 93rd Annual Congress of Korean Society of Otorhinolaryngology-Head and Neck Surgery2019 Spring Meeting of Korean Association of Otorhinolaryngologists

April 26(Fri) Otology

media, especially in cases of anterior or large TM perfora-tion as well as anterior bony overhang. This conventional procedure results in surgical scar and significant pain to the patient. However, minimally invasive otologic surgery has recently been developed along with endoscopic tech-niques. Endoscopically, the typical transcanal approach is possible by elevating a tympanomeatal flap without other incisions. This avoids other unnecessary postauric-ular incisions and soft tissue dissections and subsequent morbidities. The endoscopic approach also provides bet-ter visualization of hidden areas in the middle ear cavity including the anterior and posterior epitympanic spaces, sinus tympani, facial recess, and hypotympanum. In this talk, comparison of the outcome of endoscopic and mi-croscopic tympanoplasty as well as basic concept of endo-scopic tympanoplasty will be discussed. With endoscopic system, minimal invasive tympanoplasty can be possible with similar graft success rate, better cosmetic outcome and less pain.

» 11:35~11:55

» ENDOSCOPIC OSSICULOPLASTY

UNIVERSITY OF ISTANBUL - ISTANBUL MEDCAL

FACULTY DEPARTMENT OF ORL

KADR SERKAN ORHAN

Objective: Eustachian tube dysfunction may deterio-rate physiology of middle ear pressure and ventilation that result in ear drum retraction. Cholesteatoma can develop from retraction pocket that may result in os-sicular erosion. On the other hand, Ossicular erosion may result from prolonged contact between tympanic membrane and ossicular chain without active infection and cholesteatoma. Long process of the incus, lenticular process and/or stapes superstructure can be effected and result in complete or partial ossicular discontinuity. In lenticular process erosion, bone cement can be used for reconstruction. Incus interposition, malleus-stapes bone cement or ossicular prosthesis are the reconstruction op-tions in case of incus long process erosion. Materials and Methods: Thirty two patients whose underwent ossicu-lar chain reconstruction with bone cement included in the study. Glass ionomer was used for reconstruction by endoscope. We compared preoperative and postoperative audiogram findings. Results: We found better result of ossicular reconstruction with glass ionomer in lenticular process erosion. Malleus- stapes bone cement application

or incus interposition can be performed in case of incus long process erosion. Conclusion: Glass ionomer appli-cation by using endoscope can be safely used for ossicular reconstruction in patient with ossicular discontinuity.

» 11:55~12:10

» ENDOSCOPIC APPROACH FOR ATTIC CHO-LESTEATOMA

DEPARTMETN OF OTORHINOLARYNGOLOGY-

HEAD & NECK SURGERY, COLLEGE OF MEDICINE,

PUSAN NATIONAL UNIVERSITY

IL-WOO LEE

Attic Cholesteatoma is limited to the attic region and of-ten has no perforation on tympanic membrane. In the case of early attic cholesteatoma, extension of the lesion to the mastoid cavity is not severe, so it is not necessary to open the mastoid cortical bone just for the behidk ap-proach to the cholesteatoma. The approach to the attic cholesteatoma can be easily possible through the endo-scope with the incision of the external auditory canal skin without external skin incision. In the case of the early attic cholesteatoma, the lesion, located outside the malle-oincuidal, can be removed under wide view of operation field after removing the scutum of the ear canal. Because drilling the mastoid cortex for approaching to the lesion with microscope is not required, it can shorten the op-eration time and reduce the damage of the hearing by drilling. The entire lesion can be observed and removed from the enlarged endoscopic field. Unlike sinus surgery, which has been completely replaced by endoscopic sur-gery, many otologists are not familiar with endoscopic ear surgery for attic cholesteatoma. It can be suggested that one should consider whether it is right to stick to a familiar microscope operation just for the reason that both-hand surgery is not possible with endoscope.

» 12:10~12:30

» TRANSCANAL ENDOSCOPIC EAR SURgERY FOR CONgENITAL CHOLESTEATOMA

DEP. OF OTOLARYNGOLOGY, HEAD AND

NECK SURGERY, YAMAGATA UNIV.

FACULTY OF MEDICINE

TSUKASA ITO

April26(Fri)




Introduction: Transcanal endoscopic ear surgery (TEES) offers advantages over microscopic ear surgery (MES) such as a wide field of view, higher magnification, and less invasiveness. Our presentation shall demonstrate the use of TEES and its efficacy in the treatment of congen-ital cholesteatomas (CC). Patients: Thirty-two patients with CCs who underwent surgery from December 2011 to December 2017 (mean age/range: 7 yr/2–16 yr; 20 male/12 female; mean follow-up/range 3 yr/0.6–6.7 yr). Intervention: Patients with CCs underwent either TEES or MES. TEES was performed with a 2.7-mm endoscope coupled to a full HD video system. Some TEES proce-dures included a transcanal attico-antrostomy using an ultrasonic aspirator if the CCs extended into the antrum in a procedure called “Powered TEES”. MES was per-formed via a transcortical mastoidectomy to treat cho-lesteatomas beyond the antrum with the endoscope used to check hidden recesses. Results: Twenty-six patients underwent TEES and 6 patients underwent MES. Twen-ty-five patients with a Potsic grade III or lower choles-teatoma underwent TEES. Twenty patients underwent one-stage operation, while the remaining 12 patients required a two-stage operation due to the risk of a resid-ual cholesteatoma when the cholesteatoma could not be removed by one continuous motion under direct visual-ization during the first surgery. Six patients (19%) had residual cholesteatomas and 5 out of the 6 residual cho-lesteatomas derived from an open-type congenital choles-teatoma treated by a one-stage operation. Postoperative evaluation revealed that 26 of all 32 patients (81%) with CCs and 23 of 26 patients (88%) of the TEES group achieved good air-bone gap results of less than or equal to 20 dB HL. Conclusion: CCs can be safely and effec-tively treated by TEES with 2.7-mm endoscopes with a resulting improvement in hearing. However, a two-stage operation is the best option for open-type CCs to reduce the residual rate.

OT-KL 2Room 4-1 (Convention A)

Chair : JONG WOO CHUNG

Keynote Lecture II

» 13:30~14:00

» THE EUROPEAN BOARD ExAM IN OTORHI-NOLARYNgOLOgY-HEAD AND NECK SUR-gERY(EBEORL-HNS).PRESENT STATUS AND FUTURE ASPECTS

CHAIRMAN, EUROPEAN BOARD EXAM IN

OTORHINOLARYNGOLOGY-HEAD AND NECK

SURGERY (EBEORL-HNS), AARHUS UNIVERSITY

ULRIK PEDERSEN

The Union of European Medical Specialists ORL Sec-tion (UEMS ORL Section) was founded in 1962 with the main purpose to strengthen and improve the skills and education of European ENT Doctors. Many initia-tives have been taken through the years to fulfill this aim. Among those are the European Board Exam in ORL-Head and Neck Surgery. It was created in 2009 in Mann-heim, Germany, to access the theoretical knowledge, clin-ical performance and skills of the candidates. The exam is not only open to candidates from the European Union , but also from candidates from all over the world. It is composed of a written part to mainly assess the theoret-ical knowledge of ORL diseases and an oral part to test the clinical application of knowledge based on case sce-narios and common clinical conditions from our daily life. There are yearly 2 to 3 written exams, normally in connection with major international congresses and one oral exam with examiners from all over Europe, until now placed in Vienna, Austria. The curriculum for the exam is based on the UEMS ORL Section education program and logbook (www.orluems.com). The organisation and development of both the written and oral exam as well as the practical set up and overall results of the exam will be presented. Future aspects and perspectives for the exam will finally be presented. By the end of 2018 more than 800 candidates have passed the exam, which now is a pre-requisite for a specialist job in several parts of the world. The exam is furthermore accepted as equal to the national

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one in some European countries. The exam is not a pass-port to the European Union, but gives additional quali-fication to the candidates CV when seeking positions in major Head and Neck clinics in- and outside Europe.

OT-MTP 1Room 4-1 (Convention A)Chair : OZGUR YIGIT,

Moderator : WON-HO CHUNG

Management of Difficult or Intractable Recurrent Vertigo

» 14:00-14:30

» SUPERIOR CANAL DEHISCENCE SYN-DROME


SEOUL NATIONAL UNIVERSITY

BUNDANG HOSPITAL

JA-WON KOO

Canal plugging of the dehiscence is the principal treat-ment for the patients suffering disabling symptoms from superior canal dehiscence. Out of 29 patients, 10 patients received surgical plugging procedures via middle fossa ap-proach (age range: 28-45, follow up: 0.2-9 years). Sen-sorineural hearing loss was developed after surgery in 1 patient. In the remaining 8 patients, there were air-bone gap at lower frequency range due to lowered bone con-duction threshold below 0dB, which were normalized af-ter surgery. VEMP threshold was significantly improved after surgery (preoperative: 49 dB, postoperative: 79 dB, p<0.01). SP/AP ratio of ECoG was also improved after surgery (preoperative: 0.58, postoperative: 0.26, p<0.05). Most of subjective symptoms were relieved after canal plugging surgery via middle fossa approach. Hypersen-sitive bone conduction threshold, air-bone gap, VEMP threshold and SP/AP ratio of ECoG were normalized af-ter plugging of the dehiscence.

» 14:30-15:00

» UNILATERAL POSTERIOR CANAL-PLUg-gINg SURgERY FOR INTRACTABLE BILATER-AL POSTERIOR CANAL-TYPE BENIgN PAROx-

YSMAL POSITIONAL vERTIgO

DEP. OTORHINOLARYNGOLOGY-HEAD & NECK

SURGERY, OSAKA UNIV. GRADUATE SCHOOL OF

MEDICINE

TAKAO IMAI

Objective: To investigate the effectiveness of unilateral posterior semicircular canal (PSCC)-plugging surgery for patients with intractable bilateral PSCC-type benign par-oxysmal positional vertigo (P-BPPV). Methods: From July 2011 to December 2015, we diagnosed 136 patients with P-BPPV. Of these, 3 patients had bilateral P-BPPV, and in 2 of the 3, the condition had been refractory to conservative treatment for more than 1 year. We planned a staged PSCC-plugging surgery for these 2 patients; ini-tially one side was treated, and the contralateral side was treated 6 months later. Results: After the first surgery, both patients experienced improvement in symptoms of vertigo and nystagmus on the operated side and no change on the non-operated side. Patients underwent the Epley maneuver for the non-operated side. In one case, the non-operated side was cured. In the other case, although the P-BPPV was not completely resolved, the patient was satisfied with the result of unilateral surgery because he was now able to turn in bed to the operated side without vertigo. Before surgery, he had experienced vertigo when turning even slightly in bed. Conclusion: We propose that even unilateral PSCC-plugging surgery is effective for some patients with intractable bilateral P-BPPV.

» 15:00-15:30

» APPROACH TO INTRACTABLE MENIERE’S DISEASE; WHAT WE WOULD DO?


HEAD & NECK SURGERY, COLLEGE OF MEDICINE

INHA UNIVERSITY, INCHEON, KOREA

KYU SUNG KIM

The intractability of Meniere’s disease is not clearly de-fined. Some of the patients have a problem with their dai-ly social activities including work, schooling or even sim-ple domestic life because of frequent attacks of vertigo, progressive hearing loss, ear fullness, and roaring tinnitus

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despite lifestyle modification and proper medical treat-ment including diuretics and vasodilator. Various kinds of therapeutic modalities can be applied after a failure of medical treatment, including pressure therapy, intratym-panic application of drugs, and conservative or ablative surgeries including endolymphatic sac surgery, labyrin-thectomy, vestibular neurectomy. Accurate diagnosis is of importance when the physician selects the therapeutic modality of intractable recurrent vertigo under the con-sideration of the hearing status, vestibular function and medical condition as well as age, occupation and psycho-logical aspect. Tumarkin vestibular crisis is a sudden fall-ing sensation without loss of consciousness in the patient with Meniere’s disease. It is challenging for physician how to choose the therapeutic modality because it is a kind of otologic emergency which can cause life-threatening fall-ing. This lecture will discuss how to approach intractable Meniere’s disease and what the physicians would do for the patients.

OT-MOS 2Room 3-1 (Emerald A)

Chair : MICHAEL TONG, Moderator : GYU CHEOL HAN

Management of External Ear Malformations

» 14:00-14:20

» SURgICAL TIPS IN MINOR AURICULAR MAL-FORMATION


HEAD AND NECK SURGERY,

THE CATHOLIC UNIVERSITY OF KOREA

JEONG-HOON OH

A detailed understanding of auricular anatomy is nec-essary for successful surgical outcomes in treatment of minor auricular anomalies including protruding ear, con-stricted ear and cryptotia. The normal anatomy of the ear can be accurately understood by studying the topog-raphy of the auricle. Almost all surface landmarks of the auricle are created by the shape of the underlying elastic cartilage. The curvature of the antihelix is critical to the appearance of the middle and superior auricle. The lack

of antihelical folding is often related to the extent of au-ricular prominence, and an underdeveloped antihelical fold is often present in the prominent ear. Associated features of the prominent ear can also include a promi-nent conchal bowl, widened auriculocephalic angle, and increased conchal distance from the mastoid bone. In a constricted ear, the fundamental abnormality is that the helical rim is deficient in circumference for the scapha to which it is attached. The inadequate length of the helix “constricts” the ear and forces it into a cupped shape that protrudes from the head. The goal in standard otoplasty is a normal appearing ear without evidence that there has been surgical intervention. Sharp, unnatural contours, overcorrection, and obliteration of the normal sulcus are not acceptable results. If the sub-structures are severely underdeveloped, otoplasty may be inappropriate and the patient may be best treated by discarding the cartilage and placing a cartilage framework under total or subtotal auricular reconstruction.

» 14:20-14:40

» BASIC SKILLS FOR MICROTIA SURgERY


YONSEI UNIVERSITY COLLEGE OF MEDICINE

SUNG HUHN KIM

For the reconstruction of microtia, aesthetic concept and skilled surgical techniques are needed. Various surgical approaches and materials have been developed for total auricular reconstruction. The most popular surgical tech-nique used nowadays was developed by Satoru Nagata. The technique is two-staged operation and autologous rib cartilage is used for framework. However, detailed proce-dures are different from surgeon to surgeon, and the tech-nique should be modified depending upon the degree and combined malformation. In this presentation, basic surgical technique for microtia using modified Nagata’s technique will be covered, and the surgical approach for specific situation such as anotia, microtia with hemifacial microsomia or low hairline, and Medpor use will be dis-cussed.

» 14:40-15:00

» IMPLANTABLE HEARINg AIDS FOR CON-gENITAL ExTERNAL & MIDDLE EAR MALFOR-MATIONS

April26(Fri)




THE CHINESE UNIVERSITY OF HONG KONG,

DEPT OF ORL HNS, INSTITUTE OF HUMAN

COMMUNICATIVE RESEARCH

MICHAEL CHI FAI TONG

The principles of managing patients with congenital ex-ternal and middle ear malformations are 1. The provision of more choices; 2. The relative comparison of surgical with non-surgical options; 3. Early intervention and 4. A multidisciplinary team approach. Our experience in the use of bone conduction and middle ear implants are out-lined in this talk with reference to hearing outcomes. Ed-ucational objectives: to show with an example of running an effective hearing rehabilitation program for congenital external and middle ear malformations.

» 15:00-15:20

» SKIN gRAFTINg IN OTOLOgIC SURgERY

KPJ HEALTHCARE UNIVERSITY COLLEGE

LOKMAN BIN SAIM

Restoration of an intact skin barrier is of utmost im-portance following surgery or wounding to prevent in-fection, minimize wound contraction to maintain func-tion, and minimize cosmetic disfigurement and to avoid volume depletion. In a number of otologic surgery and certain ear conditions, skin grafting play an important role in determining the desired outcome. The author pre-fers to use split-thickness skin graft (STSG) in otology to provide rapid and effective method of reconstructing skin defects and to resurface granulations or mucosal deficits. In ear canal reconstruction for congenital atresia or ste-nosis, the skin grafting is a major factor that determine patency of the constructed ear canal and prevention of re-stenosis. Skin loss during surgery for multiple exostosis of the ear canal should also be covered with STSG. Skin graft is also useful in cessation of recurring granulations in chronic myringitis, mastoid cavities and chronic otitis externa. The method of harvesting STSG from the medi-al side of the arm will be shown. The STSG is placed on a layer of commercially available silk sheet and cut into small rectangles for ease of pasting the skin onto the area to be covered. Videos of the technique of skin grafting, its application and outcome, in several otologic conditions will be demonstrated.

OT-MOS 1Room 4-1 (Convention A)

Chair : JONG WOO CHUNG, Moderator : KI-HONG CHANG

My Favorite Approach in Skull Base Surgery

» 15:50-16:14

» ENDOSCOPIC LATERAL SKULL BASE SUR-gERY


IN SEOK MOON

The start of otologic surgery using endoscope dates back to the 1960s, but there has been much debates as to whether or not to replace operative microscope. There-fore, endoscope has been mainly used for diagnostic pur-poses for a while. Recently, with the increasing interest in minimally invasive surgery, various surgical procedures have been tried in the field of neurotology and their suc-cess has been reported. In this review, cases of vestibular schwannoma, facial nerve decompression, glomus tumor, petrous apex cholesterol granuloma, venous malforma-tions of the facial nerve, and perilymph fistula are sum-marized. Lastly, the “Exoscope” is introduced which is to replace the operative microscope.

» 16:14-16:38

» INFRATEMPORAL FOSSA APPROACH FOR JUgULAR FORAMEN TUMORS

DEPARTMENT OF ORL-HNS, SUNGKYUNKWAN

UNIVERSITY, SAMSUNG SEOUL HOSPITAL

YANG-SUN CHO

Tumors of jugular foramen (JF) are uncommon. Jugu-lotympanic paraganglioma, schwannoma and meningi-oma are most common tumors in the jugular foramen and rarely, other tumors may be encountered in this re-gion. The primary treatment of choice for these tumors is total surgical removal of the tumor. The surgery for these tumors is challenging because of the complex an-atomic location and the potential postoperative compli-

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cations such as facial nerve palsy, hearing loss, various lower cranial nerve complications including aspiration and hoarseness. Fisch in 1978 introduced an approach to the jugular foramen area and named the infratemporal fossa approach type A, which provided a wide surgical field and facilitated the surgical control of these tumors. However, this approach has inevitable complications in-cluding permanent conductive hearing loss and the fre-quent occurrence of temporary facial nerve palsy. Con-sequently, a number of modified methods of approach have been developed to avoid the postoperative com-plications. Intraoperative facial nerve monitoring and rerouting of the facial nerve with soft tissue around the stylomastoid foramen has resulted in better facial nerve outcomes. The extent of the facial nerve rerouting is also known to be closely related with the postoperative facial nerve outcome. Short rerouting and the Fallopian bridge technique, which require minimal rerouting of the facial nerve, avoids unnecessary manipulation and damage to the facial nerve. In our center a total of 44 JF tumors were surgically managed from 1997 to 2018 using lateral skullbase approaches. There were 20 JF schwannoma, 17 Jugulotympanic paraganglioma, and 7 other tumors. The surgical techniques, outcomes of facial nerve and tumor control will be presented.

» 16:38-17:02

» MANAgEMENT STRATEgY OF FACIAL NERvE TUMORS

DEPT OF OTOLARYNGOLOGY-HEAD AND

NECK SURGERY, SHANGHAI NINTH PEOPLES

HOSPITAL, SHANGHAI JIAOTONG UNIVERSITY

SCHOOL OF MEDICINE

ZHAOYAN WANG

Objective: To elucidate the clinical behavior, treatment and outcomes of facial nerve tumors and discuss strategy in management of facial nerve tumors. Methods: In this study, a total of 78 patients with facial nerve tumors un-derwent serial observation or microsurgery. 61 patients underwent surgical removal from 2002 to 2016 and 17 patients underwent serial observation. In surgical group, 55 patients were diagnosed as facial nerve schwannomas and 6 patients were facial nerve hemangioma. The main clinical outcomes were change in facial nerve function and pure-tone average from pre- to postoperative and surgical complications. Results: The three most common

sites are geniculate ganglion, internal auditory canal and labyrinthine segment. 61 patients ultimately underwent surgical excision with grafting or primary anastomosis and 17 patients underwent serial observation. In 6 pa-tients with facial nerve hemangioma, complete hearing loss occurred in all 6 patients and primary end-to-end anastomosis was performed. In 55 patients with facial nerve schwannomas, facial nerve rerouting and anasto-mosis was performed in 10 patients (18.2%), facial-hy-poglossal nerve anastomosis in 21 patients (38.2%) and sural nerve grafting in 24 patients (43.6%). Patients were followed up for at least 1 year after treatment, and MRI showed no evidence of tumor regrowth. All patients ex-perienced some level of recovery in facial nerve function. Conclusion: Good results can be achieved in patients with facial nerve tumors. Treatment strategy and surgical approaches should be changed by different patients and different tumors. Surgical removal is recommended in fa-cial nerve hemangioma. Facial nerve function is always the most important issue be considered. Preoperative di-agnosis is very important for facial nerve tumors.

» 17:02-17:26

» TRANSLABYRINTHINE APPROACH FOR vESTIBULAR SCHWANNOMA


HEAD AND NECK SURGERY, SOONCHUNHYANG

UNIVERSITY COLLEGE OF MEDICINE,

BUCHEON, KOREA

JONG DAE LEE

Surgical removal remains one of the main treatment modalities for vestibular schwannoma. Among surgical approaches, the translabyrinthine approach is chosen for patients with poor preoperative hearing in vestibular schwannomas. The size of the tumor is typically not a limiting factor for this approach. The approach has sev-eral advantages, including 1) it offers early identification of the facial nerve in the auditory canal, and 2) there is absolutely no need for cerebellar retraction. We review preoperative considerations, surgical videos including surgical skill and postoperative outcomes.

» 17:26-17:50

» MIDDLE FOSSA APPROACH FOR vESTIBU-LAR SCHWANNOMA

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COLLEGE OF MEDICINE, THE CATHOLIC

UNIVERSITY OF SEOUL, KOREA

BEOMCHO JUN

In development of magnetic resonance imaging of the brain, early detection of the patient of VS with service-able hearing has been increasing. Watchful waiting with regular scan is typically recommended for small tumors in patients with minimal or no symptoms, poor overall health, or advanced age. However, hearing loss over time is expected with conservative management, most young and middle-aged patients with even minimal symptoms tend to choose SRS or microsurgical resection for better long-term hearing outcomes The surgical option of the middle fossa approach (MFA) and retrosigmoid (RS)ap-proaches to resection of VS tumors offer the possibility of hearing preservation with real-time monitoring. The choice of microsurgical approach for VS tumors depends on the tumor size, patient age, tumor site and extent of IAC, involvement, anatomy of the vestibule, amount of tumor extension in the cerebellopontine angle, brain-stem involvement, preoperative status of FN function and hearing status, and surgeon’s preference. Generally indication for MFA for removal of unilateral vestibular schwannomas in patients with 1. Intracanalicular tumors extending less than 1 cm into the cerebellopontine angle, without brainstem contact 2. Good hearing (better than or near 30 dB PTA and 70% WRS) 3. Imaging (MRI) evidence of tumor growth and/or functional deteriora-tion (eg, progressive hearing loss, disabling vertigo) 4. No contraindications for a supratentorial craniotomy (ie, age >69 years, ASA class >II, and Karnofsky Performance Scale score <60). However, limitations include limited exposure of posterior fossa, difficulty in resecting larger tumors, higher incidence of transient facial paresis, risk of seizures, and possible language impairment in the domi-nant temporal lobe Noudel and colleagues reported a rate of preservation of hearing within the 50/50 rule of 62% for the MFC approach and 58% for the retrosigmoid approach. MFA offers a good alternative to watchful waiting or SRS for young patients with small VS. Pre-operative hearing class was the primary determinant of postoperative hearing outcome, emphasizing that metic-ulous surgical technique with careful hearing monitoring.

OT-SP 2Room 3-1 (Emerald A)

Chair : HONG JU PARK, YUN-HOON CHOUNG

Eustachian Tube Disorders

» 15:50~16:10

» PAST, PRESENT, AND FUTURE: BALLOON EUSTACHIAN TUBE DILATATION

BIELEFELD ACADEMIC TEACHING HOSP.,

GERMANY

HOLGER SUDHOFF

TBD

» 16:10~16:30

» DIAgNOSTIC CRITERIA FOR PATULOUS EU-STACHIAN TUBE

SEN-EN RIFU OTOLOGICAL SURGERY CENTER

RYOUKICHI IKEDA

Patulous Eustachian tube (PET) in which the ET is ab-normally open can lead to an enormous reduction in quality of life. Most clinical studies of PET have been reported by different institutions under their diagnosis of PET because there has not been established diagnostic criteria for PET. Recently, the Japan Otological Society (JOS) proposed Diagnostic Criteria for PET (Kobayashi et al. 2018). The Criteria will further promote interna-tional scientific communication on PET.Diagnostic criteria for Patulous Eustachian Tube pro-posed by the JOS1. There are subjective symptoms One or more of the following symptoms included: voice

autophony, aural fullness, and breathing autophony2. Tubal obstruction procedures (A or B) clearly improves

symptoms A. Posture change to the supine / lordotic positon B. Pharyngeal orifice obstruction procedure (swab, gel,

etc.)3. There is at least one of the following objective findings

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of patent E- tube: A. Respiratory fluctuation of the tympanic membrane B. Variations of external auditory canal pressure syn-

chronized with nasopharyngeal pressure C. The sonotubometry shows (1) the probe tone sound

pressure level less than 100 dB or (2) an open pla-teau pattern.

Definite PET: 1 + 2 + 3 Possible PET: 1+ (2 or 3)This criteria was made to avoid any contamination of “Definite PET” with uncertain cases so that “Definite PET” accurately reflects PET cases. Furthermore, it was also intended to minimize the number of cases that could be accidentally excluded even in the presence of some suspected findings (“Possible PET”). As the ET function may vary even over a relatively short period, repeated testing on another occasion is recommended in “Possible PET” cases. This Criteria can be used by all otolaryngol-ogists even without using the ET function test apparatus. However, the use of such an apparatus could increase the chances of detecting “Definite PET”.

» 16:30~16:50

» vARIOUS SURgICAL MANAgEMENT OF PATULOUS EUSTACHIAN TUBE

DEPARTMENT OF OTOLARYNGOLOGY HEAD AND

NECK SURGERY, PUSAN NATIONAL UNIVERSITY

COLLEGE OF MEDICINE

SOO-KEUN KONG

Symptoms of Patulous Eustachian tube (PET) vary wide-ly from transient to everyday life. In the absence of this transient symptom, the patient 's social activities will be significantly impaired. In such cases, active treatment should be attempted. Here, we summarize the various surgical treatments that the authors have conducted so far and report the results. We will discuss the results of var-ious methods such as injection E-tuboplasty, Nasopha-ryngeal ET catheter insertion, and trans-tympanic ET catheter insertion In autologous injection E-tuboplasty, we used a Bruning injector to make the cartilage fine-ly using the patient's tragus and injected into the upper and the posterior part of nasopharyngeal ET orifice, 23 ears (69%) of the 33 ears showed symptomatic improve-ment in our study. Recently, a filler (Radiesse®, Calcium hydroxylapatite) may be injected. In nasopharyngeal ET catheter insertion technique, The catheter is inserted into

the nasopharyngeal ET orifice under endoscopy after the inside of the catheter is covered with the bone wax. When inserted, the catheter is inserted until it passes completely through the isthmus (junctional portion). However, there is a disadvantage that the inserted catheter is likely to es-cape. 21 ears (73%) of the 29 ears showed symptomatic improvement in our study. In trans-tympanic catheter insertion technique, after the myringotomy with an in-travenous catheter with the bone wax, the patient was inserted into the tympanic portion of the ET, followed by patch repair. 134 ears (82%) of 157 ears reported im-provement in symptoms and were reported to be an easy and effective treatment . In this case, the 18-gauge and 25-mm catheters were cut into 5-mm posterior segments to prevent escape to the nasopharynx, and inserted into the ET via the myringotomy. After confirming the loca-tion of the ET with a 45-degree endoscope it is easy to do.

» 16:50~17:10

» COMBINED FLUOROSCOPIC AND ENDO-SCOPIC EUSTACHIAN TUBE BALLOON DILA-TION SYSTEM


HEAD AND NECK SURGERY, ULSAN UNIVERSITY

HOSPITAL, UNIVERSITY OF ULSAN COLLEGE OF

MEDICINE, ULSAN, KOREA

HONG JU PARK

A tympanostomy with ventilation tube insertion has been for decades the standard treatment for obstructive Eustachian tube (E- tube) dysfunction. Ventilation tubes, however, are prone to crusting, infection, obstruction, and extrusion, and they are associated with permanent tympanic membrane perforation. Since Ockermann and colleagues reported their first experience with endoscopic E-tube balloon dilation in 2010, the procedure has been considered a safe and effective technique for obstructive E-tube dysfunction treatment. Overall success rates of 63%-100% have been reported in studies that have in-cluded more than 11 and fewer than 1,076 E-tubes. One problem, however, is that not the entire balloon cathe-ter can be visualized during endoscopic E-tube balloon dilation. Additionally, guide wires have been considered contraindicated because of the possibility of damage to the ossicles. We recently reported that fluoroscopic E-tube balloon dilation using a flexible guide wire can

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offer the following advantages over conventional endo-scopic E-tube balloon dilation: (a) general anesthesia is not needed; (b) false passage creation is avoided; (c) the location and inflation status of the balloon catheter in the E-tube can be visualized during the procedure; and (d) low balloon pressure induces less pain and is safer than the high balloon pressures used in conventional E-tube balloon dilation. We evaluated the mid-term outcomes of fluoroscopic Eustachian tube (E-tube) balloon dilation using a flexible guide wire in patients with obstructive E-tube dysfunction. From October 2016 to September 2017, we prospectively enrolled adult outpatients with persistent otitis media who were unable to perform the Valsalva maneuver. The analysis included 32 E-tubes from 31 patients (18 women, 13 men; mean age 47 years, range 25-72 years). Participants underwent fluoroscopic E-tube balloon dilation with a 0.035-in. flexible guide wire and a 6 mm by 20 mm balloon catheter. Clinical examinations to check for ability to perform the Valsalva maneuver and otomicroscopy were conducted 1 week, 1 month, 3 months, 12 months, 18 months, and 24 months after the procedure. Balloon dilation was technically successful in all E-tubes. The mean time required for the procedure was 6.9 minutes (range, 5.8-10.3 minutes). The Valsalva maneuver was possible for 25 of 32 of E- tubes (78.1%) 3 months after balloon dilation. During the median fol-low-up of 15.9 months, failure of Valsalva maneuver oc-curred in 4 of 25 improved E-tubes (16%), yielding a 2-year patency rate of 84%. The mid-term fluoroscopic balloon dilation results were encouraging, and using a flexible guide wire for E-tube balloon dilation without the creation of a false passage. The use of fluoroscopy al-lowed us to clearly monitor the location of the guide wire and balloon catheter in the E-tube during the procedure. It also allowed us to monitor the patients' reactions to the passage of the guide wire into the E-tube and to inflation and deflation of the balloon catheter in the E-tube. Con-trary to conventional thought, the flexible guide wire was well tolerated by patients, with no specific damage to the ossicles, tympanic membrane, or inner ear. In conclusion, although further studies are needed, the mid-term results of fluoroscopic balloon dilation were encouraging. The efficacy of endoscopic guided E-tube balloon dilation not using a flexible guide wire, which is a more common-ly used method in a clinical setting, needed to be con-firmed. Randomized controlled study for the efficacy of endoscopic guided E-tube balloon dilation is planned. Furthermore, further treatment modalities should be de-veloped for the unsuccessful cases after the E-tube bal-loon dilation. Multiple trials of E-tube balloon dilation, or biodegradable or drug-eluting stent can be considered

for patients with obstructive E-tube dysfunction who is refractory to the E- tube balloon dilation.

» 17:10~17:30

» CLINICAL ASSESSMENT OF EUSTACHIAN TUBE FUNCTION


EULJI UNIVERSITY COLLEGE OF MEDICINE

HO YUN LEE

Eustachian tube (ET) has three major functions includ-ing atmospheric equalization of middle ear pressure, mucociliary clearance of secretions, and protection of tympanic membrane from nasopharyngeal sounds and secretion. For assessment of ET function, many clinical tests have been introduced. These include questionnaires, various maneuvers such as Valsalva, Toynbee, and sniff. In the past, nine-step method was considered to be a sole technique for evaluating ET function. Sonotubometry as well as tubo-tympano-aerodynamic-graphy (TTAG) has replaced this because these can provide more objective as-sessment. In this session, the basic concept of these novel techniques, how to perform these, and interpretation will be discussed.

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RH-KL 1Room 4-2 (Convention B)

Chair : SAM HYUN KWON

Keynote Lecture I

» 10:30-11:00

» ENDOSCOPIC vERSUS ExTERNAL FRON-TAL SINUS SURgERY: WHEN & HOW

ARISTOTLE UNIVERSITY, GREECE

JANNIS CONSTANTINIDIS

Extended endonasal approaches to the frontal sinus for chronic inflammatory disease should be adopted only af-ter the basic FESS techniques have failed with one excep-tion: a surgically aggressive primary approach is justified in the presence of unfavorable mucosal factors (Aspirin intolerance, allergic fungal sinusitis, ciliary dyskinesias) The median drainage procedure has offered a minimally invasive endonasal approach which seems equally effica-cious to the osteoplastic flap procedure. With regard to medially based mucoceles, this should be the procedure of first choice. The “above and below” approach is an en-donasal procedure combined with a limited trephination. It is indicated in anteriorly and laterally based frontal le-sions which are difficult to address with the median drain-age procedure alone and an osteoplastic procedure is too aggressive to consider. When the frontal sinus pathology dictates an external procedure, the osteoplastic approach is the procedure of choice for a number of reasons: wide exposure of the entire frontal sinus cavity, eradication of pathology and an excellent aesthetic result. In conclusion, the choice of an extended approach to the frontal sinus depends on patient factors, disease factors and availability of surgical expertise.

RH-SP 1Room 4-2 (Convention B)

Chair : SANG HAG LEE, KORNKIAT SNIDVONGS

Recent Perspectives on CRS

» 11:00-11:20

» CHALLENgES IN TREATINg CRS: HOW WILL RESEARCH DEvELOPMENT OF ENDOTYPES AND CLINICAL BIOMARKERS LEAD US

HUDDINGE UNIVERSITY HOSPITAL

PONTUS STIERNA

TBD

» 11:20-11:40

» EOSINOPHILIC CRS IN JAPAN

DEPT. OF OTORHINOLARYNGOLOGY, ST. LUKES

INTERNATIONAL HOSPITAL

KIYOSHI YANAGI

Introduction: Large-scale clinical research was conduct-ed in Japan from 2007 to 2010. This is a study called JESREC study (Japanese Epidemiological Survey of Re-fractory Eosinophilic Chronic Rhinosinusitis Study). As a result, the diagnostic criteria for eosinophilic sinusitis was established, and eosinophilic sinusitis was designated intractable disease. This time I will talk about the history of this eosinophilic sinusitis in Japan, the treatment that is currently being done. I also mentions the reasons for the poor prognosis after surgery. Subjects: 822 cases of chronic sinusitis were performed in our hospital over the past 10 years. Among them was a definite diagnosis of eosinophilic sinusitis JESREC score is 171 cases. Among them, 17 patients underwent re-operation. We conduct-ed the following investigation on 154 patients who did not undergo re-operation and 17 patients who under-went re-operation. Nasal findings, CT findings, number of eosinophils in blood, tissue findings, reasons for per-forming re-operation, administration status of steroids, and prognosis after re-operation were examined. Results:

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About 30% of eosinophilic sinusitis could be controlled by nasal irrigation only after surgery. On the other hand, about 40% required oral steroid administration. About 10% needed re-operation. As a preoperative finding of initial surgery, the ratio of bronchial asthma and the cases with frontal sinus shadow, it was superiorly high. Discus-sion: From this study, it was thought that the combina-tion of bronchial asthma and the severity of the frontal sinus shadow are prognostic predictors. The prognosis of re-operation was good. Therefore, we thought that re-operation should be considered for cases that cannot be controlled after initial surgery. We thought that re-op-eration improved patient's quality of life and reduced the dose of steroid after surgery.

» 11:40-12:00

» NON-EOSINOPHILIC CRS IN KOREA

DEPARTMENT OF OTORHINLARYNGOLOGY

HEAD AND NECK SURGERY, BORAMAE MEDICAL

CENTER, SEOUL NATIONAL UNIVERSITY

DAE WOO KIM

Type 2 inflammation and eosinophilia play an important role in the development of chronic rhinosinusitis with nasal polyp (CRSwNP). Specifically, the degree of mu-cosal eosinophil infiltration in NPs has been revealed as a potent predictor of the outcome of surgeries and a risk of having asthmatic comorbidities. Unlikely to Western countries, non-eosinophilic CRSwNP is more common in Korea. Besides the eosinophils, it has various kinds of inflammatory cells which infiltrate in NP tissues, but the pathological roles of these cells are not yet completely understood. Recently, one study revealed that tissue neu-trophilia in CRSwNP reduced the response to oral corti-costeroid therapy. Other study also showed that IL-36γ/IL-36R pathway may contribute to the development of neutrophilic inflammation and corticosteroid resistance via neutrophils in CRS. Additionally, one study for eo-sinophilic CRSwNP suggested that neutrophils played a pathogenic role in nasal polypogenesis by disrupting ep-ithelial barrier via production oncostatin M. These prior studies supported that CRSwNP had an increased level of tissue neutrophils which may be an important role in nasal polypogenesis. Therefore, in this presentation, the prevalence, endotype, and patho-mechanism of non-eo-sinophilic CRS will be presented based on publications from Korea.

» 12:00-12:20

» DIFFICULT FESS A SURgICAL CHALLENgE

CHIEF CONSULTANT, ENT DEPARTMENT,

IMPULSE HOSPITAL

ALI ZAHEER AL-AMIN

FESS is now the gold standard of treatment of chron-ic rhinosinusits resistant to medical therapy. Over the years the extent of diseases for which we are doing FESS has grossly advanced. We are treating more and more advanced, difficult and resistant cases to deal with this difficult situation at the moment. Revision FESS, Aller-gic Fungal Sinsinusitis, extensive nasal polyposes, antro-choanal polyp arising from the anterior wall of maxillary antrum, childhood nasal polyposes, where Sinus architect has been grossly distorted either by disease itself or by inexperienced surgeon etc are few instances where we face special difficulties while doing FESS now a days. Metic-ulous preoperative history taking, assessment, investiga-tions as well as good anesthetic technique, skilled surgeon and good instrumentations are minimum pre-requisite for dealing with these difficult cases. The author here nar-rated his vast experience dealing with this matter over the last 25 years.


Chair : HWAN JUNG ROH

Keynote Lecture II

» 13:30-14:00

» THE SHIFTINg PARADIgM IN SNORINg AND APNEA

HACETTEPE UNIVERSITY,

FACULTY OF MEDICINE, TURKEY

METIN ONERCI

The research, surgical expertise, and developments in the technology have changed our approach, sometimes com-

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pletely and we experience a shift of paradigm. Some basic information we believed as the final truth in the past now appears to be wrong. As our knowledge increases about the pathogenesis of snoring and apnea, as we learned more about the causes of the disease we perform less inva-sive but more effective surgeries with better results. Sleep apnea surgery has also changed dramatically. We learned that uvula and midpalal mucosa are important structures which should be preserved as much as possible. More radical surgery does not guarantee better results but caus-es more morbidity and more complications after surgery in many cases. Less traumatic surgical approaches with combination treatments if necessary are giving promising results in the treatment of snoring and sleep apnea.

RH-RT 1Room 4-2 (Convention B)

Chair : RAMIZA RAMZA RAMLI, Moderator : SEOK CHAN HONG

Olfaction and Taste Dysfunction: Diagnosis, Treatment and Prognosis

» 14:00-14:10

» DIAgNOSIS OF OLFACTORY DISORDERS

KANGDONG SACRED HEART HOSPITAL,

HALLYM UNIVERSITY

KYU BO KIM

1. Terminology A. Disorders of detection (Quantitative) - Normosmia : normal function - Hyposmia : decreased ability to detect odors - Anosmia : inability to smell - Hy-perosmia : increased ability to detect odors B. Disorders of identification (Qualitative) – “dysosmia” - Parosmia : altered odor perception with odor present - Phantosmia : perception of smell without odor present 2. Etiology 1) URI 2) Sinonasal disease 3) Head injury 4) Aging and dementia 5) Congenital 6) Environmental pollution 7) Neoplasm 8) Psychiatric disorder 9) Drug 10) Operation 11) Idiopathic 3. Diagnosis 1) Thorough history taking 2) Physical examination: Nasal endoscopy, olfactory cleft 3) Radiologic study: PNS CT, MRI, functional MRI 4) Olfactory function test A. Psychophysical method : UPSIT (University of Pennsylvania Smell Identification Test), CC- SIT (Cross-Cultural Smell Identification Test), CCCRC test (Connecticut Chemosensory Clini-

cal Research Center Test), T & T olfactometer, Alinamin test, KVSS test (Korean Version of Sniffin’ Sticks test), YOF test (YSK Olfactory Function test) B. Electrophys-iological method : Electro-olfactogram (EOG), olfacto-ry evoked potential (OEP), magnetoencephalography (MEG) 4. Additional laboratory evaluation

» 14:10-14:20

» EvIDENCE FOR OLFACTORY TRAININg IN THE TREATMENT OF PATIENTS WITH OLFAC-TORY LOSS


HEAD AND NECK SURGERY, SEOUL NATIONAL


BORAMAE MEDICAL CENTER

SEUNG-NO HONG

Approximately 5% of the general population is con-sidered anosmic, and an additional 15% is considered hyposmic. Previous studies have demonstrated reduced quality of life in patients with olfactory dysfunction. Although treatment options for smell loss are limited, regular, structured exposure to odors through olfactory training has been shown to be effective. Contrary to what was thought for a long time, the adult brain exhibits an impressive degree of neural plasticity. Exposure to odors may improve olfactory function and repeated exposure to odors in healthy subjects has been shown to increase olfactory sensitivity. Olfactory training is particularly at-tractive as a therapeutic approach due to its simplicity, low cost, and lack of potential side effects. In this lecture, we are going to overview the current evidence for olfac-tory training in the treatment of patients with olfactory dysfunction disease.

» 14:20-14:30

» OLFACTORY DYSFUNCTION AND AUTOIM-MUNITY


HEAD AND NECK SURGERY, INHA UNIVERSITY

COLLEGE OF MEDICINE

YOUNG HYO KIM


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The olfactory dysfunction is caused by a variety of caus-ative diseases, ranging from anatomical ones such as nasal septal deviation and nasal polyposis, to head injury, aging, infection, neurodegenerative diseases, and medications. However, it is so recent that researchers have begun to discover the link between olfactory dysfunction and the immune system. Shoenfeld and researchers first found that patients with systemic lupus erythematosus had an olfactory dysfunction. These findings were supported by further studies on animal models and by other studies on patients. Other researchers later reported that Sjögren's syndrome, polydermatomyositis, and hereditary an-gioedema are also associated with olfactory dysfunction. The relationship between olfactory dysfunction and au-toimmune diseases is known to be influenced by genet-ic predisposition, environmental effects, and hormones. Therefore, in this lecture, I will review the latest research results on the association between olfactory dysfunction and autoimmune diseases. I will also describe the results of the study to explain the possible pathophysiologic mechanisms to better understand the olfactory dysfunc-tion in patients with several autoimmune diseases.

» 14:30-14:40

» TISSUE INFLAMMATION AND OLFACTORY DYSFUNCTION

UNIVERSITY OF ALABAMA AT BIRMINGHAM

DO-YEON CHO

Olfactory dysfunction affects an estimated 5% of the population, but with the exception of chronic sinusitis, therapeutic options are limited. Patients with smell dis-orders present a distinctive diagnostic and therapeutic quandary to clinicians. The purpose of my talk is 1) to help otorhinolaryngologists understand the possible pathological mechanisms of olfactory disorder in order to educate their patients, 2) to give a summary of beneficial tools, relevant to patients’ findings, and suitable tests to support the diagnosis of smell disorder, and 3) explain the types of therapies available in the United states and possible future therapies. As a potential alternative ap-proach, Holbrook et al. recently published the first report of smell induced through transethmoid electrical stimu-lation of the olfactory bulb . Based on this pilot study, it was possible to induce a sense of smell in 3 of 5 subjects. This opens the door for future exciting research and for a potential therapeutic option. In addition, the role of

tissue inflammation in olfactory dysfunction will also be assessed in this talk.

» 14:40-14:50

» OLFACTORY TESTINg

DEPT OF OTOLARYNGOLOGY-HEAD AND

NECK SURGERY, THE MEDICAL CITY

PETER SIMON JARIN

Patients who have lost or who have decreased smell func-tion will have issues on quality of life. Anosmics and hy-posmics will also be deprived of warning signs in cases of fire and spoiled food. Olfactory disorders present a unique diagnostic and management dilemma.A discus-sion on the different ways to test the sense of smell will provide the otolaryngologist with the tools that can be offered to these patients suffering with this devastating problem. Some of the different smell tests described in literature are commercially available and can be easily used in the office as an option for further qualifying and quantifying olfaction either for purposes of documenta-tion and monitoring.

RH-SP 2Room 3-2 (Emerald B)

Chair : HUN-JONG DHONG, TE-HUEI YEH

Challenges in Sphenoid Sinus Surgery

» 14:00-14:15

» BASICS OF SPHENOID SINUS SURgERY: ANATOMY SURROUNDINg SPHENOID SINUS

DEPARTMENT OF OTORHINOLARYNGOLOGY

- HEAD AND NECK SURGERY, SAMSUNG

CHANGWON HOSPITAL SUNGKYUNKWAN

UNIVERSITY SCHOOL OF MEDICINE

YONG GI JUNG

The sphenoid sinus is the most posterior paranasal sinus. The sphenoid sinuses are paired spaces formed within the

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body of the sphenoid bone, communicating with the na-sal cavity via the sphenoethmoidal recess in its anterior wall. The two sinuses are separated by a septum which may or may not be in the midline. There are a number of ridges and depressions related to closely adjacent struc-tures in the sinus. These can include the pituitary gland, optic nerve, internal carotid artery, maxillary nerve, and vidian nerve. The sphenoid sinus is adjacent to several major structures in the vicinity. It is separated superiorly with anterior cranial fossa by planum sphenoidale, and posteriorly with posterior fossa by clivus. Sella turcica is located at postero-superior part of sphenoid sinus. There are a cavernous sinus and internal carotid artery at lateral part of the sinus. In some cases, the foramen rotundum protrudes into the sphenoid sinus. As mentioned above, the anatomical structure surrounding the sphenoid sinus is very complex. Since most textbooks and journals only provide two- dimensional images and illustrations, it is very difficult to understand these two-dimensional imag-es as the real three-dimension structure. Recently, various techniques have been developed to reconstruct three- dimensionally anatomical structures by reconstructing computed tomography or MRI images three-dimension-ally. Through this lecture, we will investigate the anatom-ical structure around the sphenoid sinus through various imaging approaches.

» 14:15-14:35

» PITFALLS AND TIPS FOR SPHENOIDOTOMY

ST. LUKES MEDICAL CENTER

BENJAMIN SAN AGUSTIN

Because of its location deep into the mid portion of the cranium with its associated optic nerve and internal ca-rotid artery (risk of blindness and exsanguination), the sphenoid sinus is often avoided by inexperienced sur-geons. We will review the approaches to this sinus and offer tips on evaluating anatomic variations that can lead to difficult sphenoidotomy. Regardless of the approach used, the surgical objectives remain to be to open the si-nus at its natural osmium, remove mucus, debris or tu-mor allowing adequate drainage and ventilation. Endo-scopic techniques through the years have been mastered and a variety of approaches can be safely and successfully achieved. Outcomes of the procedure should include minimal complications resulting in long term patency.

» 14:35-14:50

» ISOLATED SPHENOID SINUS LESIONS


DANKOOK UNIVERSITY COLLEGE OF MEDICINE

JI-HUN MO

Isolated sphenoid sinus lesion (ISSL) is a rare clinical disease entity, and the incidence has been reported be-tween 1% and 3% among patients with paranasal sinus disease1-3. The deep location of the sphenoid sinus is suggested to make it less accessible to infectious agents.2 However, there are many vital structures, including the middle cranial fossa, optic nerve and chiasm, cavernous sinuses, and cranial nerves adjacent to the sphenoid sinus. The sphenoid sinus is anatomically in close relationship with the brain, meninges, optic nerve, internal carotid artery (ICA), cavernous sinus, and cranial nerve (oculo-motor, trochlear, ophthalmic, and maxillary branches of the trigeminal nerve and abducens). Therefore, neglected sphenoid sinus disease may lead to serious complications. Inflammatory and neoplastic processes may affect the sphenoid sinus. A sphenoid sinus disease is difficult to di-agnose with history and physical examination due to the anatomical location of the sphenoid sinus. The signs and symptoms associated with isolated sphenoid sinus disease may be unclear and nonspecific.⁴ The most common pre-senting symptom of patients with isolated sphenoid sinus disease is headache, which is reported in 70%-90% of patients. An meta-analysis of 1133 cases of ISSL showed that the underlying pathologies were classified as chronic rhinosinusitis without nasal polyps (CRSsNP) (28.3%), mucoceles (20.3%), fungal sinusitis (12.5%), malignant neoplasms (7.7%), intracranial lesions (7.0%), benign neoplasms (5.7%), chronic rhinosinusitis with nasal polyps (CRSwNP) (3.4%), and other lesions (4.7%). 5 Cranial neuropathies were present in 16.3% (95% confi-dence interval [CI], 10.1- 22.5%) of ISSL patients. A favorable surgical complication rate of 1.5% (95% CI, −0.1% to 3.2%) was found in patients undergoing sur-gery for an ISSL. In this lecture, clinical characteristics and management of ISSL will be discussed in detail with some representative cases. References1. Hnatuk LA, Macdonald RE, Papsin BC. Isolated

sphenoid sinusitis: the Toronto Hospital for Sick Children experience and review of the literature. J Otolaryngol. 1994;23(1):36-41.


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2. Lawson W, Reino AJ. Isolated sphenoid sinus disease: an analysis of 132 cases. Laryngoscope. 1997;107(12 Pt 1):1590-5.

3. Metson R, Gliklich RE. Endoscopic treatment of sphenoid sinusitis. Otolaryngol Head Neck Surg. 1996;114(6):736-44.

4. Ng YH, Sethi DS. Isolated sphenoid sinus disease: differential diagnosis and management. Current opinion in otolaryngology & head and neck surgery. 2011;19(1):16-20.

5. Moss WJ, Finegersh A, Jafari A, et al. Isolated sphe-noid sinus opacifications: a systematic review and me-ta-analysis. Int Forum Allergy Rhinol. 2017;XX:1-6.

» 14:50-15:10

» COMPLICATIONS OF SPHENOID SINUS SUR-gERY AND ITS MANAgEMENT

DEP. OTOLARYNGOLOGY,

NATIONAL TAIWAN UNIV. HOSP.

TE-HUEI YEH

Isolated sphenoid sinus disease is rare with mild initial symptoms and easily to be neglected, leading to delayed diagnosis and treatment, and may result in serious com-plications. Our study mainly investigates the causes and surgical treatment of isolated sphenoid sinus disease in National Taiwan University Hospital in the past 6 years. The medical records of the isolated sphenoid sinus disease were reviewed for a total of 6 years from February 2013 to February 2019. A total of 31 patients were recruited and underwent trans-ethmoidal sphenoidectomy. Among them, there were 19 cases of non-invasive fungal sinusitis, 3 cases of chronic bacterial sinusitis, 3 cases of sponta-neous CSF leakage, 2 cases of inverted papilloma, 1 case of mucocele, 1 case of seromucinous harmatoma, 1 case of pituitary adenoma and 1 case of squamous cell carci-noma. In cases of fungal sinusitis and mucocele, 4 cases with confirmed preoperative neurological symptoms (i.e. blurred vision, diplopia or trigeminal nerve palsy). There is one case with postoperative septic shock. One case of spontaneous cerebrospinal fluid rhinorrhea complicated with postoperative encephalitis and meningitis. Isolated sphenoid sinus disease has a variety of pathological caus-es, of which fungal sinusitis is the most common one in our group. Endoscopic trans-ethmoidal sphenoidectomy is an effective and safe surgical procedure for the treat-ment of isolated sphenoid sinus disorders. Because the

sphenoid sinus is anatomically close to important struc-tures, we need to be more cautious in the treatment of isolated sphenoid sinus disease.

» 15:10-15:25

» ExTENDED APPROACHES BEYOND SPHE-NOID SINUS


HEAD AND NECK SURGERY, ASAN MEDICAL

CENTER, UNIVERSITY OF ULSAN

COLLEGE OF MEDICINE

JI HEUI KIM

The sphenoid sinuses are located within the body of the sphenoid bones and bounded superiorly and posteriorly by the skull base. The sphenoid sinuses are affected by not only sinus diseases including rhinosinusitis, mucoceles, and neoplasms but also extrinsic lesions, such as bony dehiscence of the skull base, encephaloceles, and brain le-sions. Although not directly involved, the sphenoid sinus is an important anatomical gateway for surgery on the in-tracranial structures. I show my experience with extended approaches beyond sphenoid sinus.

RH-MOS 1Room 4-2 (Convention B)

Chair : Chair : CEMAL CINGI, Moderator : Chase Lay

My Philosophy of Rhinoplasty

» 15:50-16:15

» ENDONASAL AESTHETIC AND FUNCTIONAL STRUCTURE RHINOPLASTY

DEPT OTOLARYNGOLOGY, TAICHUNG VETERANS

GENERAL HOSPITAL

CHIH-WEN TWU

Aesthetic and functional improvement in rhinoplasty can be achieved by surgical access to the nasal frame-work with or without visible incisions made outside the

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nostrils. Making a choice between external (open) and endonasal (closed) incision is usually the first step in sur-gical planning. The advantages of endonasal rhinoplasty include gaining better acceptance from the patients, mak-ing targeted improvements without taking the nose apart, preserving the nasal tip soft tissue support, decreasing the postoperative edema, and preventing the potential scar-ring and keloid formation. However, because the limited exposure of the surgical field in endonasal rhinoplasty may lead to improper correction of nasal framework and result in further complications, only surgeons with much experience and skilled techniques are capable of perform-ing structural endonasal procedures. Meanwhile, com-mon thick skin of Asian patients make endonasal rhino-plasty even more difficult. Therefore, thorough physical examination and facial analysis, precise diagnosis, careful surgical planning, as well as meticulous execution of sur-gical procedures are mandatory for endonasal rhinoplasty.

» 16:15-16:40

» ENDONASAL RHINOPLASTY

ESKISEHIR OSMANGAZI UNIV.

MEDICAL FACULTY, ENT DEP., TURKEY

CEMAL CINGI

Rhinoplasty is a procedure, that aims to improve the function and aesthetic of the nose concomitantly. As we always respect the tissues, we aim to reach our goal with less trauma in all surgical interventions. The endonasal approach has the advantage of improving the nose with less trauma. Limited dissection to only the parts that need to alter and easier fixation of grafts precisely are also im-portant features of this approach. Fewer dissection yields to less trauma and faster recovery by preserving the vascu-lar structures. Minimal postoperative swelling and short-er recovery period are other benefits of this approach. The comfort of telling the patient that there won\'t be any incision and scar on their columella brings the surgeon serenity. Preserving the tip support is also crucial in most of the cases. This approach also increases the stress of fix-ating all dissected parts securely. It permits the placement of grafts easier without the risk of displacement. Less ede-ma and faster postoperative appearance of the final result is another superiority of this method. Less maneuver and less operation time may also advantageous in some cases. Only asymmetric tips and twisted noses will be corrected easier and more precisely in the open approach. So the

best formula will be to learn both approaches but prefer the endonasal approach as much as possible.

» 16:40-17:00

» MY PHILOSOPHY IN PRIMARY AESTHETIC RHINOPLASTY OF ASIAN

DR JINS PREMIUM NOSE CLINIC

HONG RYUL JIN

The speaker’s key words for primary aesthetic rhinoplas-ty are: natural looking nose, autogenous materials, less is more, form and function, and pursuit of perfection. I strive to give my rhinoplasty patients a nose that is natu-ral, enhances one’s beauty and yet is in perfect harmony with the rest of the face. For this, an artistic sense of bal-ancing new elevated dorsum and the tip with the rest of face is required. There is no fixed standard procedure to my technique nor a pre-set aesthetic standard. Every sur-gery is specifically tailored to the patients’ requirements to achieve a natural result. Materials to work with are always a big issue in Asian rhinoplasty. In many cases, “autologous cartilages” are used with the same excellent result compared to alloplastic implant on the dorsum. In my practice, alloplastic materials for dorsal augmentation are always a last choice. In cases of alloplastic use, it is used only for dorsal augmentation and in any case, the tip work is accomplished with autologous cartilage to min-imize the risk of extrusion or infection of the implant at the tip. Having revised so many complication cases due to foreign materials on the nose, the author know the val-ue of using one’s own tissue in rhinoplasty. A know-how for ensuring the successful application of autogenous ma-terials in Asian rhinoplasty learned through 25 years of experience will be presented. “Less is more” summarizes my personal approach to rhinoplasty. This minimalist ap-proach is an invaluable lesson learned from decades of experience and thousands of patients. Doing less actu-ally gives patients a lot more. Minimizing the excision of supporting structures such as cartilage as well as soft tissue support and keeping the number of procedures to only what is necessary do less harm to the nose but means more effective surgery. I believe that “form and function” go hand in hand and are of equal importance like the bal-ance of Yin and Yang. A lot of patients want not only an aesthetically pleasing nose but also to be relieved of their breathing problems. I believe that in managing these cas-es, creating a well breathing and an aesthetically pleasing


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nose are issues of equal importance. I unceasingly remain devoted to doing my best at every step of the way, from the initial consultation to the after care. This “pursuit of perfection” comes from a concentration borne out of a genuine enjoyment of my rhinoplasty work, from physi-cal and mental fitness, and an attitude of humility and a yearning for continuous learn

» 17:00-17:20

» CREATINg A PROMINENT TIP AND NASAL BRIDgE

DEPT OF OTOLARYNGOLOGY, ASAN MEDICAL

CENTER, UNIV OF ULSAN COLLEGE OF MEDICINE

YONG JU JANG

The Asian noses are characterized by under projected na-sal tip and low nasal bridge. In order to achieve aesthet-ically pleasing rhinoplasty result, significant changes in the tip and dorsal height need to be made. I prefer to augment the nasal tip by using a septal extension graft with or without nasal tip grafting. In thick-skinned in-dividual, placement of tip grafting is required in most cases. After acquiring the desired tip height, dorsal aug-mentation should be done to match the new height of the nasal tip. The material of choice for my rhinoplasty is autologous costal cartilage for septal work and dorsal aug-mentation. When I don't need major augmentation, my choice of grafting materials are septal cartilage or ear car-tilage. Dorsal augmentation is usually done using diced cartilage glued with fibrin glue. Glue diced cartilage is covered with perichondrium or fascia in order to prevent pebbling deformity.

» 17:20-17:40

» WHAT AM I DOINg TODAY IN RHINOPLASTY AND WHY?

DEPT OF ORL-HNS AT KYUNG HEE UNIV

HOSPITAL AT GANGDONG

KUN HEE LEE

I like to show my preferred technique of bony vault and tip contouring in this presentation. Based on thorough preoperative analysis I will demonstrate what am I doing today which I did not do in the past. This is not intended

to teach how to perform primary or revision Asian rhino-plasty but rather to outline fundamental principles that need to be considered.


Chair : JIN HEE CHO, KIMIHIRO OKUBO

Recent Updates on Allergic Rhinitis

» 15:50-16:20

» ROLE OF vITAMIN D IN ALLERgIC RHINITIS



UNIVERSITY BUNDANG HOSPITAL, SEONGNAM,

KOREA MUSIC AND AUDIO RESEARCH GROUP,

GRADUATE SCHOOL OF CONVERGENCE

SCIENCE AND TECHNOLOGY, SEOUL NATIONAL

UNIVERSITY, SUWON, KOREA

SUNG-WOO CHO

Vitamin D, originally known to be a key regulator of cal-cium homeostasis, recently has been discovered as a po-tent immune modulator with a broad spectrum of effects. The action of vitamin D is mediated through the vitamin D receptor (VDR) located in the cytoplasm, and virtu-ally all immune cells are known to express VDR. Previ-ous studies have shown that vitamin D affects T cells, B cells, monocytes, and macrophages. It also regulates the activity of dendritic cells (DCs), which are key immune system cells. Vitamin D blocks the differentiation and maturation of DCs from monocytes and downregulates the expression of co-stimulatory molecules, including CD80, CD83, and CD86. The downregulation of these co-stimulatory molecules reduces T cell activation, there-by leading to immune tolerance. Despite many in-vitro and in-vivo studies showed immunomodulatory effects of vitamin D in the pathogenesis of allergic disease, still, clinical evidences are less convincing. A deficiency in the serum level of vitamin D may contribute to the develop-ment of Th2-skewed respiratory diseases, such as asth-ma and allergic rhinitis. However, low vitamin D levels have been shown to be associated with atopic dermatitis

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rather than allergic rhinitis, asthma, or IgE sensitization. Although results of previous epidemiological studies are controversial, they indicate some association between serum vitamin D and Th2-mediated allergic diseases. In significant proportion of general population, vitamin D is lacking. However, replacement of vitamin D can be easily done by increasing sun light exposure and oral up-take. From this perspective, vitamin D possess a lot of clinical interest considering its’ immunomodulatory ef-fect in allergic disease and that it can be easily corrected.

» 16:20-16:50

» ROLE OF MICROBIOME IN PATHOPHYSIOL-OgY OF AR


HEAD AND NECK SURGERY, HANYANG

UNIVERSITY COLLEGE OF MEDICINE

SEOK HYUN CHO

At the late 1880s, Robert Koch discovered bacterial pathogens such as tuberculosis, cholera, and anthrax, and then, Koch's postulates and germ theory have been claimed. Medical doctors have been trying to find and eradicate pathogens with the use of antibiotics for nearly 100 years. Hygiene hypothesis has been claimed by Stra-chan at 1989 and metagenomics has recently been devel-oped to support the hygiene hypothesis. Therefore, the traditional paradigm of the so-called pathogen is gradual-ly collapsing. The number of microbiomes that constitute the human body varies depending on the study, but it is reported to be equal to or at least 10 times that of the human body cells, and it has a very beneficial function to the human body such as metabolic function, devel-opment of the immune system, and mucous membrane protection. Recently, there have been many studies on the relationship between the changes of microbiome and allergic diseases, in which various variables (genetics, pre-natal exposures, diet, delivery method, feeding method, antibiotics, housing condition, family structure, and sea-son) are involved. As these changes in human microbes occur at a young age, allergies can increase. Although the causes of chronic airway diseases such as asthma, sinus-itis and rhinitis and atopic dermatitis, are not yet well understood, the dysbiosis is considered an important factor. Studies using germ free animal model showed no generation of systemic immune regulatory networks and increased allergic and autoimmune diseases. Reduction of

microbial diversity was a very important factor for these phenomenon. There are few studies of microbial chang-es in allergic rhinitis, compared with atopic dermatitis, asthma, and sinusitis. Chiu et al reported an increase in Proteobacteria in allergic rhinitis, while Hyun et al re-ported that the increase in S. aureus in the inferior turbi-nate of allergic rhinitis patients and the decrease in P. acne were related to the generation of systemic total IgE. So far, there are not many studies of microbiome in the field of allergic rhinitis. As a result of my experience, I know that individual heterogeneity and sampling error (con-tamination) are the major limitations in the study on the microbiome. I also hope that the mechanism of host-en-vironmental interaction will be elucidated by studying not only changes in composition but also its functional analysis and its effect on human immunity.

» 16:50-17:20

» CLINICAL TRIAL FOR ALLERgIC RHINITIS WITH OHIO CHAMBER

NIPPON MEDICAL SCHOOL

KIMIHIRO OKUBO

A pollen exposure chamber (AEC), OHIO Chamber was built in 2005 at central Tokyo, Japan, in order to study seasonal allergic rhinitis (SAR), especially for Jap-anese cedar pollinosis. Since satisfactory outcomes were obtained from the controlled pollen exposure at OHIO chamber, we conducted some studies in volunteers with SAR. Usually volunteers were challenged with JC pollen in the OHIO chamber for 3 hours. Total nasal symptom scores (TNSSs) were recorded every 30 minutes during the exposure. The symptoms were increased after start-ing exposure of JC pollens, 8000 grains per cubic meter, and reach to plateau 90 min after exposure. The clini-cal trials using OHIO chamber were done for analysis of the efficacy of anti-histamine, anti-leukotrien, and topi-cal steroid. Each pharmacotherapies have enough effects than placebo. And the better effect was revealed combi-nation anti-histamine and topical steroid than anti-hista-mine monotherapy. A pollen exposure chamber (AEC), OHIO Chamber is good tool for evaluate the therapeutic approach of allergic rhinitis, especially pollinosis. In next step, we have plan to expose dust mite in near future..


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» 17:20-17:50

» NEW HORIzONS FOR TREATMENT OF AR: BIOLOgICS, COMBINATION DRUgS

ST. LUKS MEDICAL CENTER

BENJAMIN SAN AGUSTIN

Biologic agents(also termed biologicals or biologics) are therapeutics that are synthesised by living organisms and directed against a specific determinant. Because treat-ment becomes very selective, they are used for person-alised or precision medicine. We will present an overview of biologicals used in allergic rhinitis and their target cytokines or receptor sites. We will review specific bio-logicals particularly those that have undergone Phase 1 (safety, side effects, best dose, timing of treatment) and Phase 2 (effectiveness, short term adverse effects, associ-ated risks) studies for allergic rhinitis particularly Omali-zumab, Quilizumab, VAK694, QAX576, among others. We will also give some focus on the new ARIA guidelines and the consensus on the use of combinations drugs to effectively manage moderate to severe symptoms. Com-parison of single drugs regimen versus mixed drugs will be presented.

April26(Fri)




HN-KL 1Room 4-3 (Convention C)

Chair : EUN CHANG CHOI

Keynote Lecture I

» 10:30-11:00

» HPv IN HEAD AND NECK CANCER EUROPE-AN PERSPECTIvES

CHAIR OF THE DEPARTMENT OF HEAD AND NECK

SURGERY POZNAN UNIVERSITY OF

MEDICAL SCIENCES THE GREATER

POLAND CANCER CENTRE

WOJCIECH GOlUSINSKI

The HPV is a proven causative factor of a subset of head and neck tumors. The incidence of attributable fraction of oropharyngeal tumors is increasing worldwide, howev-er significantly differs in certain geographical locations. It has been evident that determination of the HPV status is mandatory in everyday practice and gold standard de-tection techniques have been determined. The immuno-histochemical staining for p16 widely used a surrogate marker for infection became a key determinant in new TNM8 system, however a year after its introduction still remains controversial mainly due to inadequate specifici-ty of sole p16 positivity. The initial data of better progno-sis in HPV positive OPC has raised important question of de-escalation possibilities of treatment HPV positive tumors in terms longer life expectancies and better qual-ity of life. Recent year has brought more evidence from clinical trials, clearly showing that the issue is more com-plex and shift in treatment is still questionable. There is a need for further prospective trials with better determi-nation of the low risk group within HPV positive OPC population suitable for the de-escalation strategies. The developments in robotic surgery made it an import-ant modality in treatment of the HPV positive tumors. Therefore, there is a need of involving surgical procedures to the trials. The talk outlines current knowledge on HPV epidemiology, new evidence and current trials in HPV positive OPC tumors with a special focus of novel robotic surgical modalities.

HN-MOS 1Room 4-3 (Convention C)

Chair : SOON YUHL NAM, Moderator : SE-HEON KIM

Tips and Pitfalls in Surgical Management for Laryngopharyngeal Cancer

» 11:15-11:30

» TRANSORAL ROBOTIC SURgERY FOR ORO-PHARYNgEAL CANCER

YONSEI UNIV.

SE-HEON KIM

TBD

» 11:30-11:45

» OPEN CONSERvATION SURgERY FOR LA-RYNgEAL CANCER

DEPARTMENT OF OTOLARYNGOLOGY-HEAD AND

NECK SURGERY, THE CATHOLIC UNIVERSITY OF

KOREA, COLLEGE OF MEDICINE, SEOUL, KOREA

KWANG-JAE CHO

Laryngeal preservation surgery encompassing from trans-oral endoscopic procedure to open partial surgery have been reported to demonstrate promising oncologic and functional results by completely removing the primary tumors with an adequate margin while preserving the laryngeal function and improving QOL. The frequency of performing conservation laryngeal surgery has been increasing for last two decades compared to chemora-diation therapy due to the generalized practice of endo-scopic surgery using laser or robot for early and mod-erately-advanced laryngeal cancers and introduction of supracricoid laryngectomy (SCL) for locally-advanced laryngeal cancers. Currently, Conventional partial lar-yngectomy has been supplanted for many early-stage lesions by TLS, and for more advanced stages by SCL. The success or failure of conservative laryngeal surgery is dependent upon the optimal selection of patients; the most important criterion is the extent of tumor invasion. However, despite recent imaging advancements, prima-

April 26(Fri) Head & Neck Surgery

April26(Fri)



ry tumor extent cannot be determined pre-operatively in some cases, particularly in patients with advanced laryn-geal cancer with paraglottic space (PGS), pre-epiglottic space (PES), or thyroid cartilage (TC) infiltration. These shortcomings can cause T-stage understaging and lead to the adoption of a partial laryngectomy, an inadequate resection margin, and surgical failure due to local recur-rence. The oncologic purpose of SCL is to completely re-move TC, PGS, and PES that cannot be resected during a conventional partial laryngectomy, and to achieve a local control rate that is similar to that of a total laryngectomy. Nowadays, the concept of laryngeal preservation is need-ed to be reinterpreted or sufficiently clarified. “Keeping in place the larynx whether it is still functioning or not” versus “Preserving the function whether the larynx is en-tirely preserved or not”

» 11:45-12:00

» ENDOSCOPICALLY-ASSOCIATED SURgICAL TREATMENT OF CHRONIC ODONTOgENIC MAxILLARY SINUSITIS

DEP. OF MAXILLOFACIAL SURGERY, PAVLOV

FIRST SAINT PETERSBURG STATE

MEDICAL UNIVERSITY

ANDREI I. IAREMENKO

Background: The maxillary sinuses are the most im-portant paranasal sinuses in dentistry and maxillofacial surgery due to their proximity to the roots of upper dentition. The literature shows that the oroantral fistula (OAF) was the most common etiology of odontogenic sinusitis. OAF was the most common cause of odonto-genic maxillary sinusitis among all dental etiologies. The treatment of chronic and recurrent maxillary sinusitis has been changed in recent years. The radical Caldwell-Luc approach has increasingly been replaced by more conser-vative functional endoscopic sinus surgery (FESS). In our study, we observed the advantages of FESS in treatment of chronic odontogenic sinusitis. Methods: In our study, we conducted assessment of patients with chronic odon-togenic sinusitis in the Department of Maxillo-facial surgery and in the department of Otorhinolaringology of the First Pavlove State Medical University. Data on severity of symptoms, endoscopy, and coronal CT scan findings, as well as intraoperative course and complica-tions, were recorded. Surgical treatment consists of one of the following procedures: FESS; intraoral approach to

the sinus with Caldwell- Luc technique; and oroantral fistula closure with a local flap, alone or combined with FESS. Results: All OAF healed uneventfully. All patients reported improvement in severity of sinusitis symptoms, which was confirmed through results of clinical exam-inations and control CT scans. Conclusion: Dental eti-ologies are responsible for about 10 - 40% of maxillary sinusitis, and OAF may be the most common cause of all. Results of our study indicate that FESS, combined with OAF closure by local flap (if it is nessery), might be an effective and safe option for treatment of chronic odonto-genic sinusitis. Advantages of FESS are the less invasivity, the preservation of sinus anatomy and physiology, the re-duction of recovery time. Dentists and maxillofacial sur-geons must consider dental factors as important causes.

» 12:00-12:15

» R E C O N S T R U C T I v E S U R g E R Y F O R PHARYNgOESOPHAgEAL DEFECTS



UNIVERSITY COLLEGE OF MEDICINE, SEOUL

NATIONAL UNIVERSITY HOSPITAL

SOON-HYUN AHN

Total laryngectomy and partial or total pharyngectomy with reconstruction is main stay of surgical treatment for advanced hypopharyngeal cancer. Due to the increased use of concurrent chemoradiotherapy as the first treat-ment modality in laryngo-hypopharyngeal cancer requir-ing total laryngectomy, this kind of surgery is performed in salvage setting after failure of chemoradiation therapy and the postoperative complication risk is increased than before. The selection of flap depends on the setting of each institution. In department where thoracic surgeon co-works, visceral flap including jejunum or gastric pull up may be the main modality. However, if the reconstruc-tion is performed by head and neck surgeon by himself, using tubed fasciocutaneous flap is easier and safer way. In my hands, anterolateral thigh flap is choice because larger skin paddle could be made than radial forearm flap and the thickness of flap can reduce the fistula forma-tion. To reduce the complication like fistula, minimizing the dead space around suture line and making the lower esophageal anastomosis as wide as possible to reduce the pressure is key procedure. To make secure healing of su-tured lines in cervical esophagus, forming complete ad-

April26(Fri)




hesion with overlying skin and surrounding soft tissue is necessary and prevention of dead space is important, especially at the lower anastomosis suture site. Therefore, saving healthy soft tissue and placing negative drain ap-propriately is important for fast recovery.

HN-SP 1Room 3-3 (Diamond)

Chair : SHENG-PO HAO, SOON YOUNG KWON

Evidence-based Management of Oral Cancer

» 11:00-11:15

» WHICH APPROACH IS APPROPRIATE FOR ORAL CANCER

DEPARTMENT OF OTOLARYNGOLOGY HEAD

AND NECK SURGERY,SHIN KONG WU HO-SU

MEMORIAL HOSPITAL, TAIWAN

SHENG-PO HAO

Oral cancer is a common head and neck cancer in Asia-Oceania region, especially in Taiwan. The surgical approach to oral cavity cancer should be tailored accord-ing to the site of involvement, tumor size, and the pres-ence of truismus or not. The possible approaches ranges from per os, labiotomy, mandibulotomy/mandibulecto-my, pull through and lateral pharyngotomy. However, there is a paradigm shift from open to endoscopic ap-proach for oral cavity cancer in nowadays, trying to pre-serve patients’ function and cosmetics, but still pursuing oncologically sound resection.

» 11:15-11:30

» WHAT IS THE ADEQUATE RESECTION MAR-gIN FOR ORAL CANCER

DEPARTMENT OF OHNS, CATHOLIC KWANDONG

UNIVERSITY INTERNATIONAL

ST MARYS HOSPITAL

HYUN JUN HONG

Surgery is the main treatment modality for management of oral malignancies. One of the most critical issues is achieving complete removal of tumor at primary site. The “adequate surgical margin” has always been one of controversy in practice of head and neck area. Definition of resection margin The UK Royal College of Patholo-gists issued guidelines and a minimum dataset for head and neck carcinomas in 1998 in an attempt to improve and standardize cancer services. The Guidelines divided the surgical margins into ‘‘mucosal’’ and ‘‘deep’’ and in each category, defined a histological distance from inva-sive carcinoma to surgical margins of more than 5 mm as clear, 1–5 as close and less than 1 mm as involved. Involved cases may, or may not, show histological cut-through. However, using a unique definition of close for every subsite of head and neck is probably inappropriate, since every district has different characteristics in terms of lymphatic drainage, vascularization, and presence of biologic barriers (e.g. cartilage, bones, fascia). Actually, AJCC and UICC guidelines focus their attention on involved margins, while NCCN, ASCO, and IEO guide-lines define R close as < 5 mm without any distinction for anatomical subsite. How to get adequate surgical Margins There are several techniques to improve the as-sessment of the marginal extent of the tumor front and subsequently the adequacy of the excision of the primary tumor. Table 1. Methods for evaluation of surgical mar-gins I. Preoperative assessment 1. Vital tissue staining 2. Fluorescent visualization II. Intraoperative assessment 1. Thickness of resected margins 2. Frozen section analysis 3. Touch imprint cytology (TIC) 4. Microendoscope 5. Optical coherence tomography III. Postoperative assess-ment 1. Moh’s Microsurgery a. Frozen technique (Intra-op.) b. Formalin technique (Postop.) 2. Ultrasonography 3. Molecular assessment 4. Gene signature However, the procedures within Table 1 are acceptable for identifica-tion of mucosal or superficial margins. Involved deep margins (higher incidence) are more of a problem than involved mucosal margin (lower incidence) and anatom-ical restraints are more likely to affect the deep margins. Therefore, surgeons are more likely to encounter difficul-ties in achieving adequate margins for deep connective tissue planes as compared with mucosal margins. Only relatively reliable method is to get the detailed estima-tion of tumor depth from various radiologic imaging such as CT/MRI and subsequently to resect tumors with sufficient surgical margins based on tumor invasion in-formation acquired from the imaging. Conclusion The presence of tumor at the resection margin, and close to the resection margin should be considered separately with respect to prognostic significance. Especially, Intra-


April26(Fri)



operative assessment of resection margins needs to em-phasize involvement and proximity of tumor to the deep resection margin. The status of the surgical resection is an important predictor of outcome for both local recurrence and overall survival in oral cancer.

» 11:30-11:45

» APPROPRIATE MANAgEMENT OF NECK NODES IN ORAL CANCER

SENIOR CONSULTANT H & N SURGERY, HOD

DEPT. OF SURGICAL ONCOLOGY, DIRECTOR HCG

CANCER CENTER, AHMEDABAD, INDIA

RAJENDRA B TOPRANI

Oral Cancer is a Global Problem Neck Node Metasta-sis is a single most important prognostic factor in Oral Cancer. Management of N0 Neck in early Oral Cancer (T1,T2) is debatable and people are using various inves-tigative modalities like USG guided FNAC from neck node,Sentinel Lymphnode biopsy, CT Scan / MRI / PET CT,etc. to decide for or against doing Elective Neck Node Dissection (END). The current recommendation is to do END even in Early Oral Cancer (T1,T2). Modified Radical Neck Dissection (Level I, II, III, IV, V) is the standard of care in Node Positive patients but Selective Node Dissection (SND) can be done in select group of patients with better functional outcomes. Robotic Neck Dissection offers superior cosmesis compared to tradi-tional open neck dissection.

» 11:45-12:00

» WHAT ARE THE APPROPRIATE RECON-STRUCTION METHODS FOR ORAL CANCER DEFECT

DEPARTMEN OF OTOLARYNGOLOGY

HEAD & NECK SURGERY,

RAJAVITHI HOSPITAL, BANGKOK,

PHAKDEE SANNIKORN

Reconstruction after oral cancer resections should aim at maintaining the functional integrity of the different structures of the oral cavity. The tissue requirement are combination of soft tissue and the skeletal framework

that needs to be reconstructed. The reconstructive lad-der starting from skin grafts and ending with free flaps may not always be able to be followed due to anatomical and functional requirements of the defects. Skin grafts may be useful in only select cases and defects such as the small and shallow defects in the floor of the mouth or cheek. Local flaps such as nasolabial flaps provide thin, reliable skin tissue suitable for repairing, only again, in small defects. The pedicle flaps commonly used for oral reconstruction include a pectoralis major myocutaneous (PMM) flap, forehand flap , platysma myocutaneous flaps and skin flaps like a deltopectoral (DP) flap. Micro-vascular free flaps have allowed great flexibility to the re-constructive surgeon to import composite tissues match-ing the requirements at the site better than other methods and have become the method of choice in a great number of defects. This becomes more significant in reconstruc-tion of bony defects. Unfortunately not every patient is an ideal candidate for a microvascular reconstructive procedure and it is also true that not every defect strict-ly requires a free flap transfer to achieve good functional results. Nowadays the head and neck surgeon is more and more dealing with elderly patients suffering from severe comorbidities, with pre-treated patients presenting with a persistent/recurrent disease requiring salvage surgery, or with patients developing second primary tumors. In these circumstances free flap surgery, with its prolonged anes-thesia times and with the need of finding adequate recipi-ent vessels in previously operated and radiated necks may rise serious concerns. The surgeon, therefore, must not be extravagant in the application of advanced reconstructive techniques and must always carefully evaluate the general status and regional anatomy of each patient, in order to adopt and propose the most pertinent solution among multiple techniques. In this scenario, at our Institution, pedicled regional flaps still represent a valid alternative to free flaps for patients considered to be suboptimal for microvascular reconstruction

» 12:00-12:15

» COMPARTMENTAL SURgERY FOR CANCER OF THE MOBILE TONgUE AND FLOOR OF MOUTH ONCOLOgIC AND FUNCTIONAL RE-SULTS

DEP. OF OTORHINOLARYNGOLOGY - HEAD AND

NECK SURGERY, UNIV. OF BRESCIA

PIERO NICOLAI

April26(Fri)




Treatment strategies for locally advanced tongue and floor of mouth cancer have not substantially changed in the last decades, and include surgery followed by adjuvant (chemo)- radiotherapy. The standard surgical approach traditionally consists in wide surgical excision within 1-1.5 cm of macroscopically healthy margins around the lesion. However, there is no consensus on the amount of tissue that could be considered as a “safe margin”. Furthermore, local and locoregional recurrence rates remain non-negligible even in R0 resections. Different studies have highlighted the importance of neuro-vascu-lar, glandular, and intrinsic/extrinsic muscular structures as potential avenues for macroscopic and microscopic tumor spread. Once the tumor has reached these po-tential pathways for progression, the entire hemilingual compartment should be considered at risk for vascular invasion, perineural spread, lymphatic dissemination to the T-N tract, and, ultimately, regional lymph nodes metastasis. The concept of compartmental surgery is to remove the entire hemitongue with the adjacent floor of mouth, which contains the tumor with its main pathways of progression in conjunction with the adjacent areolar soft tissues and lymph nodes. No mandibular splitting is required, and reconstruction is commonly achieved with re-vascularized free flap (radial forearm or anterolateral thigh). As a result, oncologic outcomes can be optimized without significantly impacting functional performance.

HN-SP 4Room 2-3 (White Heron)Chair : SI YOUN SONG,

Moderator : CHRIS HOLSINGER

IGReHNS Panel: Innovation in Robotics and Head and Neck Surger

» 11:00-11:15

» FUTURE OF ROBOTICS AND vIRTUAL REAL-ITY IN SURgERY

SRI INTERATIONAL

THOMAS PATRICK LOW

SRI international, a Silicon Valley non-profit research in-stitute, has been a surgical robotics innovator since creat-ing the technology underpinnings of Intuitive Surgical’s da Vinci system almost 30 years ago. Thomas Low, Di-rector of SRI’s robotic lab will describe some of their past work, and will offer his views on future advancements in surgical robotics, including the role of AI and Virtual Reality devices.

» 11:15-11:30

» TRANSORAL THYROIDECTOMY: HERE TO STAY? OR JUST THE LATEST FAD?

USA

JON RUSSELL

TBD

» 11:30-11:45

» SEMI-AUTONOMY IN ROBOTIC SURgICAL SYSTEMS

UNIV. OF CALIFORNIA SAN DIEGO,

DEP. SURGERY, DIV. OTOLARYNGOLOGY

RYAN K OROSCO

Robotic head and neck surgery of today relies entirely


April26(Fri)



on direct surgeon control. The computer in the robot-ic platform works as a passive intermediary between the surgeon’s hands and the robotic instruments. At the same time, we are in an era where robotic autonomy is com-monplace outside of operating rooms. In our current surgical practice, intelligent computer assistance is an untapped yet promising realm with immense potential. Currently residing in the realm of science fiction, ful-ly autonomous surgery refers to the ability to perform surgery without human intervention. However, we look toward the automation of basic sub-tasks and semi-au-tonomy that augments surgeon capabilities as realistic potential capabilities within the near future. Early work in machine learning and semi-autonomy has shown en-couraging results with planning and execution of basic surgical maneuvers. Further advances along this path are likely to build toward expanded capabilities in more complex sub-tasks and procedures. This lecture will de-scribe the current state-of-the-art with regard to semi-au-tonomy in robotic surgery as it applies to head and neck surgery, and will encourage imagination into futuristic capabilities and expanded applications.

» 11:45-12:00

» MEASURINg OUTCOMES IN TORS FOR OROPHARYNx CANCER BEYOND THE MDADI

MD ANDERSON CANCER CENTER,

DEPARTMENT OF HEAD AND NECK SURGERY

RYAN P GOEPFERT

This lecture will explore existing data on functional out-comes after TORS for oropharyngeal carcinoma span-ning objective and subjective measures with discussion of gaps in knowledge and future directions with comparison to non-surgical data. The goal will be for the listener to leverage knowledge of existing and future data to appro-priately advocate for use of TORS in treatment of oro-pharyngeal cancer on the basis of function.


Chair : YOUNG SOO RHO

Keynote Lecture II

» 13:30-14:00

» APPROPRIATE MANAgEMENT OF CERvI-CAL NECK NODES IN ORAL CANCER

SENIOR CONSULTANT H & N SURGERY, HOD

DEPT. OF SURGICAL ONCOLOGY, DIRECTOR HCG

CANCER CENTER, AHMEDABAD, INDIA

RAJENDRA B TOPRANI

Oral Cancer is a Global Problem Neck Node Metasta-sis is a single most important prognostic factor in Oral Cancer. Management of N0 Neck in early Oral Cancer (T1,T2) is debatable and people are using various inves-tigative modalities like USG guided FNAC from neck node,Sentinel Lymphnode biopsy, CT Scan / MRI / PET CT,etc. to decide for or against doing Elective Neck Node Dissection (END). The current recommendation is to do END even in Early Oral Cancer (T1,T2). Modified Radical Neck Dissection (Level I, II, III, IV, V) is the standard of care in Node Positive patients but Selective Node Dissection (SND) can be done in select group of patients with better functional outcomes. Robotic Neck Dissection offers superior cosmesis compared to tradi-tional open neck dissection.

HN-MTP 1Room 4-3 (Convention C)

Chair : MIN SIK KIM, Moderator : SOON-HYUN AHN

A Road Less Traveled: Reconstructive Surgery in HNC

» 14:00-14:20

» A JOURNEY TO THE HEAD AND NECK SUR-gERY AS A RECONSTRUCTIvE SURgEON

April26(Fri)




DEPARTMENT OF OTOLARYNGOLOGY-HEAD &

NECK SURGERY, COLLEGE OF MEDICINE,

THE CATHOLIC UNIVERSITY OF KOREA,

SEOUL ST MARYS HOSPITAL

MIN SIK KIM

Hippocrates (460 B.C.) was the first to use the term car-cinoma. Among others he described skin cancer and rec-ommended treating malignant tumors with cautery and caustic pastes. He also cautioned against operating on deep-seated tumors. In ancient Rome, Aurelius Cornelius Celsus (30 A.D.) treated cancer of the face and the lip by excision. Until the mid-19th century, head and neck on-cology remained in the same primitive state as did the rest of medicine and surgery, with the exception that some tumors of the head and neck were relatively superficial, clearly visible and accessible to local treatment. One of the big spectrum is significant advances in reconstructive surgery that have taken place since the initial description of the pectoralis major myocutaneous flap by Ariyan in 1979. The use of these sturdy flaps of muscle and skin, which could be transferred in a single stage to provide healthy, well vascularized tissue for resurfacing large de-fects in the neck, oral cavity and other portions of the upper aerodigestive tract, removed the greatest sources of postoperative morbidity and mortality after extensive head and neck resections; namely fistulae, necrosis and exposure of the great vessels, with resultant rupture of the carotid artery. This not only permitted safe resection of the most extensive tumors, but also permitted bet-ter functional and cosmetic results after major ablative procedures on the oral cavity, pharynx, neck and max-illa, among other regions. The advent of revascularized free transfer of tissue, including skin, muscle and bone further advanced the surgeon’s ability to resect and re-construct even the most difficult and inaccessible defects. Now reconstructive surgery is the main topic for the sur-gical treatment of head and neck cancer. A journey to the head and neck surgery as a reconstructive surgeon must be a rewarding work in the modern era of medicine.

» 14:20-14:40

» CONFRONTED ISSUES IN HEAD NECK RE-CONSTRUCTION


HEAD AND NECK SURGERY, SUNGKYUNKWAN

UNIVERSITY SCHOOL OF MEDICINE,

SAMSUNG MEDICAL CENTER

CHUNG-HWAN BAEK

Head and neck surgeons, who perform both ablations of primary tumor and reconstruction must prepare them-selves for time-consuming surgery and can experience unexpected problems during and after surgery. Despite broad experience with 510 microvascular free flaps and other flaps, I still sometimes confront some problems and issue to be solved. In this session, I would like to share personal experiences for the cases, which need some solu-tions during my journey as a reconstructive surgeon.

» 14:40-15:05

» MANDIBULAR RECONSTRUCTION BY USINg COMPUTER-ASSISTED AND 3D PRINTINg AS-SISTED.

DEPARTMENT OF OTOLARYNGOLOGY


RAJAVITHI HOSPITAL, BANGKOK

PHAKDEE SANNIKORN

The reconstruction of defects of jaw should take into consideration the restoration of oral function and speech. Microvascular free flap, such as the fibular are commonly used to reconstruct the jaw. Computer-assisted opera-tions have become increasingly popular in maxillofacial surgery, possibly because we are able to simulate many conditions accurately.Three- dimensional modelling( 3D Printing) assisted by computed tomography (CT) has been helpful in obtaining information for reconstruc-tive surgery, particularly for preparation of the flap at the donor site before transplantation into the defect. Virtual surgical planning translates digital CT data and 3-dimen-sional software simulation into real-time operations, and also helps to plan the size, shape, and exact placement of the bony flap. Moreover, this technique is expected to contribute to shorter surgical times and overall cost sav-ings. The mandibular reconstruction procedures, which normally need highly skilled surgical expertise might be accomplished by inexperienced surgeons with uniform and better accuracy than by experienced surgeons using a freehand approach.This is an important issue because operations that are technically demanding can now be converted into common and simple surgical procedures


April26(Fri)



which can be uniformly and reliably performed anywhere by applying CAD/CAM generated guide, bone place-ment become easier and simpler.

» 15:05-15:30

» HOW TO AvOID COMPLICATIONS IN FREE FLAP RECONSTRUCTIvE SURgERY IN HEAD AND NECK

CHAIR OF THE DEPARTMENT OF HEAD AND NECK

SURGERY POZNAN UNIVERSITY OF

MEDICAL SCIENCES

THE GREATER POLAND CANCER CENTRE

WOJCIECH GOlUSINSKI

The free flaps have become a workhorse of reconstruction following extensive ablative surgery in head and neck. The diversity and modifications of available flaps allow to address multiple defects providing good functional out-come without compromising the oncological outcome. However in high volume centers, the flap failure rates are low, there are certain factors which may significantly in-crease the risk of complications. The previous history of the patient, age, and comorbidities however significant, should not upfront disqualify the patient from free flap reconstructions. The talk outlines the current knowledge regarding free flap reconstructive surgery, potential fac-tors of adverse prognosis and discuss available options to minimalize the risk of failure.


Chair : CHUL-HO KIM, JASON CHAN

Cutting Edges in Head and Neck Cancer Research

» 14:00-14:15

» PLASMA MEDICINE AS NOvEL THERAPEU-TIC STRATEgY IN HEAD AND NECK CANCER : IN ASPECT OF MODULATION OF MITOCHON-DRIAL E3 UBIQUITIN PROTEIN LIgASE 1

DEPARTMENT OF OTOLARYNGOLOGY,

AJOU UNIVERSITY SCHOOL OF MEDICINE

CHUL-HO KIM

Recently, non-thermal plasma (an ionized gas, NTP) has been studied and reported as a part of novel cancer thera-peutic tool. However, the molecular mechanism of NTP is unclear. Thus, we investigate that anti-cancer effect of NTP through ubiquitination dependent proteasomal degradation of AKT. AKT (also known as protein kinase B, PKB) plays an important role in cell survival or tu-mor progression. For these reasons, AKT is an emerging therapeutic target to cancer development. Previous our studies showed that mitochondrial E3 ubiquitin protein ligase 1 (MUL1, also known as MULAN/GIDE/MAPL) was suppressed in head and neck cancer (HNC) acts as negative regulator against AKT. However, the MUL1 regulatory mechanisms remain unknown. NTP induces cell death of head and neck cancer (HNC) through the AKT ubiquitin–proteasome system (UPS). In particular, gene expression of mitochondrial E3 ubiquitin protein ligase 1 (MUL1), an E3 ligase for AKT, was increased by NTP, and NTP-induced HNC cell death was prevented by MUL1 siRNA. Interestingly, MUL1 was suppressed in HNC cell lines. Furthermore, we optimized and man-ufactured new type of NTP, a liquid type of NTP (LTP), which showed biological effects via MUL1-mediated AKT ubiquitination in HNC cells that were similar to those observed in NTP. In syngeneic and xenograft in vivo tumor models, LTP inhibited tumor progression by increasing the MUL1 level and reducing p-AKT levels. Our results indicated that NTP and LTP inhibit the de-velopment of HNC in vivo and in vitro through AKT ubiquitin-dependent proteasomal degradation mediated by MUL1. On the other hand, HSPA5/GRP78/BiP plays an important role in cell survival or tumor progression. For these reasons, HSPA5 is an emerging therapeutic tar-get in cancer development. Here we report that HSPA5 contributes to head and neck cancer (HNC) survival via maintenance of lysosomal activity; however, a nonther-mal plasma (NTP, considered as a next-generation cancer therapy)-treated solution (NTS) inhibits HNC progres-sion through HSPA5-dependent alteration of lysosomal activity. HSPA5 prevents NTS-induced lysosome inhi-bition through lysosomal-related proteins or regulation of gene expression. However, NTS-induced MUL1/MULAN/GIDE/MAPL (mitochondrial ubiquitin ligase activator of NFKB 1) leads to downregulation of HSPA5 via K48-linked ubiquitination at the lysine 446 (K446) residue. MUL1 knockdown hinders NTS-induced lyso-

April26(Fri)




some inhibition or cytotoxicity through the reduction of HSPA5 ubiquitination in HNC cells. While MUL1 was suppressed, HSPA5 was overexpressed in tissues of HNC patients. NTS strongly inhibited HNC progression via alterations of expression of MUL1 and HSPA5, in vivo in a xenograft model. However, NTS did not induce in-hibition of tumor progression or HSPA5 reduction in MUL1 knockout (KO) HNC cells which were generated by CRISPR/Cas9 system. The data provide compelling evidence to support the idea that the regulation of the MUL1-HSPA5 axis can be a novel strategy for the treat-ment of HNC.

» 14:15-14:35

» THE MIROBIOME IN HEAD AND NECK SQUA-MOUS CELL CARCINOMA

DEP. OTORHINOLARYNGOLOGY,


THE CHINESE UNIVERSITY OF HONG KONG

JASON CHAN

The microbiome, particularly the gut microbiome has been shown to be associated with the development of colorectal cancer and be important in the pathogenesis and subsequent management of this diease. Within Head and Neck Squamous Cell Carcinoma (HNSCC) there have been associations of bacterial biofilms and peridon-tal disease with the development of oral cancer. However, the role that the microbiome plays in HNSCC is still a puzzle, and here we will explore the role of the microbi-ome of HNSCC patients in both the development and potentially the management of HNSCC.

» 14:35-14:55

» UNDERSTANDINg THE LARYNgEAL MICRO-BIOME IMPLICATIONS FOR HEALTH AND DIS-EASE

UNIVERSITY OF WISCONSIN MADISON

SUSAN L THIBEAULT

This session will review what we know about the larynge-al microbiome and how these findings may guide clinical care.

» 14:55-15:10

» RESISTANCE TO TARgETED THERAPY AND COMBINATION ExPLORATION OF NOvEL MO-LECULAR TARgETS AND IMMUNOTHERAPY IN HNSCC

GACHON UNIV.

HEE KYUNG AHN

Since the success of cetuximab plus radiotherapy combi-nation in 2006 and palliative cetuximab plus platinum based chemotherapy in 2008, despite the increasing knowledge on genomic aberrations of head and neck squamous cell carcinoma(HNSCC), targeting epider-mal growth factor- receptor(EGFR) has been the only approved targeted therapy in HNSCC until approval of immunotherapy. In 2015 The Cancer Genome Atlas (TCGA) consortium data on 2015 was published, found several distinctive genetic profiles, especially between HPV-positive and HPV-negative HNSCC. Several drug-gable mutations including PIK3CA, cell cycle pathways, FGFR, VEGF and others have been explored as potential new targets. Recently, immune checkpoint inhibition is another promising novel treatment, with two anti PD-L1 monoclonal antibodies approved in metastatic HNSCC progressive to platinum based treatment. This review will highlight the identified HNSCC genomic landscape and ongoing exploration of molecular targeted therapy and immunotherapy in HNSCC.

» 15:10-15:25

» PRECISION SURgERY FOR HEAD AND NECK CANCER

SAMSUNG MEDICAL CENTER, SEOUL, KOREA

HAN-SIN JEONG

Precision oncology or precision medicine is a new trend for clinical oncology, and rapidly developing. This is de-fined as molecular profiling of tumors to identify targe-table alterations, and begin to enter the mainstream of clinical practice. Among genomic profiling of tumors, appropriate next- generation sequencing (NGS) mo-lecular analysis leads to some promising clinical results. Non-small cell lung cancer has emerged as a prototype disease where genomic data from at least several well-doc-


April26(Fri)



umented alterations with approved targeted agents are es-sential for optimal treatment from diagnosis of advanced disease. Due to the development of resistance to targeted therapies, resampling and retesting of tumors, including using liquid biopsy technology after clinical progression, may be important in making treatment decisions. As techniques evolve and become more cost effective, the use of molecular testing may prove to add more specificity and improve outcomes for a larger number of patients. Precision surgery is a surgical principle using tumor spe-cific molecular biology. In HPV positive oropharyngeal cancer, redefinition of close margin (1mm) is only a part of precision surgery. Understanding tumor biology and behavior, surgery itself is evolving with more precise tumor control by surgery, and maximal preservation of function with better oncological outcomes. It also allows individualized or personalized surgery to each patient and each tumor in the head and neck. As a working tool, pre-cision surgery can utilize biomarker driven image guided surgery, according to the tumor marker from biopsy tis-sue, not to the predetermined image probes. Thus, it has potentials to overcome tumor heterogeneity in terms of space and time. Besides precision oncology using NGS information, precision surgery with tumor biology driven image guided surgery will hold a key position in surgery for head and neck cancer in the near future. [END]

HN-3D PrintingRoom 2-3 (White Heron)

Chair : CHUNG-HWAN BAEK

3D Printing Course of “The Korean Society of 3D Printing in Medicine”

» 14:30-14:45

» APPLICATION OF 3D PRINTINg IN ENT FIELD





CHUNG-HWAN BAEK

Application of 3D printing in ENT field is rapidly popu-larized with fascinating results as in other medical fields.

In this topic, I would like to introduce the areas of inter-est such as 3D simulation model for education and cus-tomized surgical planning, surgical guidance, implant-able device and tissue engineering research.

» 14:45-15:00

» APPLICATION OF 3D PRINTINg IN MEDICINE

ANYMEDI INC

GUK BAE KIM

The advent of 3D printing (3DP) technology, sometimes called rapid prototyping, has enabled the creation of a tangible and complex 3D object that goes beyond a sim-ple 3D-shaded visualization on a flat monitor. Due to the hardness of most 3D printable materials, 3DP ma-chines have been used in hard tissue applications since the early 2000s. Recently developed multi-materials for 3DP have been extensively applied in a variety of medical applications, such as personalized treatments for surgical planning and guidance, customized implants, biomedical research, and preclinical education. In this review article, we discuss the 3D reconstruction process, touching on medical imaging, a variety of 3DP systems, and various kinds of post-processing techniques applicable to med-icine. In addition, the 3DP medical applications using these recently developed multi-materials are introduced, as well as our recent results. As 3D printable multi-mate-rials with transparent, full-colored, and flexible character-istics are now commercially available, 3DP technologies have been applied to various fields of medicine, including personalized treatment, medical research, and premedi-cal education, for both soft and hard tissues. The pres-ent article discusses the generation of 3D reconstructed models, covering medical imaging, the post-processing of 3D models, and the recent 3DP systems, and reviews various related medical applications, especially those that use the recently commercialized 3DP technologies and multi-materials. For medical use, after patient scanning with CT and/or MRI, the DICOM data can be exported and processed into stereolithography data file formats by using segmentation, surface extraction, and 3D model post- processing. Less than a 1-mm CT slice thickness and voxel with isocubic spacing are recommended. In particular, segmentation is a vital procedure for improv-ing the overall accuracy and requires considerable time.And then, virtual simulation, including determination of the entry point and direction of the screw and surgical

April26(Fri)




line, is performed for patient- specific surgical planning. Based on this planning, surgical guides are designed by computer-aided design (CAD) software. After generation of a 3D model, the most suitable 3D printer for their applications needs to be chosen among various kinds of 3DP techniques. The 3D printer uses layer- by-layer ste-reolithographic accumulation to fabricate the 3D phys-ical model. In general, the accuracy of the 3DP object depends on the combination among the accuracy of the medical image, whose thickness should be as thin as pos-sible, the appropriate imaging process for 3D modeling, and the 3DP accuracy on system. The 3DP technology used in medicine can be classified by the technique, the material, or the aimed deposition process. The technical type classification includes stereolithography apparatus (SLA), multi-jet printing (MJP), PolyJet printing, digital light processing (DLP), selective laser sintering (SLS), di-rect metal laser sintering (DMLS), color-jet printing (CJP or binder-jet), fused deposition modeling (FDM), lami-nated object manufacturing (LOM), and electron beam melting (EBM) (Figs. 1-8). The material classification includes thermoplastic, metal powder, ceramic powder, eutectic metals, alloy metal, photopolymer, paper, foil, plastic film, and titanium alloys. The aimed deposition process classification includes PolyJet printing based on drop-on-drop deposition and FDM based on continuous deposition. Even though there has been a substantial in-crease in the number of 3DP medical applications, there are still some major limitations, such as those associated with the technology and the time and cost of manufac-turing 3D phantoms. Development and optimization of the entire procedure, from image acquisition to 3DP fab-rication, are required for personalized treatment, even in emergency situations.

» 15:00-15:15

» 3D PRINTINg TECHNOLOgY FOR HEAD & NECK RECONSTRUCTION

DEPARTMENT OF PLASTIC & RECONSTRUCTIVE

SURGERY ASAN MEDICAL CENTER,

SEOUL, SOUTH KOREA

JONG-WOO CHOI

Three-dimensional (3D) printing has been particularly widely adopted in medical fields. Application of the 3D printing technique has even been extended to bio-cell printing for 3D tissue/organ development, the creation

of scaffolds for tissue engineering, and actual clinical ap-plication for various medical parts. Of various medical fields, Head and neck reconstruction is one of areas that pioneered the use of the 3D printing concept. Rapid pro-totype technology was introduced in the 1990s to med-icine via computer-aided design, computer-aided manu-facturing. This lecture will address the current status of 3D printing technology and its clinical application onto the head and neck reconstructions based on personal ex-periences while focusing on the applications of the 3D technology on the microsurgical reconstructions .

» 15:15-15:30

» APPLICATION OF vARIOUS 3D PRINTINg IM-PLANTS CONSIDERINg DEFECT AREAS

H PLASTIC SURGERY CLINIC

JUNG-HWAN BAEK

Various surgical methods and many materials have been utilized to solve bone defects occurring after trauma or surgery. With the recent advances in 3D printing tech-nology, These technologies are becoming increasingly widespread. In this presentation, i will introduce the 3D printing implants of various materials used in clinical practice, and describe the required mechanical and bi-ological properties of 3D printing implants according to the defect site.

HN-KL 3Room 4-3 (Convention C)Chair : SUNG MIN JIN

Keynote Lecture III

» 15:50~16:20

» WHY ASSESSMENT OF vOCAL FUNCTION SHOULD MATTER TO LARYNgOLOgISTS

UNIV WISCONSIN, DEP SURGERY DIV

OTOLARYNGOLOGY H&N, COMM SCI & DISORD

DIANE M BLESS


April26(Fri)



Capturing a few moments of voice production and la-ryngeal visualization is like a photograph-a snapshot in time. It does not necessarily tell the laryngologist what the patient is capable of doing with his/her laryngeal mechanism nor how it impacts his/her quality of life. In contrast, complete assessment of vocal function (acoustic, aerodynamic, videostroboscopic, response to behavioral techniques, social-psychological interactions, quality of life, and readiness for change) offers a dynamic picture of how the larynx is servicing the patient and impacts his/ her life. Vocal function testing helps determine the best treatment options. Moreover, in providing a comprehen-sive picture of pre-surgical status it provides a measuring tool against which surgical results can be quantified, con-sequently helping the surgeon improve techniques. It also helps the patient understand the goals of treatment and reduces unrealistic expectations of treatment outcomes. Comprehensive records of pre-operative status of vocal function may also help avoid lawsuits.

HN-MOS 2Room 4-3 (Convention C)

Chair : KWANG YOON JUNG, Moderator : CHRIS HOLSINGER

Technical Nuances for Endoscopic/Robotic Thyroidectomy

» 16:20-16:50

» SURgICAL INDICATIONS REvISITED FOR THE RETROAURICULAR APPROACH OF RO-BOTIC SURgERY FOR THYROID AND PARA-THYROID DISEASES


TSUNG-LIN YANG

Surgery has remained as the mainstream of treating a variety of thyroid and parathyroid diseases. Thyroid and parathyroid tumors are usually excised through the open transcervical approaches. However, the postopera-tive obvious scars on the neck may be disfiguring. Many techniques of robotic and endoscopic surgery have been developed to improve the cosmetic outcome for thyroid and parathyroid surgery. The retroauricular approach has been developed and evolved to become a popular one.

Similar as other surgical approaches designed for robotic surgery, the retroauricular approach also has its own ad-vantages and limitation. Although with broad utility, the retroauricular approach has been argued for its increased invasiveness and the large wound incision. The vision for the new concept of surgical treatment calls for a person-alized approach in which selection of surgical approach is designed for each individual patient, based on the clinical profiling of the patient information and clinical-patho-logical indexes of the thyroid and parathyroid diseases. Therefore, each patient will be informed the most appro-priate personalized strategy of surgical intervention based on the state-of-the-art endoscopic and robotic surgical technique. For this purpose, the challenge comes from the familiarity and innovation of the surgeons with dif-ferent types of robotic approaches, and the use of a novel set of surgical tools and equipment. The new concept and technique used in robotic surgery is believed to improve the surgical outcome of treating thyroid and parathyroid gland diseases with an individualized and well-defined indications.

» 16:50-17:20

» TRANSORAL ENDOSCOPIC THYROID SUR-gERY

DEPARTMENT OF OTOLARYNGOLOGY-HEAD

AND NECK SURGERY, CATHOLIC UNIVERSITY

COLLEGE OF MEDICINE

JUN-OOK PARK

The transoral endoscopic thyroid surgery has been the subject of increasing interest from several institutions around the world over the last 3 years. In South Korea, surgeons in several hospitals nationwide have also been performing or attempting to initiate either transoral en-doscopic thyroidectomy vestibular approach (TOETVA) or transoral robotic thyroidectomy (TORT). There are numerous advantages to TOETVA, which may explain why this procedure has gained in popularity over a rel-atively short period of time. The purpose of this presen-tation is to review our 2-year experience and describe lessons from trial and error, and to discuss about the lim-itations and considerations that need to be addressed for transoral approach to be a universal option for thyroid surgery. TOETVA has only recently become popular and no clear evidence-based indications or contraindications have yet been established. Therefore, we will review relat-

April26(Fri)




ed papers and discuss about the indication/ contraindica-tion of TOETVA. There have been a number of reports regarding the safety and utility of TOETVA but noth-ing is known about voice dysfunction after such surgery. Therefore, we will present voice outcomes in our patients undergoing TOETVA in comparison with patients un-dergoing open thyroidectomy and other remote access approach. Carbon dioxide gas is injected to maintain the working space during surgery, possibly associated with CO2 gas-related complications. We will present how to prevent CO2 gas-related complications and introduce a new retractable blade that can provide and maintain a sufficiently large working space for TOETVA without the need for CO2 gas. We also present our initial experiences, including a videoclip, and discuss the feasibility and safe-ty of gasless TOETVA.

» 17:20-17:50

» TRANSORAL ROBOTIC THYROID SURgERY


AND NECK SURGERY, COLLEGE OF MEDICINE,

HANYANG UNIVERSITY, SEOUL,

REPUBLIC OF KOREA

KYUNG TAE

To hide neck scarring, various remote access thyroidecto-my procedures using surgical robots or endoscopy have been developed, using axillary, breast, postauicular facelift or transoral approaches. Recently, transoral thyroidecto-my has been increasingly adopted, and it is considered a form of true natural orifice transluminal endoscopic sur-gery (NOTES). It is less invasive than the transaxillary approach, BABA, and the facelift approach because the dissection area for the working space is smaller. In addi-tion, it makes it easier to perform total thyroidectomies than the transaxillary and facelift approaches because it provides midline access to both thyroid lobes. Transoral thyroidectomy includes the sublingual approach, the oral vestibular approach, and other modifications with or without CO2 insufflation. Of these, the oral vestibular approach has been most popular. The vestibular approach utilizing 3 oral ports in the oral vestibule was described first by Richmon using robot in a cadaveric model. Also, the feasibility and safety of transoral robotic thyroidec-tomy in properly selected patients has been reported. In this session, I would like to present the current status of transoral robotic thyroidectomy, and also the operative

procedure and unusual complication.


Chair : CHUNG-HWAN BAEK, PHAKDEE SANNIKORN

Reconstructive surgery update

» 16:20-16:40

» 3D PRINTINg AND vIRTUAL SURgICAL PLANNINg FOR HEAD AND NECK RECON-STRUCTIvE SURgERY

RUTGERS NEW JERSEY MEDICAL SCHOOL

RICHARD CHAN WOO PARK

Osseous reconstruction of the head and neck can be very challenging. Contouring titanium plates to achieve func-tional and aesthetic outcomes can involve a lot of trial and error. In addition, achieving maximal bony contact can be difficult with multiple bony segments. Com-plications arising from mal-aligned segments can lead to swallowing difficulties, nonunion, and poor speech mechanics. However, microvascular reconstructive sur-gery of the head and neck continues to make advances with the help of technology. These advances have been shown to improve outcomes in patients, especially those undergoing osseous reconstruction of the jaw. With the advent of 3D printing and powerful computer software, surgeons now have the capability to perform complex os-seous reconstructions “virtually” before ever entering the operating theater. This virtual planning uses CT images to accurately plan surgery in a computer environment to create customized instruments to be used in surgery that is personalized to each patient.

» 16:40-16:55

» RECONSTRUCTION FOR HEAD AND NECK DEFECT WITH SUBMENTAL FLAP





April26(Fri)



SEOUL, KOREA

YOUNG-HOON JOO

Reconstruction of soft tissue defects of the oral cavity is a complex undertaking. The submental island flap is a useful addition to the reconstructive surgeon’s armamen-tarium. Initially described in 1993 by Martin and col-leagues, modifications of its design allow for it to achieve wide mobility, good predictability, and excellent skin color match. The donor site scar is well hidden in the shadow of the mandible. This flap also has the advantage of tightening cutis laxa of the submental skin. There is de-creased operating room time and length of hospital stay associated with reconstructing defects with a submental island flap when compared with the radial forearm free flap. Here, I will present several cases of head and neck cancer with reconstruction using submental flap.

» 16:55-17:15

» COMBINED MAxILLARY AND MANDIBULAR RECONSTRUCTION CONSIDERATIONS OF THE MASTICATOR SPACE

STANFORD UNIVERSITY, DEPARTMENT OF

OTOLARYNGOLOGY - HEAD AND NECK SURGERY

FRED M BAIK

Combined resection of the mandible and maxilla is ne-cessitated by advanced tumors involving both structures. In these cases, the mandible is usually reconstructed with vascularized bone, whereas the maxilla can be restored with soft tissue alone in cases of limited defects. However, combined mandibular- maxillary resection often exposes the sinonasal complex, which can drain secretions into the masticator space and lead to secondary infection, and at worst, flap failure. Creating a seal between the sinona-sal complex and the masticator space is challenging unless the entire cavity is obliterated by soft tissue. Depending on the bony free flap used, this may not be possible un-less a second flap is harvested. We present three cases in-volving free tissue reconstruction of maxillomandibular tumors with a composite resection of the ramus of the mandible and infrastructure of the palatomaxillary com-plex. In two cases, we describe the utilization of a vacu-um-assisted closure (VAC) system: in one case to treat and in another case to prevent secondary infection of the masticator space. In a third case, we utilize a scapular-la-

tissimus dorsi free flap to obliterate the maxillary defect.

» 17:15-17:30

» DEvELOPMENT AND IMPLEMENTATION OF HANDS-ON TRAININg PROgRAM OF MICRO-vASCULAR SURgERY AND FREE FLAP RAIS-INg

DEPARTMENT OF OTORHINOLARYNGOLOGY -



SCHOOL OF MEDICINE

MAN KI CHUNG

In this session, I will present experiences of developing the process of protocol development and related outcomes of hands-on program of microvascular surgery as a part of STEP (Support and Training for Excellent Physician) at Samsung medical center. Specifically, as an institutional program for hands-on training of surgical skills for the physicians, microvascular surgical training program was developed and implemented from Mar 2016 to Jan 2017. From ENT department, 8 trainees (4 residents and 4 fel-lows) joined and finished the program. Training course, evaluation methods and trainee’s feedbacks were investi-gated. As results, basic course comprised of 1) reviewing video clips for the introductory and intuitive lectures, 2) steps using practice board and artificial vessel to learn the basic manipulation of microvascular instruments and microscope, and 3) hands-on anastomosis of the vessels in the chicken leg. By web-based evaluation of the skill improvements with photos and videos taken during the course, pass or failure was decided by the instructor. As for the advanced course, femoral and abdominal vessels were used to drill the end-to-end or end-to-side anasto-mosis in the rats. Video clips for the consistency and pa-tency after anastomosis was evaluated by the instructor. As a next step, hands-on cadaveric dissection course was implemented covering basic head and neck surgery as well as reconstructive surgeries. These serial protocols can provide informative and educative processes for surgeons to acquire practical skills as competent microvascular sur-geons.

» 17:30-17:55

» PROPER INDICATION FOR RECONSTRUC-

April26(Fri)




TION; WHEN FREE FLAP IS REQUIRED




SEOUL NATIONAL UNIVERSITY HOSPITAL

SOON-HYUN AHN

In the past, free flap reconstruction is described as located at the top position of reconstructive ladder according to the complexity of technique. However, the surgical tech-nique is evolved, and free tissue transfer is no longer a specialized technique or difficult surgery in nowadays. During the surgery of oral cavity or pharyngeal cancer, free flap is performed frequently with this trend of wide spread use. Although free flap reconstruction could be performed easily and with minimal morbidity, the hospi-tal course is longer than the surgery finished with primary closure or secondary healing. And the tracheostomy or Levin tube feeding is required with free flap reconstruc-tion. The development of transoral surgical technique let us realize that considerable defect could heal secondari-ly without functional deficit especially in oropharyngeal area. Even in cases with excision of tongue base or hy-popharyngeal mass via lateral pharyngotomy approach, primary closure with remaining muscles without flap sur-gery was successful with shortened hospitalized day. In most of T2 oral tongue cancer, less than hemiglossectomy defect could heal secondarily if the adequate amount of tongue tip and floor of mouth mucosa is saved. In ad-dition, relighted usage of various local flaps including myomucoal flap based on facial artery showed excellent functional result in selected cases. For rapid healing and better functional result after oncologic surgery, the indi-cation of free tissue transfers needs readjustment.

HN-SP 5Room 2-3 (White Heron)

Chair : KYUNG TAE, JAN PLZÁK

CEORL-KOREAN JOINT SYMPOSIUM : Best Practices and Optimizing Outcomes in Well

Differentiated Thyroid Cancer

» 16:20-16:35

» KOREAN THYROID IMAgINg REPORTINg

AND DATA SYSTEM

DEPARTMENT OF RADIOLOGY,

KOREA UNIVERSITY COLLEGE OF MEDICINE

SUNG-HYE YOU

The rate of detection of thyroid nodules and carcinomas has increased with the widespread use of ultrasonography (US), which is the mainstay for the detection and risk stratification of thyroid nodules as well as for providing guidance for their biopsy and nonsurgical treatment. The Korean Society of Thyroid Radiology (KSThR) published their first recommendations for the US-based diagnosis and management of thyroid nodules in 2011. These rec-ommendations have been used as the standard guidelines for the past several years in Korea. Lately, the application of US has been further emphasized for the personalized management of patients with thyroid nodules. The Task Force on Thyroid Nodules of the KSThR has revised the recommendations for the ultrasound diagnosis and im-aging-based management of thyroid nodules. The review and recommendations in this lecture will be based on “Ultrasonography Diagnosis and Imaging-Based Man-agement of Thyroid Nodules: Revised Korean Society of Thyroid Radiology Consensus Statement and Recom-mendations.” [Malignancy Risk Stratification According to Korean Thyroid Imaging Reporting and Data System (K-TIRADS) and FNA Indications] Category 5 (high suspicion): solid hypoechoic nodule with any of 3 suspi-cious US features*; malignancy risk, > 60 %; FNA indi-cation, ≥ 1cm (> 0.5 cm selective) Category 4 (interme-diate suspicion): 1) Solid hypoechoic nodule without any of 3 suspicious US features* or 2) Partially cystic or isohy-perechoic nodule with any of 3 suspicious US features*; malignancy risk, 15-50 %; FNA indication, ≥ 1cm Cate-gory 3 (low suspicion): Partially cystic or isohyperechoic nodule without any of 3 suspicious US features*; malig-nancy risk, 3-15 %; FNA indication, ≥ 1.5 cm Category 2 (benign): 1) Spongiform, 2) Partially cystic nodule with comet tail artifact, 3) Pure cyst; malignancy risk, < 3 %; FNA indication, ≥ 2 cm for spongiform nodule Category 1 (no nodule) * Microcalcification, nonparallel orienta-tion (taller-than-wide), spiculated/microlobulated mar-gin Reference) Shin, J. H., Baek, J. H.,et al (2016). Ul-trasonography diagnosis and imaging-based management of thyroid nodules: revised Korean Society of Thyroid Radiology consensus statement and recommendations. Korean journal of radiology, 17(3), 370-395.


April26(Fri)



» 16:35-16:55

» NECK MANAgEMENT IN THYROID CANCER

DEP. OF OTORHINOLARYNGOLOGY AND HEAD

AND NECK SURGERY 1ST FACULTY OF MEDICINE,

CHARLES UNIV., MOTOL UNIV. HOSP.

JAN PLZAK

The management of regional lymph nodes in thyroid car-cinoma is guided by preoperative evaluation, histologic subtype, and often a consideration of data for potential benefit and morbidity of a neck dissection. The goal of neck dissection is complete surgical resection of grossly evident metastatic disease and the removal of regional lymph node groups at highest risk for microscopic dis-ease. Surgery should achieve disease eradication but pre-serve voice, airway, swallowing, and parathyroid func-tion. The indications for both central and lateral neck dissection will be discussed.

» 16:55-17:15

» MANAgEMENT OF RECURRENT WELL DIF-FERENTIATED THYROID CARCINOMA (WDTC)

DEPARTMENT OF OTOLARYNGOLOGY, HEAD AND

NECK SURGERY, CARMEL MEDICAL CENTER,

RAPPAPORT FACULTY OF MEDICINE, TECHNION,

HAIFA, ISRAEL

ILANA DOWECK

Recurrence of WDTC was found in 30% of patients, about 66% of them within 10 years. There is an increase in the detection of subclinical disease in the last decade. The pattern of spread and recurrent disease, as well as commonly missed lymph nodes will be reviewed. Surgi-cal intervention Vs active surveillance will be discussed, with emphasis on revision surgery in central and lateral compartments, as well as local recurrence. Nonsurgical treatment such as external beam radiotherapy and thy-rosine kinase inhibitors will be reviewed. Goals and ex-tent of resection should be tailored to the specific patient and situation, and emphasis will be given to the role of multidisciplinary team in the management of recurrent disease.

» 17:15-17:30

» INTRAOPERATIvE NEUROMONITORINg FOR THYROID SURgERY


PUSAN NATIONAL UNIVERSITY HOSPITAL

BYUNG-JOO LEE

The preservation of recurrent laryngeal nerve in thyroid surgery is very important. The injury of the recurrent laryngeal nerve leads to voice changes and swallowing difficulty, resulting in decreasing quality of life for the patient. Sometimes, it is difficult to confirm the status of nerve even after visual identification of recurrent larynge-al nerve during thyroid surgery. Therefore, an intraopera-tive neuro-monitoring (IONM) system was developed to confirm the location and status of the recurrent laryngeal nerve during thyroid surgery. IONM system used in thy-roid surgery measures electromyography (EMG) of the vocalis muscle using an electrode-attached endotracheal tube. The IONM system consists of a stimulating side and a recording side. The location and status of the re-current laryngeal nerve can be confirmed during surgery, which can reduce temporary or permanent vocal palsy due to thyroid surgery. IONM is also very useful for re-operation or revision surgery. In addition to preservation of recurrent laryngeal nerve, it is also used to preserve the superior branch laryngeal nerve, which is involved in the phonation of high pitch. Currently, the IONM used is obviously useful, but it has a disadvantage of using a separate nerve stimulator to stimulate recurrent larynge-al nerves. There is also a problem with the accuracy of the IONM. In some cases, the stimulation of the nor-mal recurrent laryngeal nerve with the nerve stimulator does not detect EMG signal (loss of signal) in electrode endotracheal tube. So, I will present the usefulness and limitations of the current IONM. And, I would like to present the recent development and attempt to overcome the drawbacks of IONM used in thyroid surgery.

» 17:30-17:45

» USEFULNESS OF ADHESIvE SKIN ELEC-TRODES FOR IONM OF RLN


NECK SURGERY, KOSIN UNIVERSITY

COLLEGE OF MEDICINE

April26(Fri)




HYOUNG SHIN LEE

Intraoperative neuromonitoring (IONM) of recurrent laryngeal nerve (RLN) has been considered as a useful method to help localization and preservation of the nerve and also to predict postoperative nerve function. Howev-er, recording side error of IONM has been a barrier for the surgeons due to false positive outcomes. Malposition or displacement of the EMG tube has been considered as the most frequent cause of false ‘loss of signal’ (LOS) of IONM of the RLN. Recently, an animal study showed that skin electrodes successfully presented the evoked la-ryngeal EMG during IONM of RLN, with stability and accuracy. In this lecture, clinical experience and feasibil-ity of IONM of RLN with adhesive skin electrodes in patients undergoing monitored thyroidectomy will be introduced. A comparative study of IONM using EMG tube versus skin electrodes will be presented. While lower amplitude is the major limitation of this technique, ad-hesive skin electrodes may be considered as an alternative method of IONM during thyroidectomy with excellent cost-effectiveness and lower incidence of false LOS.

April 26(Fri) Instruction Course

April26(Fri)



April 26 (Fri)

[IC 1] 14:30-15:30 Room 2-6 (Peacock)

TRanSORaL enDOSCOPIC & ROBOTIC THyROIDeC-TOMy: SeT uP & BegInnIng

YOONwOO KOH, JUN-OOK ParK (YONseI UNIv., CatHOlIC UNIv.)

[IC 2] 15:50-16:30 Room 2-6 (Peacock)

ManageMenT OF FungaL SInuSITIS CHaLLengeS, DILeMMaS, FInDIngS anD SuggeSTIOnS

sOUraBHa KUMar PatrO (all INDIa INstItUte Of MeDICal sCIeNCes, JODHPUr, DePartMeNt Of OtOlarYNGOlOGY &

HeaD aND NeCK sUrGerY)

[IC 3] 16:30-17:10 Room 2-6 (Peacock)

WHaT KInDS OF LaRyngeaL DISeaSe COuLD Be TReaTeD WITH FIBeROPTIC LaRyngeaL LaSeR SuR-geRy (FLS) unDeR LOCaL aneSTHeSIa

seUNGwON lee (DePartMeNt Of OtOlarYNGOlOGY - HeaD aND NeCK sUrGerY, sOONCHUNHYaNG UNIversItY

COlleGe Of MeDICINe, BUCHeON)

[IC 4] 17:10-17:50 Room 2-6 (Peacock)

PROPeR aPPLICaTIOn OF CLInICaL PRaCTICaL guIDeLIne TO SuDDen HeaRIng LOSS

YONGHwI aN (DePt Of OtOrHINOlarYNGOlOGY, eUlJI UNIversItY sCHOOl Of MeDICINe,

eUlJI MeDICal CeNter, seOUl)

Instruction Course

April 26 (Fri)

[VL 1] 10:30-11:30 Room 2-5 (Crane)

auTOLOgOuS BOne-CaRTILage COMPOSITe gRaFT OSSICuLOPLaSTy

sHI Nae ParK (DePartMeNt Of OtOlarYNGOlOGY-HeaD aND NeCK sUrGerY, COlleGe Of MeDICINe,

tHe CatHOlIC UNIversItY Of KOrea)

SuRgeRy FOR SuPeRIOR CanaL DeHISCenCe Syn-DROMe

HONG JU ParK (Ulsan Univ.)

ReTROLaByRInTHIne VeSTIuLaR neuReCTOMy


FaCIaL ReanIMaTIOn uSIng HyPOgLOSSaL-FaCIaL neRVe anaSTOMOSIS aFTeR SCHWannOMa Re-MOVaL


[VL 2] 11:30-12:30 Room 2-5 (Crane)

InFeRIOR PaRTIaL MaxILLeCTOMy

KINaM ParK (sOONCHUNHYaNG UNIv.)

PaROTID SuRgeRy - HOW I DO By ReTRO-auRICu-LaR InCISIOn

DewaN MaHMUD HasaN (sarKarI KarMaCHarI HOsPItal)

MeDIaL SuRaL aRTeRy PeRFORaTOR FRee FLaP FOR HeaD anD neCK ReCOnSTRuCTIOnS

wOO-JIN JeONG (seOUl NatIONal UNIv.)

SuRgICaL TeCHnIQueS OF RaDIaL FOReaRM FRee-FLaP

YOO seOB sHIN (DePartMeNt Of OtOlarYNGOlOGY, sCHOOl Of MeDICINe, aJOU UNIversItY, sUwON, KOrea)

RaReLy uSeD BuT eFFICIenT aPPROaCHeS FOR FOReIgn BODy OR aBSCeSS ReMOVaL In HeaD anD neCK RegIOn

sO-YOON lee (CHa UNIv.)

[VL 3] 13:30-14:30 Room 2-5 (Crane)

TeMPORaLIS TenDOn TRanSFeR FOR SMILe ReS-TORaTIOn aFTeR FaCIaL neRVe PaRaLySIS

JI YUN CHOI (CHOsUN UNIversItY COlleGe Of MeDICINe)

uLTRaSOnIC RHInOPLaSTy neW TeCHnOLOgy LeaDS neW COnCePT

HONGrYUl JIN, JONGsOOK YI (DOCtOrJINs NOse ClINIC)

Video Lecture

April26(Fri)




IC 1

Room 2-6 (Peacock)

Instruction Course

» 14:30-15:30

» TRANSORAL ENDOSCOPIC & ROBOTIC THYROIDECTOMY: SET UP & BEgINNINg

YONSEI UNIVERSITY, CATHOLIC UNIVERSITY

YOONWOO KOH, JUN-OOK PARK

The transoral endoscopic thyroidectomy vestibular ap-proach (TOETVA), as a concept of natural orifice translu-minal endoscopic surgery (NOTES), is an operation in which an endoscope is passed through a cannula inserted into the oral vestibule to perform thyroidectomy using only a small mucosal incision, rather than an external skin incision. Since Anuwong reported successful results in 60 patients, TOETVA has become widely known and has increasingly been used by several head and neck sur-geons around the world. Transoral robotic thyroidectomy (TORT), as performed by the da Vinci system (Intuitive Surgical, Inc., Sunnyvale, CA, USA), has also attracted attention and is also performed. For beginners who want to set up transoral endoscopic/robotic thyroid surgery (TOETVA or TORT), we would like to talk about pre-operative preparations, patient selection, surgical proce-dures, and postoperative management. We also introduce our early experiences of TORT using DaVinci SP Single Port from cadaveric preparation to surgery for live human patients.

IC 2

Room 2-6 (Peacock)

Instruction Course

» 15:50-16:30

» MANAgEMENT OF FUNgAL SINUSITIS CHALLENgES, DILEMMAS, FINDINgS AND SUggESTIONS

ALL INDIA INSTITUTE OF MEDICAL SCIENCES,

JODHPUR, DEPARTMENT OF OTOLARYNGOLOGY

& HEAD AND NECK SURGERY

SOURABHA KUMAR PATRO

Fungal sinusitis involves spectrum of disorders ranging from fungal ball through allergic fungal sinusitis, AFS with granulomas, chronic granulomatous and chronic invasive fungal sinusitis to acute fulminant fungal sinus-itis. The instruction course will have the following sec-tions. 1. Diagnosis, evaluation, diagnostic challenges and masquerading features of various forms of fungal sinus-itis. 2. Investigations and objective findings establishing diagnosis in challenging clinical scenarios and deciding the management. 3. Issues and controversies in surgical management. 4. Issues and controversies in medical man-agement/ adjuvant treatment. 5. Impressions, outcomes and take home messages in management of various forms of fungal sinusitis. The aim of the instruction course is to develop understanding and impressions about various diagnostic and management challenges in various types of fungal sinusitis in residents and young ENT surgeons/ rhinologists.

April 26(Fri) Instruction Course

April26(Fri)



IC 3

Room 2-6 (Peacock)

Instruction Course

» 16:30-17:10

» WHAT KINDS OF LARYNgEAL DISEASE COULD BE TREATED WITH FIBEROPTIC LA-RYNgEAL LASER SURgERY (FLS) UNDER LO-CAL ANESTHESIA

DEPARTMENT OF OTOLARYNGOLOGY - HEAD AND

NECK SURGERY, SOONCHUNHYANG UNIVERSITY

COLLEGE OF MEDICINE, BUCHEON

SEUNGWON LEE

The indications for fiberoptic, laryngeal laser surgery (FLS) have expanded significantly. As potassium titanyl phosphate (KTP) lasers afford excellent hemostasis, such lasers are now widely used. Earlier, FLS was used to treat small, hemorrhagic vocal polyps. With accumulation of surgical experience and developments in surgical tech-niques, FLS is now used to treat large vocal polyps, Re-inke edema, recurrent respiratory papillomatosis (RRP), and vocal fold granulomas and dysplasia. KTP lasers have been employed to treat patients (under general anesthe-sia) with sulcus vocalis and early-stage glottal cancer. Al-though FLS is very useful, it remains but one of several treatment modalities. Both FLS and conventional laryn-gomicroscopic surgery are valuable. Here, we offer practi-cal FLS tips and discuss the advantages and disadvantages thereof; we show (in detail) how to perform various pro-cedures. Key Words: Laser, Larynx, Fiberoscopy

IC 4

Room 2-6 (Peacock)

Instruction Course

» 17:10-17:50

» PROPER APPLICATION OF CLINICAL PRAC-TICAL gUIDELINE TO SUDDEN HEARINg LOSS

DEPT OF OTORHINOLARYNGOLOGY,

EULJI UNIVERSITY SCHOOL OF MEDICINE,

EULJI MEDICAL CENTER, SEOUL

YONGHWI AN

Korean otologic society developed a treatment strategy for sudden sensorineural hearing loss (SNHL) in 2011, and American academy of otolaryngology-head and neck surgery foundation suggested a clinical practice guideline of sudden hearing loss in 2012. From those, we can assure the evidence-based recommendations on the criteria and method of diagnosis, tools for treatment and their results, and guideline for reporting results and follow up. The guideline made strong recommendations that clinicians should (1) distinguish SNHL from conductive hearing loss in a patient presenting with sudden hearing loss; (2) educate patients with idiopathic sudden SNHL about the natural history of the condition, the benefits and risks of medical interventions, and the limitations of exist-ing evidence regarding efficacy; and (3) counsel patients with incomplete recovery of hearing about the possible benefits of amplification and hearing-assistive technolo-gy and other supportive measures. The guideline made recommendations that clinicians should (1) diagnose presumptive sudden SNHL if audiometry confirms a 30-dB hearing loss at 3 consecutive frequencies; (2) evaluate patients with sudden SNHL for retro-cochlear patholo-gy by obtaining MRI, auditory brainstem response, or audiometric follow-up; (3) offer intra-tympanic steroid perfusion when patients have incomplete recovery from sudden SNHL after failure of initial management; and (4) obtain follow-up audiometric evaluation within 6 months of diagnosis for patients with idiopathic sudden SNHL. There are some limitations of this guideline such

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as (1) the evaluation of cost-effectiveness just in USA where the medical expenses are extremely high; (2) no comment on benefit-harm assessment of diuretics for pa-tients with sudden SNHL; and (3) lack of recent data on the efficacy of simultaneous oral and intra-tympanic steroids for sudden SNHL. In consideration of these is-sues, we should understand that the guideline does not provide the only appropriate approach to diagnosing and managing sudden SNHL and that it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies.

April 26(Fri) Video Lecture

April26(Fri)



VL 1

Room 2-5 (Crane)

Video Lecture

» 10:30-11:30

» AUTOLOgOUS BONE-CARTILAgE COMPOS-ITE gRAFT OSSICULOPLASTY




SHI NAE PARK

A novel surgical technique of ossiculoplasty, named au-tologous bone-cartilage composite graft (BCCG) ossicu-loplasty, as well as its surgical result, will be demonstrated in the our video lecutre. Analytic data of ossiculoplasty of BCCG showed satisfactory hearing outcome and the lowest complication rate among three different materials of ossiculoplasty: BCCG, Polycel® and titanium. In par-ticular, its extrusion rate was 0%. We propose that BCCG can be successfully used as an alternative ossiculoplastic material in patients who need ossicular reconstruction. Moreover, BCCG ossiculoplasty might be considered in patients with Eustachian tube dysfunction or who may have foreign body reaction to synthetic materials.

» 10:30-11:30

» SURgERY FOR SUPERIOR CANAL DEHIS-CENCE

DEPARTMENT OF OTOLARYNGOLOGY, ASAN

MEDICAL CENTER, UNIVERSITY OF ULSAN

COLLEGE OF MEDICINE, SEOUL, KOREA

HONG JU PARK

Middle fossa craniotomy is a safe surgical procedure and is the most common approach used to repair SCD. Plug-ging with bone wax and placement of cartilage on SCD has been used to create a stable seal of the dehiscent supe-

rior semicircular canal. After the video lecture, the listen-ers can know how to find SCD via middle cranial fossa approach and how to seal the SCD.

» 10:30-11:30

» RETROLABYRINTHINE vESTIULAR NEUREC-TOMY



SUNG HUHN KIM

Vestibular Neurectomy is a surgical method that can be used for the patients with intractable vertigo, especially in Meniere’s disease. It is one of the most invasive surgical technique in managing the vertigo, therefore, is should be used in the patients in whom their vertigo spell is not controlled by non-invasive and less invasive treatment modalities. The first-line treatment modalities for Me-niere’s disease are life style modification and medication. If the patients do not respond to the first-line treatment, pressure therapy and intratympanic steroids can be tried. In the cases intractable to those treatment, endolymphat-ic sac surgery and intratympanic gentamicin can be used depending on the hearing level of the patients. The last treatment approach to the patients who do not show any response to the treatments, labyrinthectomy and vestib-ular neurectomy can be used. Comparing to labyrinthec-tomy and intratympanic gentamicin injection, vestibular neurectomy has little risk for hearing aggravation. Tra-ditionally, there are three approaches for vestibular neve section; middle cranial fossa approach, retrosigmoid ap-proach, and retrolabyrinthine approach. In retrolabyrin-thine approach, 8th cranial nerve is not separated into cochlear and vestibular branch. Therefore, we should be careful during sectioning the vestibular branch of 8th cra-nial nerve to preserve the hearing level of the patient. In addition, surgical field of retrolabyrinthine approach is very small. In this lecture, the surgical tips and pitfalls of vestibular neurectomy via retrolabyrnithine approach will be showed and discussed. In spite of the several difficulties in the technique for retrolabyrinthine vestibular neurec-tomy, it is a still useful method for controlling intractable vertigo in Meniere’s disease because of the small incision and relative small tension during brain retraction.

April26(Fri)




» 10:30-11:30

» FACIAL REANIMATION USINg HYPOgLOS-SAL-FACIAL NERvE ANASTOMOSIS AFTER SCHWANNOMA REMOvAL

YONSEI UNIV.

IN SEOK MOON

Introduction: Neural reconstruction of facial paralysis typically involves epineural anastomosis from a donor motor nerve. The ipsilateral hypoglossal nerve has been the popular options. The traditional hypoglossal–facial nerve anastomosis procedure is effective in establishing facial tone , rest symmetry, and some movement, but it may later be associated with lack of movement and the progressive atrophy of ipsilateral tongue. Srugical Pro-cedures: The hypoglossal nerve was split longitudinally. For each half, nerve’s response was measured intraopera-tively by recording the compound action potential of the tongue muscle. The remainder half that showed the least response was selected for anastomosis. The facial nerve was transected at the proximal to stylomastoid foramen, and its distal part underwent a direct anastomosis with the hypoglossal nerve. Personal Experiences: This study included 23 patients who underwent hypoglossal-facial nerve anastomosis after schwannoma removal and fol-lowed more than one year. The three kinds of surgical techniques – end-to-end, end-to-side and split types - were performed. Facial palsy and tongue atrophy af-ter anastomosis were evaluated and graded with a scales suggested by House-Brackmann and Martins. Totally, 15 of 23 (65.2%) patients showed favorable facial outcomes and 13 of 23(56.5%) patients showed favorable tongue outcomes. For the facial palsy, 9 of 12(75.0%) end-to-end patients and 4 of 6(66.7%) split patients showed favorable facial functions. The only 2 of 5 (40.0%) pa-tients of end-to-side showed favorable outcomes. For the tongue atrophy, all the 5 of 5(100%) end-to-side patients showed favorable tongue outcomes. The 5 of 6(75.0%) split patients and 2 of 12(16.7%) end-to-end patients showed favorable tongue outcomes. The effect of tumor volume and surgical time was not significant to facial out-comes. Discussion: In our case, 2/3 patient postopera-tively showed better than moderate dysfunction (grade III). Mastication and pronunciation function were well preserved with only moderate tongue atrophy.

VL 2

Room 2-5 (Crane)

Video Lecture

» 11:30-12:30

» INFERIOR PARTIAL MAxILLECTOMY

SOONCHUNHYANG UNIVERSITY

KINAM PARK

When the tumors in maxillary sinus were confirmed to the floor of the antrum, the patients may be managed by inferior partial maxillectomy. It is different from total maxillectomy on the preservation of orbital floor and in the selected cases of the infraorbital nerve. The preser-vation of orbital floor and zygomatic prominence may result in great cosmetic outcomes when the defect was managed by free flap reconstruction or prosthesis. Most of maxillectomy video-clip in Youtube are shaky videos, about total maxillectomy and has low-quality resolution. Here is the video clip plus anatomical guide about right inferior partial maxillectomy for maxillary sinus cancer confirmed by CaldWell-Luc antrostomy biopsy.

» 11:30-12:30

» PAROTID SURgERY - HOW I DO BY RET-RO-AURICULAR INCISION

SARKARI KARMACHARI HOSPITAL

DEWAN MAHMUD HASAN

Parotidectomy is usually done by 'Lazy S' incision (pre auricular - mastoid - cervical), may cause ragged scars & skin deformity. Minimally invasive parotidectomy or para-auricular is also alternative of 'Lazy S' incision en-tails less scarring. Aim of the study was to evaluate the surgical treatment of Parotid Swelling in selected group of patients by retro auricular incision. Total number of patients-Sixty two (62). Patients suffering from Pleo-morphic adenoma (40), Chronic Parotitis(2)mucoepi-dermoidcarcinoma(9), wardinstumour (5), tuberculo-


April26(Fri)



sis(3),Adenocarcoma(1),Benign parotid cyst (2)were re-viewed. Superficial parotidectomies were done in all cases by retro auricular incision. Retro auricular incision has very good aesthetic result and no visible incision mark from the first post-operative day. All patients were very happy with no visible scar/incision mark. Temporary post-operative facial weakness developed in 4 cases & no permanent facial serve palsy. 2 cases suffered from infec-tion (one patient was diabetic and one had very thin skin flap) and 2 patients suffered from Frey”s syndrome.of .2 patients from sialocele and 1 from salivary fistula. 20 (Twenty) patients suffered from hypoesthesia of the op-erative area. Transient ear discomfort occurred in 15 pa-tients. These complications have been described by other surgeons, by other incisions for parotidectomy operation. Parotidectomy by retro auricular incision may be highly acceptable procedure both from aesthetic point of view as well as surgical approach.

» 11:30-12:30

» MEDIAL SURAL ARTERY PERFORATOR FREE FLAP FOR HEAD AND NECK RECON-STRUCTIONS


BUNDANG HOSPITAL

WOO-JIN JEONG, YOUNG KANG

Reconstruction of head & neck defects are challenging because of lack of local options and the need for a thin and pliable flap. The radial forearm (RFFF) and antero-lateral thigh (ALTF) free flap have been the workhorse flap of choice for such defects. Nevertheless, the con-spicuous donor-site morbidity and regular need for skin grafting of RFFF and thickness and bulk of ALTF are considered major drawbacks of these flaps. Medial sural artery perforator free flap (MSAPF) was first described in 2001 and has major advantages including its long pedi-cle, thin, pliable nature, and a well-hidden donor site that can be closed primarily with minimal functional deficit.The purpose of this video lecture is to introduce the expe-rience of medial sural artery perforator free flap in terms of indication, harvest techniques, flap characteristics, and outcomes.

» 11:30-12:30

» SURgICAL TECHNIQUES OF RADIAL FORE-

ARM FREE-FLAP


SCHOOL OF MEDICINE, AJOU UNIVERSITY,

SUWON, KOREA

YOO SEOB SHIN

Radial forearm free flap (RFFF) has been widely used for the reconstruction of various head and neck de-fect, since 1978 developed by Dr. Yang Goufan and coworkers in China. The RFFF is a useful and ver-satile fasciocutaneous flap designed on the radial ar-tery. The RFFF has still used as a workhorse for soft tissue replacement in head and neck cancer surgery. In this video presentation, surgical anatomy, pre-oper-ative consideration and specific surgical techniques will be presented and discussed for head and neck surgeons, especially who begin microvascular reconstruction.

» 11:30-12:30

» RARELY USED BUT EFFICIENT APPROACH-ES FOR FOREIgN BODY OR ABSCESS RE-MOvAL IN HEAD AND NECK REgION

CHA BUNDANG MEDICAL CENTER

SO-YOON LEE

Foreign bodies pose a diagnostic challenge to surgeons because of the small size of the object, difficult access, and the close anatomical relationship to vital structures. Unusually swallowing physiology can sometimes make happen to foreign body impaction in an unusual site.In this lecture, a modified median glossotomy approach will be introduced for removal of foreign body n indeep and center of the tongue in the edentulous patient.Isolated medial pterygoid abscess is uncommon. The most common cause is odontogenic problems. A trismus is the hallmark sign of this disease and surgical drainage is the major treatment method. However, this deep space is not readily accessible and no consensus exists. Invasive approaches to drain are usually used, and it depends on the abscess characteristics. In this lecture, a less invasive-ness procedure will be introduced.

April26(Fri)




VL 3

Room 2-5 (Crane)

Video Lecture

» 13:30-14:30

» TEMPORALIS TENDON TRANSFER FOR SMILE RESTORATION AFTER FACIAL NERvE PARALYSIS

CHOSUN UNIVERSITY COLLEGE OF MEDICINE

JI YUN CHOI

Temporalis tendon transfer is a technique for dynamic fa-cial reanimation. Since its inception, nearly 80 years ago, it has undergone a wealth of innovation to produce the modern operation. Temporalis tendon transfer is a rela-tively minimally invasive technique for the dynamic rean-imation of the paralyzed face. This technique can produce significant and appropriate movement of the lateral oral commissure, more closely mimicking the normal side. The temporalis tendon transfer through the intraoral ap-proach is a suitable procedure for dynamic treatment of minimally invasive facial paralysis in treating long-term facial paralysis patients. This procedure can keep the shape of the face similar to the normal side by moving the angle of mouth tightly and adequately. Both esthetic and functional improvements can be achieved with the transfer of the temporalis tendon to the oral commissure.

» 13:30-14:30

» ULTRASONIC RHINOPLASTY NEW TECH-NOLOgY LEADS NEW CONCEPT

DOCTORJINS NOSE CLINIC

HONGRYUL JIN, JONGSOOK YI

Even though the philosophy of rhinoplasty may not change, the techniques to achieve the goals are continu-ously evolving. Recent technology allows the expert na-sal surgeon to perform more delicate alterations to the nose than was previously possible with traditional tools.

Among many rhinoplasty techniques, osteotomy is the most challenging and destructive technique that surgeons get used to lastly. Problems with conventional osteotomy technique are swelling, bleeding, instability of bony frag-ments and difficulty in fine control of the bony shape. Ultrasonic bone cutting instrument, Piezotome®, is a new device which uses high speed sound waves to power tiny tools to vibrate ever so gently to perform but cutting and drilling. With this instrument, bone is cut and sculpt-ed rather than fractured in routine pathway. Fine bone cutting with preservation of underlying periosteum en-ables fine shaping of the nose even in patients with severe bony pyramidal deformity. The routine sequence or types of osteotomies is no longer valid with this instrument. Multiple osteotomies can be added as necessary without a routine sequence of persecution. While this instrument gives us a huge advantage, it also has a few drawbacks. It requires open approach with wide dissection over the bony pyramid. The instrument and the saw blades are expensive. In this video, we’d like to introduce new ultra-sonic osteotomy device, its concept, techniques to use it, and its application result in case series.

Plenary Session

Room 4-2 (Convention B)

Plenary Session

» 09:20-10:00

» THE WORLD IN 2019 AND THE KOREAN PENINSULA

KYUNGHEE UNIV.

JOON OH

Oh Joon is a professor of United Nations studies at Kyung Hee University in Seoul, Korea. He serves as an Eminent Person Adviser to the UN Economic and So-cial Commission for Asia and the Pacific (ESCAP). He is also the Chair of Save the Children Korea and a board member of Save the Children International. Previously he was Ambassador and Permanent Representative of the Republic of Korea to the United Nations in New York from 2013 to 2016. During this time, he also served as


April26(Fri)



the 71st President of the Economic and Social Council (ECOSOC) and as President of the Conference of States Parties to the Convention on the Rights of Persons with Disabilities (CRPD) in 2015 and 2016. Before that, he was Korean Ambassador to Singapore from 2010-13 and Deputy Minister for Multilateral and Global Affairs in the Ministry of Foreign Affairs and Trade in Seoul from 2008-10. The Korean Government awarded him an Order of Ser-vice Merit twice, in 1996 and 2006. In 2018, he received a Global Korea Award from Michigan State University in the United Sates. Rehabilitation International (RI) gave him a Global Presidential Award in 2016 in acknowledg-ment of his achievements as President of the Convention on the Rights of Persons with Disabilities. He also re-ceived the 2014 Youngsan Diplomat of the Year Award for his work on North Korean human rights issues. He published his first book in Korean “For Mica, Who Con-templates Life” in 2015.

April26(Fri)




OTOP-1Room 4-1 (Convention A)

Chair : DONG HEE LEE, CHI KYOU LEE

Trauma & Tumor

» OTOP-01 08:00~08:10

» DO FACIAL BONE FRACTURES HAvE THE IMPACT-ABSORBINg EFFECT PREvENTINg COMPLICATIONS IN TEMPORAL BONE FRAC-TURE



HANTAI KIM, OAK-SUNG CHOO, HUN YI PARK, YUN-HOON CHOUNG, JEONG HUN JANG

Objectives: Temporal bone fracture is one of the most commonly encountered traumatic diseases in the field of otolaryngology. In previous studies of brain injury, some researchers have reported that facial bone (mandible, maxilla, zygomatic, and orbital wall) fractures have the impact-absorbing effect, which could prevent traumatic brain hemorrhage if the fractures were accompanied by head trauma. The purpose of this study is to investigate the impact-absorbing effect of facial fractures on the complication of temporal bone fracture. Methods: Pa-tients who were referred for treatment of temporal bone fracture from the trauma center in Ajou University Hos-pital from 2016 to 2018 were initially included. Among those, patients who were transferred to another hospital or who were unable to follow up due to death during treatment were excluded. Finally, a total of 134 subjects were included in the study. Their demographic infor-mation, the results of their TBCT, the presence of facial fracture, and their otologic symptoms were investigated. All the TBCTs were reviewed by radiologists. Results: Of the 134 patients, 110 were males and 24 were females. Their mean age was 47.3±16.5 years. Of the 24 patients with suspected ossicular disruption in the initial TBCT, 16 (66.7%) continued to complain of conductive hear-ing loss. If facial nerve canal involvement was suspicious in TBCT (n=13), immediate facial palsy was assumed in 5 (26.3%) of them. Delayed type facial palsy was more common in subjects without facial fractures (12.3% vs.

4.3%, p=0.022). In posttraumatic dizziness, 13 patients (20%) without the facial fracture complained vestibulop-athy; however, it was only 4 (5.8%) in them with any of the facial fractures. Conclusion: In temporal bone frac-tures without facial fractures, both delayed facial palsy and posttraumatic vestibulopathy were more common, which suggest that the impact-absorbing effect of facial fractures might also affect the complications of temporal bone fracture.

» OTOP-02 08:10~08:20

» AUDIOvESTIBULAR MANIFESTATIONS OF INTRACANALICULAR vESTIBULAR SCHWAN-NOMAS


GANGNAM SEVERANCE HOSPITAL,

YONSEI UNIVERSITY COLLEGE OF

MEDICINE, SEOUL, KOREA

MIN PYO HONG, GEUN CHEOL SHIN, JI HYUNG KIM, INON KIM, EUN JIN SON

Objectives: The diagnosis of intracanalicular vestibular schwannomas has become straightforward with wide-spread use of MRI scans. Audiovestibular symptoms in-cluding hearing impairment, tinnitus, or dizziness may be present in ICVS, but incidental diagnosis tends to be more common especially in patients with tumor limited to the internal auditory canal. In these subset of ICVS, periodic imaging and observation remains a valid treat-ment option. In this study, we investigated audiovestib-ular findings in confirmed ICVS who were follow-up with yearly examination and their changes over time. Methods: Retrospective review of 21 subjects (mean age 59±13 years, M:F=15:6) with ICVS confined to the in-ternal auditory canal were included. Initial presentation, hearing status, vestibular function status, and tumor size were examined. Yearly audiovestibular test results were re-viewed for 11 patients who were followed up more than 1year (range 14-125 months). Results: Mean tumor length of the ICVS was 6.18±3.74 mm. Most common initial symptoms among 21 ICVS patients were dizzi-ness (12 patients, 57 %), followed by sustained or slowly progressive hearing loss (7 patients, 33 %), tinnitus (7 patients, 33 %) and sudden hearing loss (4 patients, 19 %). Mean pure tone thresholds in the tumor side was 27.17±20.98 dB, compared to 30.82±34.45 in the nor-mal side. Caloric weakness was noted in 5 cases (24 %)

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operative hearing, postoperative facial palsy, and com-plications were compared to retrosigmoid approach and middle fossa approach. The size of the tumor measured the largest diameter and CPA invasion. Hearing averaged 0.5 KHz, 1 KHz, 2 KHz, and 3KHz, and postoperative facial nerve function evaluated with HB grade. The de-gree of involvement to fundus (FEI: fungus extension index) is indicated by the degree of invasion of the tu-mor to the entire internal auditory canal. Results: Most tumors were almost removed (gloss total removal). The average tumor size in 6 patients of retrosigmoid approach was 14.7mm (10mm-21mm) and the average CPA inva-sion was 5.09mm (1.5mm-10.5mm). The FEI was 0.77 (0.73-0.87). Facial nerves were normal postoperatively in all 6 patients. Hearing was preserved in 3 patients, dete-riorated in 1 patient, and lost in 2 patients. The delayed cerebrospinal fluid leak was occurred from 1 patient, but recovered with conservative treatment. 1 patient showed temporary abducens nerve pasly , but recovered soon. In 5 patients of middle fossa approach, the average tumor size was 11.6mm (9mm-14mm) and the CPA invasion with an average 2.8mm (2mm-4mm). The FEI was 0.76 (0.56- 0.96). The 2 patients showed HB II of facial palsy, and the remaining 3 patients showed normal facial func-tion postoperatively. Postoperative hearing was preserved in 3 patients and lost in 2 patients. Conclusion: We think that the extents of fundus involvement by tumor can be used effectively in choosing a surgical approach for acous-tic tumor besides conventional preoperative hearing state, tumor size. And use of this parameter could contribute to the preservation of postoperative hearing However, in order to generalize this, we will need to further collect the case of retrosigmoid approach in the future.

» OTOP-04 08:30~08:40

» THE POTENTIAL PROTECTIvE EFFECTS OF MASTOID PNEUMATIzATION IN TEMPORAL BONE FRACTURES


GACHON UNIVERSITY GIL MEDICAL CENTER

TAE KYU KANG, WOONGSANG SUNWOO

Objectives: We hypothesize that when temporal bone fractures occur, the pneumatic cells in the temporal bone are able to absorb most of the impact force during a traumatic event. This study aims to correlate the de-gree of pneumatization of the temporal bone with clini-

of 16 cases that performed the test. Gain was decreased for video head impulse test in 3 cases (14 %) of 12 cases that performed the test. Hearing deterioration was ob-served in 7/11 cases (63 %) overall. Conclusion: Even in patients with rather small sized tumors confined to the internal auditory canal, hearing and vestibular func-tion status varied widely. Our results suggest that com-prehensive audiovestibular workup should be advised in ICVS patients even incidentally diagnosed cases, and also during follow-up with regular MRI scans.

» OTOP-03 08:20~08:30

» COMPARISON OF HEARINg RESULTS IN MI-CROSURgICAL REMOvAL OF ACOUSTIC TU-MOR WITH RETROSIgMOID APPROACH AND MIDDLE FOSSA APPROACH


AND NECK SURGERY, ST PAULS HOSPITAL, THE

CATHOLIC UNIVERSITY OF KOREA,

SEOUL, KOREA

HYE-SOOK LEE, JI-SUN KIM, JEONG-HOON OH, KI-HONG CHANG

Objectives: Surgical treatment of acoustic tumor in-cludes a translabyrinthine approach, middle fossa ap-proach and retrosigmoid approach. Preoperative hearing and tumor size are known to be the most important fac-tors in choosing surgical approach. In order to preserve the hearing and facial nerves functionally in a small-sized tumor after microsurgery, it is very important to secure sufficient space in the fundus area. The retrosigmoid ap-proach can be used in patients with preoperative good hearing regardless of the tumor size, but there is a limit in securing the surgical field when the tumor invades the fundus. In contrast, middle fossa approach, which is also able to preserve hearing like the retrosigmoid approach, is easy to treat fundus area, but is difficult to use when the tumor is large. The authors performed this study to find out whether the degree of fundus invasion affects post-operative hearing in addition to preoperative hear-ing and tumor size. Methods: We performed this study in 11 patients with surgically removed acoustic tumor from September 2016 to Desember 2018. Retrosigmoid ap-proach was used in 6 patients, and middle fossa approach in 5 patients. Preoperative hearing, tumor size, extents of CPA invasion, extents of fundus involvement, post-

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is a retrospective analysis of 24 subjects who underwent exploratory tympanotomy or ossiculoplasty for second branchial arch-derived ossicular anomaly from April 2015 to December 2018. Results: The average preopera-tive bone- and air-conduction pure tone thresholds were 16.3±10.1 dB and 56.8±13.2dB, respectively, while the postoperative 6 month average bone- and air-conduc-tion thresholds improved significantly to 13.3±10.6dB and 23.5±11.6dB (P=0.045 and P<0.001, respectively). The average preoperative air-bone gap was 40.6±7.5dB, which significantly improved to 10.2±5.9dB at postop-erative 6 months (P<0.001). 3 subjects encountered frac-ture of the footplate while checking the mobility of the stapes. Of these 3, the footplate was microfractured and thus footplate repair and ossiculoplasty with total ossicu-lar replacement prosthesis(TORP) were performed in one case, while the other 2 had to undergo either malleostape-dotomy or footplate reconstruction with soft tissue and ossiculoplasty with TORP due to near- total fracture of the footplate. Conclusion: Taken together, ossiculoplasty in subjects with second branchial arch- derived ossicular anomaly showed excellent outcomes. However, subjects with second-branchial arch-derived ossicular anomaly may have relatively thin footplate as compared with those with normal ossicular development. In this regard, a frag-ile footplate should always be expected and it is of utmost importance not to exert excessive force on the footplate when checking the mobility or placing ossicular prosthe-sis on it.

OTOP-2Room 3-1 (Emerald A)

Chair : GI JUNG IM, SO YOUNG PARK

Inner Ear Basic II

» OTOP-06 08:00~08:10

» RARE vARIANTS IN PORE REgION OF KCNQ4 FOUND IN NORMAL POPULATION HAvE IMPAIRED CHANNEL ACTIvITIES CAUS-INg HEARINg IMPAIRMENT


YONSEI UNIVERSITY COLLEGE OF MEDICINE1,

DEPARTMENT OF PHARMACOLOGY,

cal sequelae of temporal bone fracture (TBF). Methods: Charts and computed tomography scans representing 54 TBFs, diagnosed from 2012 to 2017 at a single tertiary hospital, were retrospectively reviewed. Temporal bone pneumatization (TBP) in the petrous apex and mastoid region was evaluated using previously published classifica-tion systems. TBP classifications and fracture types were correlated with TBF complications such as sensorineu-ral hearing loss (SNHL), facial nerve palsy (FNP), and vestibular dysfunction. Results: Patients with increased mastoid pneumatization had significantly fewer and less severe SNHL. SNHL more strongly correlated with TBP in the mastoid (P=.005) than did TBP in the petrous apex(P=.024). On the other hand, the TBP classifica-tion system correlated poorly with FNP and vestibular dysfunction. However, the mastoid hypopneumatization demonstrated significant correlation with otic-capsule vi-olations (P=.002). Fractures with otic-capsule violation (OCV) were 4 times more likely to have vestibular dys-function (P=.043) and 3 times more likely to have SNHL (P=.006). FNP did not correlated with OCV but was 3.5 times more common in comminuted fractures (P=.025). Conclusion: The increased degree of TBP in the mastoid reduced the incidence of OCV and the severity of hear-ing impairment in patients with temporal bone fracture. This study substantiated the potential protective effect of mastoid pneumatization in TBFs.

» OTOP-05 08:40~08:50

» BEWARE OF FRAgILE FOOTPLATE - LES-SONS FROM OSSICULOPLASTY IN SUBJECTS WITH SECOND BRANCHIAL ARCH-DERIvED OSSICULAR ANOMALY



UNIVERSITY BUNDANG HOSPITAL

SUN A HAN, GOUN CHOE, JA-WON KOO, BYUNG-YOON CHOI, JAE-JIN SONG

Objectives: The long process of the incus, the suprastruc-ture of the stapes, and the lateral half of the footplate are the derivatives of the second branchial arch. In this study, we aim to analyze intraoperative findings and post-operative results of ossiculoplasty in subjects with second branchial arch-derived ossicular anomaly, and summarize pitfalls that may be encountered and precautions that should be taken intraoperatively. Methods: This study

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els of the main potassium channels Kir4.1(KCNJ10), NKCC1 and KCNQ4. Methods: In order to find the conditions in which HEI-OC1 cells express many ion channels, Expression of ion channels was confirmed in 33C condition and 39C condition, respectively. Kana-mycin and furosemide were treated at different concen-trations to select a concentration that did not induce cy-totoxicity. Expression changes in Kir4.1, NKCC1, and KCNQ4 channels by kanamycin and furosemide were confirmed by Western blot and quantitative real-time PCR (qRT-PCR). In vivo experiments, a 'one- shot' hear-ing loss animal model was made by injecting Kanamycin and Furosemide into C57BL / 6 mice. After 14 days, co-chlear sections were paraffin sectioned, and changes in the expression levels of Kir4.1, NKCC1 and KCNQ4 were confirmed by immunofluorescence (IF). Results: HEI-OC1 cells highly express Kir4.1 at 39C, day5. Thus, all experiments were conducted under these conditions. Cytotoxicity by concentration When the experiment was conducted, Kanamycin was not cytotoxic to 2.5mM and Furosemide to 50uM. All drug experiments were con-ducted under conditions that did not cause cytotoxicity. When Kanamycin was used alone, the expression level of Kir4.1 increased. However, when treated with Furo-semide alone, the expression level of Kir4.1 decreased. When Kanamycin and Furosemide were treated togeth-er, expression of both Kir4.1, NKCC1 and KCNQ4 decreased. After Kir4.1 was inhibited by siRNA, When treated with the same concentration of aminoglycoside drug, cell death was induced. Conclusion: Kir4.1 tries to maintain potassium in the cell through compensating action when other channels are deficient. That is why, Kir4.1 is an inwardly-rectifying potassium channel, but when the outward channel is inhibited, it acts outwardly through compensation.

» OTOP-08 08:20~08:30

» TRANSPLANTED HUMAN INDUCED NEURAL STEM CELL IMPROvES SPIRAL gANgLION POPULATION AND NEURAL CONNECTION TO-WARD CENTRAL AUDITORY PATHWAY



DANKOOK UNIVERSITY1 INSTITUTE OF

TISSUE REGENERATION ENGINEERING (ITREN),

DANKOOK UNIVERSITY, CHEONAN2

MIN YOUNG LEE1, SO-YOUNG CHANG1,

YONSEI UNIVERSITY COLLEGE OF MEDICINE2

JINSEI JUNG1, HAIYUE LIN1, HEON YUNG GEE2, JAE YOUNG CHOI1

Objectives: KCNQ4 is one of the most common caus-ing mutated gene in autosomal dominant non-syndromic hearing loss (NSHL). Most KCNQ4 mutations linked to hearing loss are clustered around the pore region of the protein and lead to loss of KCNQ4-mediated potassium currents. To understand the contribution of KCNQ4 variants to NSHL, we investigated the rare KCNQ4 vari-ants found in public databases. Methods: We evaluated public databases including genetic analyses in normal population and found 17 loss-of-function and six mis-sense KCNQ4 variants affecting amino acids around the pore region. the expression and function of the selected variants in KCNQ4 was evaluated by western blotting, immunostaining, and whole cell patch clamp recording. Results: We examined the functional impact of these variants, which showed a reduction in potassium channel activity without altering expression or trafficking, being functionally similar to DFNA2-associated KCNQ4 mu-tations. Therefore, these variants may act as risk factors for late-onset hearing loss and individuals with one of these variants may develop hearing loss during adult-hood. In addition, reduced channel activity could be rescued by KCNQ activators, suggesting the possibili-ty of medical intervention. Conclusion: These findings indicate that KCNQ4 variants may contribute more to late-onset NSHL than expected, and therefore, genetic screening for this gene is important for prevention and treatment of this condition.

» OTOP-07 08:10~08:20

» THE IMPORTANT ROLE OF KCNJ10 ION CHANNEL IN AMINOgLYCOSIDE-INDUCED OTOTOxICITY IN HEI-OC1 CELLS


YONSEI UNIVERSITY WONJU

COLLEGE OF MEDICINE

JINSIL CHOI, YOUNG JOON SEO

Objectives: Our aim is to reveal that the Kir4.1 channel plays an important role in HEI-OC1 cells and that the ototoxic drug is responsible for the correlation between the channels through the change of the expression lev-

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COLLEGE OF MEDICINE, DANKOOK UNIVERSITY2,

DEPARTMENT OF BIOMEDICAL ENGINEERING,

COLLEGE OF MEDICINE, DANKOOK UNIVERSITY 3

SO-YOUNG CHANG1, MIN YOUNG LEE1,2, ILYONG PARK1,3, JI EUN CHOI2,

JAE YUN JUNG1,2*

Objectives: Salicylate (SS), a component of the aspirin, can cause reversible tinnitus by high dose. Gap-Prepulse Inhibition of the Acoustic Startle Reflex (GPIAS) is a par-adigm for detecting tinnitus objectively in animal. We in-duced tinnitus using SS in mouse, and less variable, and efficiently reduced GPIAS parameter was determined. In addition, protein expressions (such as VGLUT 1&2 and TRPV1) in cochlea, spiral ganglion neuron (SGN), and cochlea nucleus (CN) are compared between control and tinnitus group. Methods: Various inter-stimulus interval (ISI) (0 to 100 ms) and startle pulse duration (20, 40 and 60 ms) were tested to normal mice. For the induction of tinnitus, SS with different concentration was injected three consecutive days. Then GPIAS, of which the param-eters that were determined in present study, was tested 2 h after each SS injection. Using the parameters GPIAS were measured. Epifluorescence analysis of cochlea, SGN and CN was performed. VGLUT 1&2 and TRPV1 ex-pression were analyzed. Results: In the untreated mice, 20 ms of ISI and 20 ms of startle pulse duration showed highest reduction of GPIAS and showed least variability. No alteration was observed after SS injection in cochlea and SGN with epifluorescence analysis. The expression of VGLUT 1 in CN was significantly decreased after SS injection compare to the control, while the expression of VGLUT2 in CN was significantly increased compared to the control. In addition, the expression of TRPV1 in CN was significantly increased after SS injection. Conclusion: GPIAS value reduced after SS injection with current protocol for GPIAS, which indirectly proves the existence of tinnitus. After SS injection VGLUT2 and TRPV1 increased while VGLUT1 decreased.

» OTOP-10 08:40~08:50

» DIFFERENT DISTRIBUTIONS AND CONTRI-BUTIONS OF ION CHANNELS ALONg THE TO-NOTOPIC TURNS OF RAT COCHLEA


NECK SURGERY, KOREA UNIVERSITY COLLEGE

HOSUP SHIM2, JAE YUN JUNG1

Objectives: Hearing rehabilitations rely on to hearing aids and cochlear implant(CI)s depending on the degree of hearing loss. As to CI, neural structures and connec-tion network is important for appropriate function of cochlear implant and progressive degeneration of these neural structure and network after loss of cochlear HC is big obstacle for CI application. In the present study, we evaluated the population and cell characteristics of spiral ganglion neuron(SGN) and central neural connections in cochlear nucleus(CN) after induced neural stem cell(iN-SC) delivery into cochlea in auditory neuropathy animal model. Methods: Adult gerbils were used for the exper-iment. To induce auditory neuropathy in all animals, ouabain was applied to round window then hearing func-tion was evaluated. Animals were divided into two group; iNSC transplanted group and Ouabain only group. As for the iNSC transplantation, cells were transplanted into scala tympani at 2 weeks after initial modeling. Two week after the transplantation, hearing function was assessed then sacrificed for histology. Results: As to histology of SGN, cell density was statistically higher in iNSC group. With epifluorescence analysis, these cells were TuJ positive indicating the functioning neural cells and GFP positive suggesting transplanted iNSC. Statistically expression of NF was observed suggesting the possibility of increased neural structures adjacent to SGN. Both peripheral and central neural connections were evaluated after confirm-ing minimal improvement of hearing function. Despite poor connection of periphery, central synaptic popula-tion in CN was increased in iNSC group compared to control. Conclusion: iNSC transplantation resulted in increased population of SGN possibly replaced by trans-planted cells and increased neural structures. Despite no functional improvement, enhanced neural structures might be a possible evidence for application of stem cell therapy as an adjuvant for cochlear implantation.

» OTOP-09 08:30~08:40

» CONFIRMATION OF vgLUT REDISTRIBU-TION IN SALICYLATE INDUCED TINNITUS ANIMAL DETERMINED BY OPTIMAL gPIAS PA-RAMETER

BECKMAN LASER INSTITUTE KOREA,

DANKOOK UNIVERSITY1, DEPARTMENT OF

OTOLARYNGOLOGY-HEAD & NECK SURGERY,

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Chair : MOO JIN BAEK, HYUN JOON SHIM

Inner Ear Basic I

» OTOP-11 11:30~11:40

» ExPRESSION OF IMMEDIATE-EARLY gENES IN RAT WITH NOISE-INDUCED TINNITUS

1DEPARTMENT OF OTORHINOLARYNGOLOGY,

EULJI UNIVERSITY, DAEJEON, 2DEPARTMENT

OF MEDICAL SCIENCE, CHUNGNAM NATIONAL

UNIVERSITY, DAEJEON, KOREA,3DEPARTMENT OF

OTOLARYNGOLOGY-HEAD AND NECK SURGERY,

CHUNGNAM NATIONAL UNIVERSITY, DAEJEON

HO YUN LEE1, SUN AE SHIN2, AH-RA LYU2, YONG-HO PARK3

Objectives: Various areas of the brain are thought to be involved in the development of tinnitus. We aimed to observe the changes of immediate-early genes (IEGs) in the auditory pathways and limbic system in the noise - induced tinnitus animal model. Methods: Rats were exposed to noise only in the left ear. Serial prepulse in-hibition of the acoustic startle was evaluated to deter-mine whether the rats had tinnitus. Western blot was performed to measure expression of EGR-1, c-fos in the various brain regions before and after noise exposure. Results: In the cochlear nucleus, the expression of EGR-1 and expression of c-fos differed between time points (p<0.01). Compared with the normal control, increased expression of c-fos on day 14 and the expression of EGR-1 decreased on day 3 and 28 was observed(p<0.05). On day 3 in the auditory cortex, the abrupt decrease and then increase of EGR-1 expression were remarkable. The expression patterns of IEGs in the hippocampus were similar to cochlear nucleus. In the amygdala, changes in the expression of IEGs were not significant (p>0.05). Compared to right side, expression of IEGs on the left side tended to increase in the cochlear nucleus, auditory cortex and hippocampus except amygdala. Conclusion: Sustained neuronal activity in cochlear nucleus may be the main focus that causes tinnitus. In addition, neuronal

OF MEDICINE, SEOUL, KOREA1, COLLEGE OF

PHARMACY AND NATURAL MEDICINE RESEARCH

INSTITUTE, MOKPO NATIONAL UNIVERSITY,

MUAN, REPUBLIC OF KOREA2

SE HEE LEE1, KUSHAL SHARMA2, EUNYOUNG YI2, EUYHYUN PARK1,

SUNG WON CHAE1, HAK HYUN JUNG1, GI JUNG IM1*

Objectives: The aim of this study was to investigate the tonotopic distribution/contribution of ion channels in rat cochlea using whole-cell patch-clamp recordings, quantitative PCR, and western blotting. Methods: using the organ of Corti dissected from the cochlea of rats at postnatal days 8-10. Three tonotopic regions in the organ of Corti were examined:apical,middle,basal. Electrophys-iological patch responses to ACh were recorded in IHCs of these three regions. Multiple ion channels were ana-lyzed in the three regions using PCR/western(BK1,SK2). Results: Activity of BK1/SK2 was significantly increased in basal turn. Patch-clamp showed that the efferent re-sponses of the inner hair cells differed along the tono-topic turns of the cochlea, and that the ACh response of the basal region was stronger than that of the apical region (2-fold higher). High concentration potassium solution evoked synaptic events, which significantly in-creased from the apical to the basal region (6 fold higher). Number of BK1/SK2 was increased in basal turn (high-freq) using molecular studies. BK1 mRNA were signifi-cantly increased (1.96±0.2 fold) from the apical to the basal region, and BK1 protein tended to increase along the whole cochlear turn. SK2 mRNA were similar along the whole turn from the apical to basal region, where-as SK2 protein were significantly increased in the basal region compared with the apical region (4±1.64 fold). Conclusion: The different distribution and contribution of ion channels may play a role in tonotopical detection of sound in cochlea, and may be related to ion exchange, especially potassium exchange through BK1. In the basal turn, BK1/SK2 were higher than in the apical turn, and it is presumed that the uneven distribution or development of ion channels is induced by different efferent synaptic events. These differences in ion channel distribution may also be related to different sensitivities to both ototoxic drugs and noise damage, which typically induce more damage in the basal turn compared with apex

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group. Additionally, GAP43 and p-Smad2/3 were sig-nificantly higher in deaf group than control group, and significantly decreased in losartan group than deaf group. Conclusion: Losartan might prevent axonal sprouting in IC, following unilateral hearing loss by blocking TGF-β signaling. Axonal sprouting might be involved in the change of inhibitory neurotransmission after hearing loss.

» OTOP-13 11:50~12:00

» PROTECTIvE EFFECTS OF AgMATINE AgAINST CISPLATIN-INDUCED APOPTOSIS IN AUDITORY CELL LINE


HEAD AND NECK SURGERY, KOREA UNIVERSITY

COLLEGE OF MEDICINE

EUYHYUN PARK, SE HEE LEE, JAE-JUN SONG, SUNG WON CHAE,

HAK HYUN JUNG, GI JUNG IM

Objectives: Agmatine, an endogenous metabolite of arginine, is known to has antioxidant activity, protects mitochondrial function and confers resistance to cellular apoptosis. The known functions of agmatine is to against Ca2+-induced mitochondrial swelling and mitochondrial membrane potential collapse. Thus, the aim of this study was to evaluate the protective effects of agmatine on cis-platin-induced cellular apoptosis in HEI-OC1 auditory cell line. Methods: HEI-OC1 cells were cotreated with 6 mM agmatine and 15 uM cisplatin for 48 h. The cel-lular viability was measured by using the Cell Counting Kit-8 (CCK-8) assay kit. The intracellular ROS level was measured by using a fluorescent dye, 2′,7′-dichlorofluo-rescein diacetate (DCFH-DA). Both Annexin V-FITC and propidium iodide (PI) staining were performed to analyze the pattern of apoptosis. Also, the enzymatic ac-tivity of caspase-3 and expression of Bcl-2 family mem-bers were performed to analyze the pathway of apopto-sis and mitochondrial function. Results: Co-treatment with 6 mM agmatine protected HEI-OC1 cells against cisplatin- induced apoptosis. Agmatine provided signifi-cant protection against 15 uM cisplatin applied for 48 h (50.1% cell viability in the cisplatin group vs. 63.9% in the cisplatin-plus-agmatine group). There was a 11.7% reduction of reactive oxygen species (ROS) and 33.3% decrease in necrosis and late apoptosis as compared to cisplatin group. Agmatine also decreased the activity of caspase-3 and expression of proapoptotic Bcl-2 family

changes in auditory cortex and hippocampus were also observed to a lesser extent.

» OTOP-12 11:40~11:50

» LOSARTAN PREvENTS AxONAL SPROUT-INg AND THE DECREASE OF INHIBITORY NEUROTRANSMITTERS IN INFERIOR COLLIC-ULUS AFTER UNILATERAL HEARINg LOSS



CHUNG-ANG UNIVERSITY COLLEGE

OF MEDICINE1, DEPARTMENT OF


SEOUL NATIONAL UNIVERSITY HOSPITAL2

MUNYOUNG CHANG1, YUJU SEO2, SEONYONG SOHN1, XIAN-YU PIAO1,

JUN HO LEE2, SEOG-KYUN MUN1

Objectives: Several studies reported that the neuronal activity and neurotransmission in the inferior colliculus (IC) are altered following hearing loss. We hypothesized that axonal sprouting, which is promoted by TGF-β signaling, might be associated with the alteration of the excitatory and inhibitory neurotransmission in IC, and investigated whether the neurotransmission and axonal sprouting in IC are changed with losartan which blocks TGF-β signaling. Methods: Rats were randomly divided into three groups: control group that underwent a sham operation, deaf group that underwent cochlea ablation on the left side and losartan group that underwent co-chlear ablation on the left side and received losartan for 2 weeks. IC of the right side were harvested 1 or 2 weeks after surgery. Hearing level was estimated with auditory brainstem responses (ABRs). Western blotting was per-formed for NR2A, Calb, GaBAAa1, GAD67, GAP43, Synaptophysin, PDS95, ATRX, GDF10, Lingo1, IGF1, pSmad2/3. Results: Baseline ABR thresholds before sur-gery ranged from 20 to 35 dB SPL. After cochlear abla-tion, ABR thresholds were higher than 80dB. Comparing control, deaf and losartan group at 2 weeks after surgery, deaf and losartan group had significantly lower levels of NR2A than control group. There was no significant dif-ference between deaf and losartan groups. The expres-sion of GABAAa1 and GAD67 showed significantly lower level in deaf group than control group. However, losartan group showed significantly higher level than deaf

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el of KCNJ11. The auditory brainstem response (ABR) threshold on the right ear was also correlated (r=0.678, p<0.05). Conclusion: This DNA methylation profile in-dicates the susceptibility loci of DRHL. The potassium metabolism may play a critical role in the hearing loss caused by hyperglycemia.

» OTOP-15 12:10~12:20

» AvOCADO OIL ExTRACT MODULATES AUDI-TORY HAIR CELL FUNCTION THROUgH THE REgULATION OF AMINO ACID BIOSYNTHESIS gENES



DEPARTMENT OF PREVENTIVE PHARMACY

AND TOXICOLOGY, COLLEGE OF PHARMACY,

KYUNG HEE UNIVERSITY2, GACHON INSTITUTE

OF PHARMACEUTICAL SCIENCES, COLLEGE OF

PHARMACY, GACHON UNIVERSTY3, COLLEGE

OF PHARMACY, YONSEI INSTITUTE OF

PHARMACEUTICAL SCIENCES,

YONSEI UNIVERSITY4, R&D CENTER,

DONGKOOK PHARM CO, LTD5

IN SEOK MOON1, TONG HO KANG2, KWANG WON JEONG3, SEUNG HYUN KIM4,

DO HOON KIM5

Objectives: Prevention or therapy of SNHL has not been widely studied. Avocado oil has shown many health ben-efits but it has not yet been studied in regards to SNHL. Therefore, we aimed to investigate the efficacy of avoca-do oil on SNHL in vitro and in vivo and elucidate its mode of action. Methods: We used enhanced functional avocado oilextract (DKB122). To evaluate the effect of DKB122 on otic hair cell recovery,the neomycin solu-tion was used for ototoxic agent. Then thezebrafish were exposed to DKB122 10 ug/mL for 8 h at 28C. The ex-perimental mice were exposed to 115 dB sound pressure level (SPL) as a broad band noise with a frequency spec-trum from 100 Hz to 10 kHz for 1 h 30 min to induce hearing loss. The mice were divided into 3 groups (n = 10/group) and treated orally once daily as follows:control mice with 0.3 mL of vehicle (80% distilled water, 10% dimethyl sulfoxide (DMSO), and 10% Tween 20), 100 mg/kg DKB122 in the vehicle (DKB122, 100 mg/kg),

members. Conclusion: Agmatine significantly protected a cisplatin-induced apoptosis in auditory cell line. These effects were mediated by its scavenging activity against ROS, protects mitochondrial function, and inhibition of apoptosis.

» OTOP-14 12:00~12:10

» gENOME-WIDE DNA METHYLATION ANAL-YSIS OF HUMAN PERIPHERAL BLOOD RE-vEALS SUSCEPTIBILITY LOCI OF DIABE-TES-RELATED HEARINg LOSS

DEP. OF OTOLARYNGOLOGY, HEAD & NECK

SURGERY, BEIJING TONGREN HOSP. OF

CAPITAL MEDICAL UNIV.

JIN HAO, LIN HUA, XINXING FU, XUELIANG ZHANG, QIJUANG ZOU,

YONGXIN LI

Objectives: Diabetes-related hearing loss (DRHL) is a complication of diabetes mellitus which is drawing more attention currently. DNA methylation plays a critical role in the pathogenesis of type 2 diabetes mellitus (T2DM) and its complications. Therefore we investigated the ge-nome-wide DNA methylation of peripheral blood of T2DM patients with/without hearing loss in order to explore the susceptibility loci of DRHL. Methods: A battery of hearing test, including pure tune average (0.5, 1, 2 and 4 kHz), impedance, DPOAE and ABR, were performed for the selected subjects. Reduced Represen-tation Bisulfite Sequencing (RRBS) was used to detect genome-wide DNA methylation level. In order to ap-prove the classification effect of the extracted differen-tially methylated regions (DMRs), cluster analysis and principal component analysis (PCA) were performed for their DNA methylation profile. Results: Between DRHL group and control group, 113 gene sites were identified to be DMRs. Among 38 DMRs with whole samples, the classification accuracy is up to 90.0%. With alignment to T2DM susceptibility genes and deafness genes pub-lished, KCNJ11 was found to be the only overlapped gene. The DNA methylation level of KCNJ11 was associ-ated with stroke (t=2.595, p<0.05), but not with diabetic nephropathy and diabetic retinopathy. The detective rate of distortion product otoacoustic emissions (DPOAE) from low to high frequencies (0.7~6 kHz) on the right ear was significantly correlated with the methylation lev-

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investigated the changes in auditory-somatosensory in-nervation and the role of axonal sprouting by compar-ing these findings in animal with tinnitus and without tinnitus. Methods: The rats which were exposed to noise inducing transient threshold shift were divided into tin-nitus and non-tinnitus groups based on the results of gap pre-pulse inhibition of acoustic startle (GPIAS). The DCNs were collected from 3 groups of rats divided by time lapse of 1, 2 and 3weeks after noise exposure, re-spectively. We measured the protein levels of vesicular glutamate transporters representing auditory input to DCN; VGLUT1 and somatosensory input; VGLUT2, and axonal sprouting-related factors; GAP-43, PSD95, synaptophysin, PSD95, ATRX, GDF10 and Lingo1 using western blot. Results: Compared to non-tinnitus group and noise-unexposed controls, tinnitus group had earlier decrease in VGLUT1 at 1week and significant in-crease in VGLUT2 at 3weeks. Concurrently, only tinni-tus group showed significant increase in GAP43, ATRX and GDF10, in DCN at 3 weeks after noise exposure. Conclusion: The results of present study provided fur-ther evidence that the change of neural input distribution in DCN can cause tinnitus and the axonal sprouting is the basis of this alteration.

OTOP-4Room 2-1 (Flamingo)

Chair : CHANG HO LEE, KYOUNG HO PARK

Auditory System & Neuropathy

» OTOP-17 14:30~14:40

» DEvELOPMENT OF SOUND FIELD AUDIOM-ETRY SYSTEM FOR SMALL AUDIOMETRIC BOOTHS


CHONNAM NATIONAL UNIVERSITY

COLLEGE OF MEDICINE

HYONG-HO CHO, YOUNG MI CHOI, YONG-BEOM CHOO

Objectives: Sound field audiometry tests are usually con-ducted in more than 2x2 m sized audiometric booths.

and 300 mg/kg DKB122 in the vehicle (DKB122, 300 mg/kg). The treatment started 1 day after noise exposure and continued up to 20 days. HEI-OC1 cells were pre-treated with DKB122 (5~40 ug/mL) for 1 h and then neomycin was added (10 mM). After 24 h, cells were washed using PBS. Total RNA was extracted, qPCR & sequencing were performed. Results: DKB122 led to recovery of auditory hair cells in zebrafish after neomy-cin- induced otic cell damage. Also, DKB122 improved auditory sensory transmission function in a mouse model of noise induced-hearing loss. In addition,RNA sequenc-ing was performed to elucidate the mechanism involved. KEGG pathway enrichment analysis of differentially ex-pressed genes showed that DKB122 protected HEI-OC1 cells against neomycin-related alterations in gene expres-sion due to oxidative stress, cytokine production and pro-tein synthesis. Conclusion: Our results demonstrate that DKB122 protects hair cells from neomycin by reducing the altered gene expression in the oxidative stress, cyto-kine production and protein synthesis pathways.

» OTOP-16 12:20~12:30

» THE ROLE OF AxONAL SPROUTINg IN THE DORSAL COCHLEAR NUCLEUS FOR THE DEvELOPMENT OF TINNITUS


NATIONAL MEDICAL CENTER1, DEPARTMENT

OF OTORHINOLARYNGOLOGY-HEAD AND NECK

SURGERY, CHUNG-ANG UNIVERSITY COLLEGE

OF MEDICINE2, DEPTMENT OF BIOMEDICAL

ENGINEERING, DANKOOK UNIVERSITY

COLLEGE OF MEDICINE3

KYU-HEE HAN1, SEONYONG SOHN2, XIAN-YU PIAO2, SEOG-KYUN MUN2,

ILYONG PARK3, MUNYOUNG CHANG2

Objectives: Maladaptive auditory-somatosensory plas-ticity after hearing loss in the dorsal cochlear nucleus (DCN) is one of the main theories for the pathogenesis of tinnitus. This phenomenon is presumed to arise as a form of axonal sprouting. There have been evidences that disrupted balance of auditory and somatosensory input occurs after hearing damage and is supposed to induce tinnitus. However, most studies have been undergone with hearing damage model that whether these chang-es are linked to tinnitus is still not evident. Herein, we

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patients with normal hearing thresholds. Several human studies have demonstrated that subjects with tinnitus and normal audiograms show significantly reduced auditory brainstem response (ABR) wave I amplitudes compared with control subjects. We aim to reconfirm the “synap-topathy-induced tinnitus” hypothesis in subjects with a normal audiogram through a within-subject comparison of wave amplitudes in conventional ABR and another comparison of wave latency shifts with increasing noise level in masked ABR. Methods: Human subjects includ-ed 23 unilateral tinnitus patients (14 females, 40.2 ± 13.7 years) with normal and symmetric hearing thresholds and 22 control subjects with normal audiograms. The ampli-tudes of wave I and V were measured twice at 90 dB nHL click stimuli in conventional ABR setting. For masked ABR, the latency of wave V at 80 dB nHL click were recorded twice in broadband noise varying from 80 dB to 40 dB H in 10 dB steps. Because of known sex differ-ence, we analyzed ABR data separately according to sex. Results: In conventional ABRs, the comparison between TEs and NTEs showed no significant differences in wave I and wave V amplitude, or wave V/I ratio in both the male and female groups. In masked ABRs, wave V laten-cies were prolonged with background noise level in both tinnitus subjects and controls. However, there were no significant differences in the wave V latency shift in noise from 40 dB to 70 dB between TEs and NTEs. Similarly, in multiple comparisons among TEs, NTEs, and control ears revealed no significant differences in all ABR pa-rameters. Conclusion: Our ABR data did not represent meaningful evidence supporting the hypothesis of “syn-aptopathy-induced tinnitus”. Although “cochlear synap-topathy” might contribute the generation of tinnitus in some cases, it does not seem to be a common mechanism in tinnitus subjects with normal audiograms.

» OTOP-19 14:50~15:00

» vASCUALR DEMENTIA IS CORRELATED WITH IMPAIRED AUDITORY FUNCTION, BUT NOT ALzHEIMERS DISEASE



DEPARTMENT OF NEUROLOGY,


SEONG-HOON BAE1, JIN-SEI JUNG1, BYUNG-SUK YE2

However, the most common ENT clinics has a 1x1 m sized audiometric booth, so sound field audiometry test-ing is difficult. The aim of this study was to evaluate the usefulness of newly developed sound field audiometry system for small audiometric booths to evaluate the hear-ing aid functional gains. Methods: The newly designed sound field audiometry system can give a sound field signal at a distance of about 30 cm from the subject's ears and adjust the height according to the subject's head height. We compared the hearing results of the existing sound field audiometry system and the newly developed sound field system for 20 normal hearing adults (40 ears) who did not wear hearing aids and 24 hearing loss adults (38 ears) who used hearing aids. The comparative param-eters were pure tone test findings of 250Hz, 1kHz, 2kHz, 4kHz, and 8kHz, speech reception score(SRT), and speech discrimination score(SDS) obtained using sound field test. Results: In the normal hearing group, the pure tone hearing threshold, SRT, and SDS for each frequency were similar in both systems. In the hearing aids group, the pure tone audiometry and SRT were similar in both systems, but SDS was better in the newly developed system. Conclusion: The newly developed sound field audiometry system for the small audiometry booths has similar hearing results to the conventional sound field audiometry system. Therefore, it can be concluded that a small sound field audiometry system could be applied to the small audiometric booths that most ENT clinics have.

» OTOP-18 14:40~14:50

» COMPARISONS OF AUDITORY BRAINSTEM RESPONSE IN TINNITUS EARS AND NON-TIN-NITUS EARS IN UNILATERAL TINNITUS PA-TIENTS WITH NORMAL AUDIOgRAMS - WAvE LATENCY SHIFT IN BACKgROUND NOISE



EULJI UNIVERSITY SCHOOL OF MEDICINE,

EULJI MEDICAL CENTER, SEOUL

HYEON SIK OH, YEON SHIN KANG, DONG HYUN KIM, YONG-HWI AN,

HYUN JOON SHIM

Objectives: Recently,“cochlear synaptopathy” has been suggested as a potential pathophysiology of tinnitus in

April26(Fri)




ing ear is deaf. In this study, we investigated the effect of worse-hearing ear deaf duration on outcome of cochle-ar implantation in asymmetrical hearing loss patients. Methods: We analyzed the medical record and audio-gram of 18 asymmetric hearing loss subjects, whose aver-age hearing threshold of worse-hearing ear is over 90dB HL and that of better-hearing ear is within 90dB HL. We estimated the deaf duration of worse-hearing ear for each subjects, and divided subjects into two groups depending on whether deaf duration of worse-hearing ear is more than 4 years or not. We compared outcomes of cochle-ar implantation for each groups. Results: Spondee word score and everyday sentence score of the subjects whose deaf duration of worse-hearing ear is over 4 years are not inferior to those whose deaf duration of worse-hearing ear is under 4 years. And we cannot observe statistically significant correlation between speech evaluation scores 3 months after cochlear implantation and deaf duration of worse- hearing ear. Conclusion: We can say that cochlear implantation on worse-hearing ear to asymmetric hear-ing loss patients will show good performance regardless of deaf duration of worse-hearing ear.

» OTOP-21 15:10~15:20

» IMPACTS OF PERINEURONAL NETS DIgES-TION WITH CHONDROITINASE ON CENTRAL AUDITORY NERvOUS SYSTEM


CHA UNIVERSITY-HEAD AND NECK SURGERY

CHANG HO LEE, MI KYUNG KIM, HYOUNG-MI KIM, CHEONGSE WON,

TAE HYUN SHIN, SO YOUNG KIM

Objectives: A few studies reported the alteration of peri-neuronal nets (PNNs) after auditory deprivations. The degradation of PNNs was suggested to restore plasticity and enhance recovery from various types of central ner-vous system damages. This study was investigated the effects of PNNs digestion on auditory nervous system in noise-induced hearing loss. Methods: The 8-week-old female Sprague-Dawley rats were divided into four groups (n = 40). Narrow-band-noise (NBN) were de-livered for 2 hours in NBN group (n = 10). One day after 2 hours NBN exposure, the intracranial chondroiti-nase ABC (ChABC) injection was performed in NBN + ChABC group (n = 10). For control groups, the in-tracranial ChABC (ChABC group, n = 10) or vehicle

Objectives: Researches about cognitive impairment with hearing loss proved their relationship, however no stud-ies paid attention to type of cognitive impairment even though there are several different etiologies in cognitive impairment. This cross-sectional study sought to investi-gate the possibility of different hearing abilities depend-ing on etiology of cognitive impairment. Methods: One hundred and twenty three cognitive impairment patients with subjective hearing loss were enrolled. Etiologies of patients were judged from clinical symptoms, cogni-tive function test and image studies. Hearing abilities of patients were evaluated by pure tone audiometry and speech audiometry. Results: Patients with vascular etiol-ogy shows significant worse hearing ability (p < 0.001). Patients with Alzheimer etiology shows significant better hearing ability (p < 0.001). Odd ratio of vascular etiol-ogy patients have significant hearing loss is 5.510 with statistical significance. Periventricular white matter hy-perintensities positively correlated with average pure tone threshold (r = 0.394). Conclusion: Cognitive im-pairment with vascular etiology have worse hearing abil-ities than patients with other etiologies. Common cause theory is supported by this study. Vascular cognitive im-pairment has to be considered as a confounding factor in research of cognitive impairment related hearing loss.

» OTOP-20 15:00~15:10

» INFLUENCES OF WORSE-HEARINg EAR DEAF DURATION ON THE OUTCOME OF CO-CHLEAR IMPLANTS IN POST-LINgUAL ASYM-METRIC HEARINg LOSS

DEPARTMENT OF OTOLARYNGOLOGY, INSTITUTE

OF MEDICAL SCIENCE, WONKWANG UNIVERSITY

SCHOOL OF MEDICINE1, DEPARTMENT OF

OTORHINOLARYNGOLOGY, SEOUL NATIONAL


NATIONAL UNIVERSITY BUNDANG HOSPITAL2

SANG-YOUP LEE1, GOUN CHOE2, BYUNG-YOON CHOI2

Objectives: For post-lingual bilateral hearing loss pa-tients, the outcome of cochlear implants has been report-ed to be poor with longer duration of auditory depriva-tion. By the way, asymmetric hearing loss is different from bilateral hearing loss in that hearing signals can be given through the better-hearing ear even though worse-hear-

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data were obtained from the two hearing aid compa-nies(Phonak&Resound) for patients who were satisfied with their hearing. The PLL was measured by allowing the subject to adjust the output of the hearing aid for satisfactory listening and compared with NAL-NL2 rec-ommend target. The gain value data were collected when 50dB, 65dB and 80dB sound were given respectively at each Hz. The difference in gain values was analyzed along with the following factors: monaural versus binau-ral measures, type of hearing aids, degree of hearing loss, frequency, intensity, age, and gender. Results: The aver-age PLL gain was statistically significant higher than the NAL-NL2 recommended targets. The gain difference was 2.2dB for monaural and 1.5dB for binaural. The BTE user group noted statistically significantly higher gain than the other hearing aid users. When classified accord-ing to the degree of hearing, only moderate group showed significant difference. When viewed in frequency (Hz), there was a meaningful difference in gain values in the or-der of 1kHz, 2kHz, and 4kHz. The gain value of young-er group was higher than the older group. Conclusion: This study was the first in Korea to analyze the difference between actual patient satisfaction level of gain (or PLL) and NAL-NL2. PLL showed higher gain than the NAL-NL2 on average, and sub-analysis was done throughout the study. Linguistic characteristics, age, degree of hear-ing loss, and other many factors may be expected to make this difference, and further research will be needed in the future.


Chair : CHIN SENG CHO, HE IL NOH

Auditory Rehabilitation I

» OTOP-23 15:50~16:00

» CORTICAL REORgANIzATION BY SOUND DEPRIvATION IN POSTLINgUALLY DEAF ADULTS AND CLINICAL UTILITY AS A PRE-DICTION MARKER FOR gOOD COCHLEAR IMPLANT PERFORMANCE USINg ADvANCED MACHINE LEARNINg TECHNIQUES


(vehicle group, n = 10) were injected without NBN ex-posure. The auditory brainstem responses (ABR) of all rats were measured at day 0 and day 7. The expression of aggrecan, brevican, neurocan, tenascinC, tenascinR, matrix metalloprotease (MMP) 9, and MMP14 were measured using reverse transcription polymerase chain reaction (RT-PCR). Primary auditory cortex was im-munostained for Wisteria floribunda agglutinin (WFA), aggrecan, and neurocan. Results: The 2hours of NBN exposure increased the mean ABR thresholds in NBN group and NBN +ChABC group. Although mean ABR thresholds were not increased, the ChABC group showed delayed wave V latencies compared to vehicle, NBN, and NBN + ChABC groups. The mean ABR thresholds and wave V latencies were comparable between NBN group and NBN + ChABC group. The amounts of expression decrease were most for brevican, followed by aggrecan, and tenascinC in NBN + ChABC group compared to NBN group. The expression of neurocan, MMP9, and MMP14 were comparable between NBN group and NBN + ChABC group. Conclusion: The PNNs diges-tion increased the wave V latency in normal hearing rats. Noise-induced hearing loss accompanied rebuilding of digested PNNs. The expression of brevican was most affected by ChABC digestion in noise-induced hearing loss rats.

» OTOP-22 15:20~15:30

» DIFFERENCE BETWEEN THE PREFERRED LISTENINg LEvELS AND THE NAL-NL2 gAIN vALUE IN SOUTH KOREA


KOREA UNIVERSITY COLLEGE OF MEDICINE,

KOREA UNIVERSITY MEDICAL CENTER

JONG-GEUN LEE1, JAE-JUN SONG2, JUNE CHOI3, GI-JUNG IM4, JUNG KYU LEE5,

SUNG-WON CHAE6

Objectives: The patient who adjusts to the hearing aid initially sets the gain to a low value to reduce the feeling of rejection, and then adjust the value depending on in-dividual. Hearing aid companies prescribe hearing aids according to their own formulas or well-known meth-od as NAL-NL2(National Acoustic Laboratory 2nded). Comparison was made between preferred listening level (PLL) and targets from the NAL-NL2. Methods: Retro-spective, single-center, 322patients PLL and NAL-NL2

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dle temporal cortex and thalamus showed a convincing predicting capacity when combined with other clinical measurements. Conclusion: Our findings suggested that auditory and language-associated cortices showed decreased GM volumes, however, cross-modal take-over could reverse the part of the decreasing GM probability of the auditory cortex when deafness was persistent for years. The decreasing GM probability of the right middle temporal cortex and putamen, involved in language and semantic memory process, might work as a useful marker for predicting the outcome of cochlear implant.

» OTOP-24 16:00~16:10

» HYPERBARIC OxYgEN (HBO) THERAPY AS AN EFFECTIvE THERAPEUTIC OPTION FOR PATIENTS WITH SEvERE IDIOPATHIC SUD-DEN SENSORINEURAL HEARINg LOSS


HEAD AND NECK SURGERY, UNIVERSITY OF

ULSAN COLLEGE OF MEDICINE,

ASAN MEDICAL CENTER

YEONJOO CHOI, WOO SEOK KANG, HONG JU PARK, JONG WOO CHUNG,

JOONG HO AHN

Objectives: Idiopathic sudden sensorineural hearing loss (ISSNHL) is defined as hearing loss of 30 dB or more involving 3 or more frequencies over 3 days or less with-out unknown causes. As one of convincing etiology of SSNHL is cochlear ischemia, HBO therapy is suggested to be a promising treatment for hearing recovery, espe-cially for the patients with severe hearing loss (over 70 dBHL). The aim of this study is to demonstrate the effec-tiveness of HBO therapy for patients with severe hearing loss. Methods: We retrospectively reviewed the medical records of consecutive patients who were diagnosed with ISSNHL at Asan medical center from January 2016 to December 2017. All the patients enrolled in this study showed over 70 dB HL on the affected ears. Patients in HBO group received HBO therapy more than 10 times with systemic and intratympanic steroid therapy, while patients in control group received only systemic and in-tratympanic steroid therapy. Results: Total 82 patients (83 ears) were enrolled in this study. 37 patients (38 ears) were enrolled for HBO group and 45 patients (45 ears) were enrolled for control group. There were no difference

HEAD & NECK SURGERY, SAMSUNG CHANGWON

HOSPITAL, SUNGKYUNKWAN UNIVERSITY

SCHOOL OF MEDICINE1, 1DEPARTMENT OF

NEUROLOGY, USC STEVENS NEUROIMAGING

AND INFORMATICS INSTITUTE, KECK

SCHOOL OF MEDICINE, UNIVERSITY OF

SOUTHERN CALIFORNIA2, DEPARTMENT

OF OTORHINOLARYNGOLOGY-HEAD AND

NECK SURGERY, ASAN MEDICAL CENTER,

UNIVERSITY OF ULSAN COLLEGE OF MEDICINE3,

DEPARTMENTS OF OTORHINOLARYNGOLOGY

- HEAD AND NECK SURGERY, SANGGYE PAIK

HOSPITAL, COLLEGE OF MEDICINE,

INJE UNIVERSITY4

JIWON SEO1, ZHE SUN2, JEE YEON LEE3, MIN YOUNG KWAK3, YEHREE KIM3,

JE YEON LEE4, JUN WOO PARK3, WOO SEOK KANG3, JOONG HO AHN3,

JONG WOO CHUNG3, HOSUNG KIM, HONG JU PARK3

Objectives: Long-term hearing loss in postlingually deaf adults may lead progressive structural changes in the ce-rebral cortices where auditory and language functions are processed. These alterations may affect the outcome of the cochlear implant. In our study, we aim to predict the out-come of the cochlear implant using imaging features that characterize such cortical structural changes. Methods: We compared T1-weighted structural magnetic reso-nance images of 47 postlingually deafened subjects who underwent CI surgery with those of 35 sudden hearing loss subjects who were expected no structural changes. We used voxel-based morphometry approach to calculate the brain GM density. To reconstruct a smaller feature-set while collapsing the number of voxel-wise GM density values, we applied an anatomically hypothesized ROI-based method and a data-driven cluster-based method. We fed the reconstructed features to a Random-For-est Regression model combined with clinical features. Results: Our results showed decreased GM probability in bilateral superior, middle and inferior temporal cortices, pre-/post-central cortices as well as putamen in long-term deafness group, most of which are auditory and language processing associated cortices. Interestingly, the GM probability of superior temporal cortex decreased initially but reversed as a function of deaf duration. In post-CI outcome prediction, we found clusters in the right mid-

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bilateral earbuds that were directly paired to the same type of cellphone used for the hearing aid condition. For the quiet condition, subjects were seated in a sound-proof booth and target speech signals were transmitted to the cellphone located inside the booth. The cellphone in the booth transmitted the signal either to the hearing aids or earbuds. For the noisy condition, babble noise was pre-sented from four loud speakers at 75 dBA in the booth. Listening effort was measured and sound quality ques-tionnaire were administered. Results: In case of word and sentence test in noise, using wireless transmission via both hearing aid and ear buds were beneficial for the subjects compared to not using wireless feature (p<0.05). Listening effort in noise was significantly lower with us-ing Bluetooth wireless function (p<0.05). However, there was no significant difference in terms of speech recogni-tion performance and listening efforts between the hear-ing aids- and ear buds-conditions. Regarding sound qual-ity, ear buds-condition were slightly better than hearing aids-condition. Conclusion: Bluetooth wireless stream-ing function is helpful for phone conversation in noisy environments. Additionally, using ear buds can be also beneficial for phone conversation in hearing-impaired listeners.

» OTOP-26 16:20~16:30

» COCHLEAR IMPLANTATION IN POSTLIN-gUALLY DEAF ADULTS IS TIME- SENSITIvE TOWARDS POSITIvE OUTCOME PREDICTION USINg ADvANCED MACHINE LEARNINg TECHNIQUES

DEPARTMENT OF NEUROLOGY, USC STEVENS

NEUROIMAGING AND INFORMATICS INSTITUTE,

KECK SCHOOL OF MEDICINE, UNIVERSITY

OF SOUTHERN CALIFORNIA1, DEPARTMENT

OF OTOLARYNGOLOGY, ASAN MEDICAL

CENTER, UNIVERSITY OF ULSAN COLLEGE

OF MEDICINE, SEOUL, SOUTH KOREA2,


HEAD AND NECK SURGERY, ULSAN

UNIVERSITY HOSPITAL, UNIVERSITY OF ULSAN

COLLEGE OF MEDICINE, ULSAN, KOREA3,

DEPARTMENT OF OTOLARYNGOLOGY, HANIL

GENERAL HOSPITAL, SEOUL, SOUTH KOREA4,



in baseline parameter between two groups; gender, age, affected side, combined symptoms such as tinnitus and dizziness, initial glucose level and initial hearing. After 2-weeks treatment, HBO group showed significantly im-proved hearing than control group (28.1 ± 26.9 in HBO group and 14.8 ± 13.5 in control group, P < 0.05). Al-though HBO group showed more improvement of au-diologic function by Siegel’s criteria than control group, there was no significant difference. Conclusion: From this study, we recommend HBO therapy as initial treat-ment option for ISSNHL patients who suffer from severe hearing loss or as salvage treatment option for patients who failed from initial steroid treatment.

» OTOP-25 16:10~16:20

» COMPARISON OF CELLPHONE CONvER-SATION PERFORMANCE USINg THE BLUE-TOOTH WIRELESS CONNECTION OF HEARINg AIDS AND EARBUDS IN HEARINg-IMPAIRED LISTENERS



UNIVERSITY SCHOOL OF MEDICINE, SAMSUNG

MEDICAL CENTER1, HEARING RESEARCH

LABORATORY, SAMSUNG MEDICAL CENTER2,




SAMSUNG CHANGWON HOSPITAL3

YOUNG SANG CHO1,2, SU YEON PARK2, YEON KYOUNG PARK2, HYE YOON SEOL2,

SUNG HWA HONG1,3, IL JOON MOON1,2

Objectives: The purpose of this study was to compare cell phone conversation performance for hearing-impaired listeners when the subject was using the Bluetooth wire-less connection in a hearing aid or earbud, and a general call status without using the wireless feature. Methods: Twenty-three adults with hearing loss participated (Mild: 3, Moderate: 12, Moderately severe: 7, Severe: 1). First, sentence recognition performance without using the wireless function while wearing hearing aids was evaluat-ed. Second, sentence recognition performance during bi-lateral Bluetooth streaming through the hearing aids was measured. Third, for the earbud condition, subjects wore

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Conclusion: Health care providers should be aware that the patients with severe- to-profound hearing loss who cannot have benefit from hearing aids need to proceed with CI as soon as possible and should continue using hearing aids until after CI operation.

» OTOP-27 16:30~16:40

» PREDICTIvE FACTORS FOR SUCCESSFUL ELECTROACOUSTIC STIMULATION REHA-BILITATION IN CHILDREN WITH PRELINgUAL DEAFNESS




MYONGJI HOSPITAL, HANYANG UNIVERSITY


GI-SUNG NAM1, MEE HYUN SONG2, JAE YOUNG CHOI1, JINSEI JUNG1

Objectives: To evaluate the clinical feasibility and audi-tory benefits of hearing rehabilitation using electroacous-tic stimulation (EAS) after cochlear implantation (CI) and to identify the predictive factors for successful EAS rehabilitation in children. Methods: We retrospectively reviewed seventeen children (21 ears) under the age of 15 years with residual low-frequency hearing who un-derwent CI using hearing preservation techniques. EAS rehabilitation was applied in patients with successful low-frequency hearing preservation. Improvements in speech perception in both quiet and noise conditions were compared between the EAS mode and the CI-only mode. The predictive factors for successful EAS rehabilitation in children were analyzed. Results: Hearing preservation was achieved in 81.0% of patients and successful EAS rehabilitation was possible in 9 of 21 ears. Better speech perception scores were observed in quiet conditions using the EAS mode compared to the CI-only mode, although the difference did not reach statistical significance. Sig-nificantly better scores were observed in noise conditions with the EAS mode compared to the CI-only mode. Post-operative low-frequency pure tone average (PTAlow) was the only significant predictive factor of successful EAS rehabilitation. Conclusion: CI surgery using hearing preservation techniques with EAS rehabilitation should be performed in children, even in patients with limited residual hearing, to improve auditory outcomes and post-




SURGERY, SEOUL NATIONAL UNIVERSITY

HOSPITAL, SEOUL NATIONAL UNIVERSITY


HOSUNG KIM1, WOO SEOK KANG2, HONG JU PARK2, JEE YEON LEE2,

JUN WOO PARK2, YEHREE KIM2, JI WON SEO2, MIN YOUNG KWAK2, BYUNG CHUL KANG3,

CHAN JOO YANG4, BEN A DUFFY1, YOUNG SANG CHO5, SANG-YOUP LEE6,

MYUNG WHAN SUH6, IL JOON MOON5, JOONG HO AHN2, YANG-SUN CHO5,

SEUNG HA OH6, JONG WOO CHUNG2

Objectives: Moderate-to-moderately severe hearing loss can usually be corrected with hearing aids; however, se-vere-to-profound hearing loss often requires a cochlear implant (CI). However, postoperative CI results vary, and the performance of the previous prediction models is limited, indicating that a new approach is needed. For postlingually deaf adults (n=120) who received CI with full insertion, we predicted CI outcomes using a Ran-dom-Forest Regression (RFR) model and investigated the effect of preoperative factors on CI outcomes. Methods: Postoperative word recognition scores (WRS) served as the dependent variable to predict. Predictors included duration of deafness (DoD), age at CI operation (ageCI), duration of hearing-aid use (DoHA), preoperative hear-ing threshold and sentence recognition score. Prediction accuracy was evaluated using mean absolute error (MAE) and Pearson’s correlation coefficient r between the true WRS and predicted WRS. Results: The fitting using a linear model resulted in prediction of WRS with r=0.7 and MAE=15.6 9. RFR outperformed the linear mod-el (r=0.96, MAE=6.0 4.7, p<0.00001). Cross-hospital data validation showed reliable performance using RFR (r=0.90, MAE=9.7 6.9). The contribution of DoD to prediction was the highest (MAE increase when omitted: 14.8), followed by ageCI (8.9) and DoHA (7.5). After CI, patients with DoD<10 years presented better WRSs and smaller variations (p<0.01) than those with longer DoD. Better WRS was also explained by younger age at CI and longer-term DoHA. Machine learning demonstrated a robust prediction performance for CI outcomes in post-lingually deaf adults across different institutes, providing a reference value for counseling patients considering CI.

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provide FG up to 20.5 dB HL which is 4.0-9.8 dB better than other devices. Also, WRS was 3% better than the other devices. It should also be noted that this significant difference was achieved with less distortion, which may be an important point to the patients.


Chair : MIN HYUN PARK, JAE JUN SONG

Auditory Rehabilitation II

» OTOP-29 16:50~17:00

» HEARINg REHABILITATION AND CLINICAL CHARACTERISTICS OF COCHLEAR IMPLANT PATIENTS WITH NOONAN SYNDROME



UNIVERSITY COLLEGE OF MEDICINE1,

DEPARTMENT OF PEDIATRICS, SEOUL NATIONAL

UNIVERSITY COLLEGE OF MEDICINE2

SUNG-DONG CHO1, SANG-YEON LEE1, JUNG MIN KO2, MYUNG-WHAN SUH1,

MOO KYUN PARK1, JUN HO LEE1, SEUNG-HA OH1

Objectives: Noonan syndrome (NS), characterized by cardiac problems, craniofacial dysmorphic features, and short stature, is a genetic multisystem disorder. Mu-tations that cause NS alter encoding proteins based on the dysregulation of RAS-MAPK pathway. Especially, PTPN11, a missense variant, was closely linked to the sensorineural hearing loss (SNHL) in NS. We, herein, aimed to elucidate the audiological characteristics of NS with attention to genotype- phenotype correlation. In ad-dition, we sought to investigate the clinical implications of cochlear implant (CI). Methods: From January 2001 to December 2018, we retrospectively reviewed medical records from patients clinically diagnosed with NS at the Seoul National University Hospital. Ultimately, 291 eli-gible patients were enrolled in this study. Identification of genetic etiology was assessed by Sanger sequencing in

operative PTAlow.

» OTOP-28 16:40~16:50

» DIFFERENCE IN THE REALISTIC OUTCOME OF BONE CONDUCTION DEvICE SPEECH PROCESSORS WITH THE SAME BONE COU-PLER


SEOUL NATIONAL UNIVERSITY HOSPITAL SEOUL


SE JIN HYUN, SANG-YEON LEE, MOO KYUN PARK, JUN HO LEE,

SEUNG HA OH, MYUNG-WHAN SUH

Objectives: Patients who underwent an implantable bone conduction device (BCD) surgery can use either “Oticon Medical” or “Cochlear Limited” speech pro-cessor interchangeably, without any additional surgery. But switching the speech processor is rarely performed due to lack of information and outcome prediction. This study compared the functional gain (FG) and subjective benefit when using the BAHA 5 Power and the Oticon Ponto 3 Superpower in the same subjects with the same coupler. Methods: BAHA Power and Ponto Superpower were tested with the same coupler (Oticon soft band for normal subjects and BAHA implant BI210 in patients). MedEl Adhere was tested in the same location with stick-er type coupler. With the same linear maximum gain set-ting, sound field warble tone air conduction threshold for 0.25, 0.5, 1, 2, 4, and 8 kHz was measured. Mono-sylla-ble WRS was tested at 60 dB HL. As for subjective ben-efit, the IOI-HA questionnaire and forced choice survey on the preferred device were asked. Results: The FG threshold improved to 24.5±5.9 dB HL with the BAHA5 Power. It was 20.5±6.4 dB HL with the Ponto Superpow-er and 30.7±5.0 dB HL for the MedEl Adhere. This dif-ference was statistically significant (p<0.001) The WRS was 95.7±2.0% with the BAHA5 Power, 98.7±2.4% with the Ponto Superpower, and 95.0±3.3% with the MedEl Adhere. The average of IOI-HA was 22.0±4.0 (BAHA5 Power), 25.8±1.7 (Oticon Superpower), and 21.7±0.8 (Medel Adhere). Conclusion: Since speech processors from different manufacturers can be interchangeably used in patients who have already undergone a BCD im-plant, the clinician should know the realistic outcome of different devices. We found that Superpower devices can

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Objectives: Peptide vaccine GV1001 was developed as an anticancer drug and reported to have anti-oxidant and anti-inflammatory effects. Previously, we reported that GV1001 prevent hearing loss and outer cell damages in a kanamycin (KM)-induced ototoxicity model. Now, we studied the effect of GV1001 treatment in the acute noise-induced hearing loss mouse model. Methods: We made the acute noise-induced hearing loss mouse model through exposure of 120 dB noise for 2 hours to C57BL/6 mice. And GV1001 and saline were injected immediately after noise exposure. Hearing threshold was measured on the day of 1, 7, and 14 after noise exposure. And hair cell damages were evaluated on 14 days after noise exposure. Results: GV1001-treated mice showed significantly better hearing level after noise trauma than control group. Hearing threshold shift after noise trau-ma in GV1001 group was 4.4dB at 8kHz, 11.3dB at 16kHz, and 15.6dB at 32kHz, and significantly different with that of control group (45.0dB at 8kHz, 63.8dB at 16kHz, 51.9dB at 32kHz) (All P<0.01). Despite of large thresholds shift after noise trauma, outer hair cell damage was not evident in control group. Intact hair cell rate was 96.9%, 89.0%, and 91.9% at apex, mid, and basal area of cochlear, respectively. GV1001 injected mice showed higher intact hair cell rate in mid (99.7%, P<0.01) and basal area (98.9%, P=0.02). Conclusion: Administration of GV1001 right after noise exposure showed protective effect on noise-induced hearing loss.

» OTOP-31 17:10~17:20

» INFLUENCE OF HEARINg AIDS IN ADULTS WITH UNILATERAL HEARINg LOSS_A PRO-SPECTIvE STUDY

DEPARTMENT OF OTOLARYNGOLOGY, AJOU

UNIVERSITY SCHOOL OF MEDICINE, SUWON,

REPUBLIC OF KOREA1

OAK-SUNG CHOO1, SANG EUN DO1, JEONG HUN JANG1, HUN YI PARK1,

YUN-HOON CHOUNG1

Objectives: Patients with unilateral hearing loss (UHL) receive degraded or absent binaural cues and demonstrate decreased sound localization or linguistic understanding abilities. These may contribute to disturbance in conver-sation and communication in everyday life. Still, there is no definite treatment for these patients. In this study, we evaluated the effect of hearing aid (HA)s in patients with

patients with a characteristic phenotypic marker. Those without the phenotypic markers and those carried no pathogenic variants were evaluated by whole-exome se-quencing. For cochlear implantees, Infant-Toddler Mean-ingful Auditory Integration Scale (IT MAIS), Categories of Auditory Performance (CAP) score were compared by follow-up period. Results: Molecular genetic etiology was identified in 50 (17.2 %) of 291 subjects, comprised of NS genes including PTPN11, RAF1, SOS1, RIT1, etc. Of 50 genetically diagnosed with NS, PTPN11 was dominant in approximately 50%. Among 8 NS patients with SNHL, 7 with PTPN11 demonstrated exclusively profound SNHL while 1 with RAF1 exhibited moderate to severe SNHL, suggesting potential genotype-pheno-type correlation. Based on available 5 cochlear implan-tees with PTPN11, there are significant improvements of CAP (changes of score: 4.57 ± 3.00, P<0.05) and IT-MAIS (changes of score: 28.6 ± 11.9), respectively, at postoperative 1-year evaluation. The postoperative mean aided audio was 28.2 ± 3.37dB. Specifically, younger age at CI was inversely correlated with auditory performance. Conclusion: Through a comprehensive approach includ-ing whole-exome sequencing, we observed heterogeneous genetic background in NS patients. Interestingly, our results suggest that PTPN11 exclusively play a key role of SNHL in NS patients, leading to mostly profound impairment. Also, the potential genotype-phenotype correlations may aid risk assessment and patient manage-ment because the early intervention with CI provides the audiological benefit for NS patients.

» OTOP-30 17:00~17:10

» EFFECT OF PEPTIDE vACCINE gv1001 TREATMENT IN THE ACUTE NOISE-INDUCED HEARINg LOSS MOUSE MODEL


AND NECK SURGERY, SOONCHUNHYANG


DEPARTMENT OF OTOLARYNGOLOGY, INSTITUTE

OF MEDICAL SCIENCE, WONKWANG UNIVERSITY




BUNDANG HOSPITAL3

JAE JOON HAN1, SANG-YOUP LEE2, GAON JUNG3, JA-WON KOO3

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NECK SURGERY, SEOUL UNIVERSITY COLLEGE

OF MEDICINE4, DEPARTMENT OF BIOSTATISTICS,

COLLEGE OF MEDICINE, CATHOLIC UNIVERSITY

OF KOREA5, DIVISION OF SPEECH PATHOLOGY

AND AUDIOLOGY, HALLYM UNIVERSITY COLLEGE

OF NATURAL SCIENCES, CHUNCHEON6,


AND NECK SURGERY, HANYANG UNIVERSITY

COLLEGE OF MEDICINE, SEOUL, KOREA7

SU-KYOUNG PARK1, GI JUNG IM2, JOONG HO AHN3, JUN HO LEE4,

KYUNG DO HAN5, JONG WOO CHUNG3, JIN-SOOK KIM6, HYUNSOOK JANG6,

SEUNG HWAN LEE7

Objectives: Since 2007, Korea has been conducting in-fant health screenings at 4 to 66 months of age for all infants. The purpose of this study is to analyze the status of early hearing loss detection and intervention using na-tional infant health screenings’ database. Methods: Using Korean National health Insurance Research Database, we retrospectively identified infants who were performed newborn hearing screening (NHS) and their NHS re-sults in the hearing questionnaires of the 4 months of age from 2010 through 2016. According to NHS results, we classified the population into pass and refer groups of each year, and analyzed the data. The total No.of per-formed NHS was 1,741,556, which was 55.4% of to-tal newborns (2,179,306) and 85.3% of total infants of hearing health screenings (2,042,577). The total no. of pass group was 1,730,615 and that of refer group was 10,941. Results: The coverage rate of NHS gradually in-creased from 79.5% in 2010 to 89.0% in 2016. In the abnormality rate of head and neck, 4.5% of refer group was significantly higher than that of the pass group 0.7%. In the following general and language development test of each year population from 2010 to 2014, almost refer groups showed significant delay than pass groups. More tracking hearing tests of the refer group was significant-ly performed more and earlier than the pass group. In the CI operation, the No (351, 1.55%) of CI of refer group was significantly higher than that of pass group (225, 0.013%) and the average age of the first CI was 37 months for refer group and 52 months for pass group (p<.0001). The mortality rate of refer group was 0.16%, which was higher than pass group, 0.04%. Conclusion: In the period of national health insurance does not cover NHS, the NHS coverage rate was up to 89%. The refer

UHL. Methods: The study was designed prospectively from September 2017 to December 2018. Mild to severe UHL patients were included in the study; 30 to 90 dB in one ear and below 25dB HL in the normal hearing ear detected by PTA. Two types of HA (RIE or CIC) were prescribed to patients provided by a single brand com-pany. For objective analysis, FGT, K- HINT, and sound localization were repeated before and after the use of HAs during the study period of 6 months. Surveys includ-ing K-HHIE and K-IOI-HA were filled in, accordingly. Results: In a total of 30 patients, mean hearing thresh-olds were 59.2 dB in the impaired ear and 17.0 dB in the normal hearing ear. FGT showed immediate improve-ment, especially in the mid frequencies (1, 2, 3, 4 kHz, p <.001) as well as in aided SA (p<.001). After 3 months of HA use, HINT results were improved in quiet from 23.1 to 21.0 dB (p=.004), and a trend of decrease in SNR was also noted. By 6 months of rehabilitation, patients began to show better results in sound localization with increased total percent correct percentage and decreased error measures. K-HHIE and K-IOI-HA surveys for sub-jective measures all showed better outcomes after the use of HAs (p <.029 and p <.005, respectively). Conclusion: Use of HAs has not been aggressively recommended for UHL probably due to expected limited improvement in sound localization and unsatisfying subjective outcomes. However, based on our study, use of HAs may become a definite treatment option for UHL with proper use and adequate period of rehabilitation.

» OTOP-32 17:20~17:30

» NATIONWIDE ANALYSIS OF HEARINg LOSS DETECTION AND INTERvENTION STATUS OF NEWBORNS AND INFANTS IN SOUTH KOREA 2010-2016 USINg NATIONAL INFANT HEALTH SCREENINgS DATA


HEAD AND NECK SURGERY, HALLYM

UNIVERSITY COLLEGE OF MEDICINE, KANGNAM

SACRED-HEART HOSPITAL1, DEPARTMENT OF


KOREA UNIVERSITY COLLEGE OF MEDICINE2,


AND NECK SURGERY, ASAN MEDICAL CENTER,



April26(Fri)




» OTOP-34 17:40~17:50

» HEARINg HANDICAP IN ASIAN DEMENTED PATIENTS

DEPARTMENT OF PHARMACOLOGY, NATIONAL

UNIVERSITY OF SINGAPORE, SINGAPORE⒥,

RAFFLES NEUROSCIENCE CENTRE, RAFFLES

HOSPITAL, SINGAPORE2, DEPARTMENT OF

OTOLARYNGOLOGY, HEAD AND NECK SURGERY,

NATIONAL UNIVERSITY HOSPITAL, SINGAPORE⒧

BIBEK GYANWALI⒥, SAIMA HILAL⒥, NARAYANASWAMY VENKATASUBRAMANINA2,

CHRISTOPHER CHEN⒥, JENNY HOOI YIN LOO⒧

Objectives: The primary objective of this study was to establish the prevalence of hearing loss in Asian memory clinic patients with mild dementia. Secondly, this study aimed to measure the hearing handicap of these dement-ed patients compared to healthy controls. Methods: This study includes the data obtained from mild dementia patients (Global Clinical Dementia Rating Score=1) who attended the National University hospital mem-ory clinics and non-demented healthy subjects among spouses, caregivers and accompanying persons who are non-genetically related to our patients. All participants underwent comprehensive physical, medical, neuropsy-chological and audiological assessments (i.e. pure tone audiometry - PTA). Disabling hearing loss was defined as a hearing loss of greater than 40 dB in better ear on PTA. Amsterdam Inventory for Auditory Disability and Hand-icap (AIADH) questionnaire was administered through the verbal interview together with their caregivers to measure their hearing handicap score. Linear regression models were used to investigate the association between hearing loss and hearing handicap with dementia. Mean differences (β) with 95% confidence intervals (CI) were calculated. Results: Of 91 participants (65-90 years old) were recruited for this study, 39 of them were demented patients and 52 non-demented healthy controls. 64.1% of the demented patients had disabling hearing loss, which is higher than the non-demented controls (43.2%) (p=0.040). The significant association between hearing handicap (as measured by AIADH) and dementia was observed, which was independent of demographic factors and audiology related history and PTA average (β= -5.78 95% CI= -11.24, -0.34, p=0.038). There was no inde-

group of NHS had significant abnormality of head and neck, delay of general and language development, higher no of CI and morality rate. Therefore, it is necessary to systematically manage the hearing impaired children af-ter NHS.

» OTOP-33 17:30~17:40

» THE EFFECT OF DIABETES ON THE PROg-NOSIS OF SUDDEN SENSORINEURAL HEAR-INg LOSS



HANYANG UNIVERSITY

HEE WON SEO1, JAE HO CHUNG2, HA YOUNG BYUN3, SEUNG HWAN LEE4, CHUL WON PARK5, JIN HYEOK JEONG6

Objectives: The aim of this study was to investigate the clinical implication of diabetes in the management of idiopathic sudden sensorineural hearing loss (ISSNHL). Methods: From January 2015 to December 2018, four hundred three ISSNHL patients who received inpatient management were analyzed. All patients were managed by a uniform treatment protocol of high dose steroid therapy and salvage intratympanic steroid injections. Treatment results were evaluated 3month after the start of treatment, according to Siegel’s criteria. We compare the clinical parameters and treatment outcome between ISSNHL with diabetes and without diabetes. We also evaluate the influence of diabetes in prognosis of ISSN-HL by propensity score matching analysis. Results: Overall 403 ISSNHL patients, ninety-four (94/403, 23.3%) patients had diabetes and 11 patients were newly diagnosed diabetes. Patients with diabetes were signifi-cantly older than who without diabetes (p < .001). And the initial hearing threshold was significantly increased in patients with diabetes (p <. 001). Diabetic patients were hospitalized for a longer period. In addition, poor hear-ing recovery rate was observed in diabetic ISSNHL How-ever, by adjusting age, sex and initial hearing level with propensity score matching analysis, diabetes patients and matched control group showed similar treatment results. Conclusion: ISSNHL with diabetes usually present with severe hearing loss and need longer duration of hospital-ization. However, diabetes itself might not influence on the prognosis of ISSNHL Proper management must be provided in SSNHL with diabetes.

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pendent association between hearing loss and dementia (p>0.05). Conclusion: A significant association between hearing handicap and dementia was found. The mecha-nism of this association requires further research and may involve higher order central processing disorder.

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RHOP-1Room 3-2 (Emerald B)

Chair : WOO YONG BAE, YONG BOK KIM

Sleep Related Breathing Disorders I

» RHOP-01 08:00~08:10

» IMPLICATION OF STAgE SPECIFIC APNEA HYPOPNEA INDEx IN SURgICAL OUTCOME IN MILD TO MODERATE OBSTRUCTIvE SLEEP APNEA




MIN-KYUNG KIM, HYUNG GU KIM, SUNG-WOO CHO, TAE-BIN WON,

CHAE-SEO RHEE, JEONG-WHUN KIM

Objectives: Apneic or hypopneic events are affected by sleep stage and usually during REM stage apnea hypo-pnea index (AHI) becomes greater. However in some pa-tients this does not occur. Therefore difference in AHI ratio according to sleep stage among patients with OSA may represent different pathophysiology. In this study, we analyzed AHI during REM stage(AHIREM) and NREM stage(AHINREM) for patients who had surgi-cal treatment for OSA and tried to evaluate the relation-ship between stage specific AHI and treatment outcome. Methods: This is a retrospective single center study. Pa-tients who underwent sleep apnea surgeries due to mild to moderate degree of OSA were reviewed. PSG and ana-tomical features, type of surgery, and treatment outcomes were analyzed. Patients whose AHIREM/AHINREM>2 were regarded as REM dependent OSA, and the others were regarded as REM non- dependent OSA. Results: In total 42 patients were reviewed. 10 patients were REM dependent OSA, and the other 32 were REM non-depen-dent OSA. There was no significant difference in time in sleep stages, BMI, Freidmann stage and the frequency of performed tongue base surgery among groups. In REM dependent OSA, mean AHI and REM AHI decreased significantly from 13.5 to 5.7/hr (p=0.037) and from 28.8 to 7.0/hr (p=0.005) respectively, while as in REM

non-dependent OSA patients, mean AHI and REM AHI did not change significantly (19.2 to 18.2/hr, p=0.073 and 14.6 to 17.3/hr, p=0.495, respectively). In REM non-dependent OSA patients. mandibular plane to hyoid distance was significantly higher than REM dependent OSA patients (22.0mm vs 16.4mm, p=0.022). There was a significant correlation between mandibular plane to hyoid distance and REM/NREM AHI ratio (r=-0.433, p=0.004), however there was no significant correlation between mandibular plane to hyoid distance and BMI (r=0.239, p=0.128). Conclusion: REM non-dependent OSA had lower hyoid position and was less responsive to surgical treatment implicating these clinical parameters may represent different trait in OSA.

» RHOP-02 08:10~08:20

» vALIDITY OF COMMERCIAL WEARABLE SLEEP AND ACTIvITY TRACKERS COMPARED TO POLYSOMNOgRAPHY


HEAD AND NECK SURGERY, KANGDONG

SACRED HEART HOSPITAL, HALLYM UNIVERSITY

COLLEGE OF MEDICINE1, DEPARTMENT OF

OTOLARYNGOLOGY, AJOU UNIVERSITY

SCHOOL OF MEDICINE2

KYUBO KIM1, JUNG JUN LEE2, DO-YANG PARK2, HYUN JUN KIM2

Objectives: Polysomnography is the gold standard for monitoring sleep. Alternatives of polysomnography are attracting interest for clinical and personal use. Wrist-worn sleep and activity trackers are most commonly used, because of their convenience. However it is not known whether they accurately measure sleep and sleep disturbance events, compared with polysomnography. Methods: One hundred seventy subjects, visiting with sleep disturbance disorders, were assessed in sleep lab-oratory during sleep, concurrently with polysomnogra-phy. Mi Band (Xiaomi inc., China), Gearfit (Samsung inc., Korea) and Fitbit (Fitbit inc., USA) were enrolled as wearable wrist-worn sleep and activity trackers. After excluding ineligible subjects, available sleep parameters of wearable sleep trackers were analyzed with polysom-nography. Scatter plot of wearable sleep trackers and polysomnography, Pearson’s correlation, and Bland-Alt-man plot were used. A p-value of <0.05 was considered


April26(Fri)



and to evaluate influencing factors in the treatment of severe OSA. Methods: From March 2016 to December 2017, 45 patients diagnosed with severe OSA by poly-somnography were enrolled in this study. Patients were prescribed CPAP or APAP by one doctor and decided whether to purchase the machine after a one-month lease period. And after 4 months of prescription, compliance with each PAP was compared. Results: The purchase rate of CPAP (84%) was statistically significantly higher than APAP (55%) (p<0.05). Furthermore, there was a signifi-cant difference in compliance rate between CPAP (64%) and APAP (35%) (p<0.05). The mean pressure and 95th centile leak were 8.62 cmH2O and 12.97 L/min in the CPAP and 10.55 cmH2O and 20.36 L/min in the APAP, respectively. The mean pressure and 95th centile leak were significantly lower in the CPAP than APAP (p=0.010 and p=0.014, respectively). Conclusion: The compliance was significantly higher in the fixed CPAP than APAP, which is may be influenced by the pressure and leak according to the PAP machine.

» RHOP-04 08:30~08:40

» LOW RESPIRATORY AROUSAL THRESHOLD IN OBSTRUCTIvE SLEEP APNEA PATIENTS_ AgE AND gENDER DIFFERENCES


HEAD & NECK SURGERY, SCHOOL OF MEDICINE,

KYUNG HEE UNIVERSITY, SEOUL, KOREA1,


HEAD & NECK SURGERY, KING FAHD MILITARY

MEDICAL COMPLEX, DHAHRAN, SAUDI ARABIA2

KHALID AL-DILAIJAN1,2, OH EUN KWON1, JIN-YOUNG MIN1, KUN HEE LEE1,

SUNG WAN KIM1

Objectives: This study aims to 1) identify the prevalence of low respiratory arousal threshold (low ArTH) among obstructive sleep apnea (OSA) patients, 2) identify differ-ent characteristics in low vs high ArTH groups, and 3) explore the relationship between age and gender of OSA patients on one hand and low ArTH on the other hand. Methods: This was a retrospective study on adult OSA patients who had their polysomnography over three years duration (from Jan. 2015 to Dec. 2017). Low ArTH was estimated by scoring 2 or more points (one point for each: apnea-hypopnea index (AHI) < 30/h, nadir ox-

statistically significant. Results: Total sleep time, deep sleep, light sleep, and wake after sleep onset of Mi band and total sleep time of Gearfit and total sleep time REM, deep sleep, light sleep, and wake after sleep onset of Fit-bit were enrolled as available sleep parameters of device. Total sleep time of Mi band, total sleep time of Gearfit, REM, deep sleep, and wake after sleep onset of Fitbit were correlated in Pearson correlation. However all cor-relation coefficients were relatively low and underestimat-ed in Bland-Altman plot. And most of sleep parameters of all devices are not correlated in correlation studies. Conclusion: Most of sleep parameters of wearable wrist-worn sleep and activity trackers were not suitable, com-pared with polysomnography. Therefore, there is a limit to these devices yet. The accuracy of these devices should be increased in the future, and accurate sleeping informa-tion should be provided to the consumers through accu-rate validation study for future devices.

» RHOP-03 08:20~08:30

» COMPARATIvE ANALYSIS OF AUTOMATIC vERSUS FIxED CONTINUOUS POSITIvE AIR-WAY PRESSURE FOR THE TREATMENT OF OBSTRUCTIvE SLEEP APNEA


HEAD AND NECK SURGERY, PUSAN NATIONAL

UNIVERSITY SCHOOL OF MEDICINE, PUSAN

NATIONAL UNIVERSITY HOSPITAL1,DEPARTMENT


NECK SURGERY, YANGSAN PUSAN NATIONAL

UNIVERSITY SCHOOL OF MEDICINE, YANGSAN

PUSAN NATIONAL UNIVERSITY HOSPITAL2

ILYOUNG CHO1, JUNG WOO LEE1, KUEN-IK YI2, SUNG-DONG KIM1,

SUE JEAN MUN2, HWAN-JUNG ROH2, KYU-SUP CHO1

Objectives: Although continuous positive airway pres-sure (CPAP) is effective in treating obstructive sleep apnea (OSA), inadequate compliance remains a ma-jor cause of treatment failure. Automatic PAP (APAP) has been promoted as having an added advantage over CPAP because of their ability to adapt the pressure lev-el to the patient's need. The purpose of this study was to compare the compliance between CPAP and APAP

April26(Fri)




ness in OSA patients with lateral pharyngeal wall collapse Methods: 133 patients who were diagnosed with OSA were enrolled and the patients (median age 43.2, medi-an BMI: 27.3) were confirmed to have lateral pharyngeal wall collapse under sleep endoscopy in Seoul National University Hospital from 2015 to 2018. Their medical records including polysomnography (PSG), endoscopic findings, change of subjective symptoms, post-operative complications were reviewed retrospectively. Results: We performed relocation pharyngoplasty in OSA patients who showed AHI > 10 events/hr, over grade II retropalatal circumferential narrowing when wake (cm2), and bulky soft tissue around lateral pharyngeal wall. The objective success rate of relocation pharyngoplasty in patients with lateral pharyngeal collapse was 64.3% and significant reduction of mean AHI including improvement of low-est SpO2 was seen at 3 months after relocation pharyn-goplasty. Pre-operative AHI varied from 10.5 to 106.9 (median: 38.1) and postoperative AHI decreased to 20.1. Lowest SpO2 changed from preoperative median value of 80 to postoperative 84%. Total sleep time, daytime sleepiness improved and VAS of snoring also decreased after relocation pharyngoplasty. The rate of postoperative complications including pain or bleeding was minimal and a few patients complained of subtle taste loss after relocation pharyngoplasty. Conclusion: Our data suggest that relocation pharyngoplasty seems to be a promising surgical technique to reduce lateral pharyngeal collapse in OSA patients and is a favorable surgical option for OSA patients with palatal circumferential collapse and bulky lateral pharyngeal tissue.


Chair : BYOUNG JOON BAEK, YING-PIAO WANG

Allergic Rhinitis

» RHOP-06 11:30~11:40

» ENvIRONMENTAL RISK FACTORS FOR PE-DIATRIC ALLERgIC RHINITIS SEONgNAM AT-OPY PROJECT 2017


CHA BUNDANG MEDICAL CENTER,

ygen saturation (SaO2) > 82.5%, hypopneas constitute > 58.3% of all respiratory events). Low ArTH was ana-lyzed according to gender then according to gender and age using 4 subgroups (young females, young males, old females, and old males) where the age groups 18-45 and ≥60 years were considered as young and old age groups, respectively. Results: 608 patients were included (432 (69.6%) males and 185 (30.4%) females). The severity of OSA among enrolled patients was 15.8%, 30.3%, and 53.9% for mild, moderate, and severe OSA, respectively. The mean age for all included subjects was 49.36±15.38 years while the mean BMI was 26.08±3.91 kg/m2. Low ArTH was identified in 360 out of 608 patients (59.2%). 96.4% of mild to moderate OSA patients had low ArTH. Female patients showed a significantly higher tendency for low ArTH (75.1% vs 52.2% in females vs males, re-spectively) (p<0.001). The proportion of low ArTH in young female, old female, young male, and old male OSA patients was 92.6%, 66.2%, 58.9%, and 53.4%, respectively. Conclusion: Low ArTH is a common find-ing in adult OSA patients especially in mild to moderate OSA group. This finding is more common in young, fe-male and non-obese OSA individuals. Among adult OSA patients, young females exhibited the highest proportion of low ArTH while old males had the lowest proportion of low ArTH.

» RHOP-05 08:40~08:50

» THERAPEUTIC OUTCOME AND CLINICAL EF-FICACY OF RELOCATION PHARYNgOPLASTY IN OSA PATIENTS WITH LATERAL PHARYNgEAL WALL COLLAPSE


SEOUL NATIONAL UNIVERSITY COLLEGE OF

MEDICINE, SEOUL NATIONAL UNIVERSITY

HOSPITAL

HEONJEONG OH, YOON JAE SONG, DEUKTAE CHO, YUJU SEO, DONG-YOUNG KIM,

CHAE-SEO RHEE, HYUN JIK KIM

Objectives: The surgical correction of lateral pharyngeal wall collapse seems to be critical in the treatment of OSA and relocation pharyngoplasty has been expected to be a promising surgical option in OSA patients. The purpose of our study is to evaluate the therapeutic outcomes of re-location pharyngoplasty and to assess its clinical effective-


April26(Fri)



derstood. Allergic rhinitis (AR) is often cited as a risk fac-tor for developing AH, but this relationship has not been studied extensively. Our hypothesis is that AR may have relationship in late childhood who have AH. We aim to compare the effects of AR in patients with AH according to age. Methods: Patients of 301 children underwent ad-enoidectomy were evaluated by retrospective chart review. The patients were divided into two groups;< 5 year old (pre-school group), 13~18 year old (adolescent group). In addition, we categorized AR and non-AR(NAR) groups according to the allergy test result. AH was evalu-ated by calculating adenoid-to-nasopharynx ratio (ANR) through the lateral view of paranasal sinus (PNS) x-ray. We compared ANR, total immunoglobulin E (IgE) and AR prevalence between pre-school group and adolescent group. Results: Among 301 patients, pre-school group is 245 and adolescent group is 56. The average ages were 4.28 and 13.95 respectively. The average of total IgE was 148.30±256.29 and 244.68±357.55 in each group.(p=0.004). The AR prevalence of adolescent group (75%) was much higher than those of 13-18 years old children according to the statistics of National Health Insurance Service (12.94%).(p<0.01) And also it was higher than the AR prevalence of pre-school group(38.8%).(p<0.01) The average of ANR was higher in pre-school group than in adolescent group (p=0.038). In addition, we compared ANR between AR and NAR group, the average of ANR was significantly higher in AR group than NAR group (p=0.007). Conclusion: In this study, the AR prevalence of late childhood with AH was higher than those of pre-school group and general population. The phenomenon that symptoms of AH occurred in late childhood may has a relationship with allergic disease and we need to make some further studies.

» RHOP-08 11:50~12:00

» DIFFERENCE OF THE PREvALENCE AND CLINICAL PRESENTATION IN ALLERgIC RHI-NITIS OF THE KOREAN ELDERLY POPULA-TION


YONSEI UNIVERSITY WONJU COLLEGE OF

MEDICINE, WONJU, SOUTH KOREA, DEPARTMENT

OF OTORHINOLARYNGOLOGY, GANGNAM

SEVERANCE HOSPITAL, YONSEI UNIVERSITY

COLLEGE OF MEDICINE, SEOUL, SOUTH KOREA

CHI SANG HWANG1, MIN PYO HONG2,

CHA UNIVERSITY OF MEDICINE

JAE-CHEUL AHN

Objectives: Pediatric allergic rhinitis (AR) is a common disease in rhinology. Several studies reported the increase of pediatric AR. Modern life style and environment could influence the development of AR. this study evaluated the impact of birth and growth environment on pediatric AR. Methods: This study used data of Seongnam Atopy Project (SAP) 2017 where 619 fourth- and fifth-grade elementary students participated. In SAP 2017, AR was diagnosed by Korean version of International Study of Asthma and Allergies in Childhood (ISAAC ) question-naire and skin prick test (SPT). Additional questionnaire evaluated the environment of birth and growth including family structure, feeding, use of daycare facility, indirect smoking, residence, and pets. Results: There were 316 boys and 303 girls with mean age 11.6 ± 0.6 years old. There were 186 (33.0%) children with AR. The preva-lence of AR was 38.9% in boys while it was 27.3% in girls (p<0.001). Most common sensitized allergen was house dust mites (93.0%) in AR. After adjusting gender, multi-ple logistic regression analysis highlighted 2 risk factors: household size < 5 persons (OR 1.889; 95% CI 1.125 – 3.191; p=0.016) and daily natural home ventilation time < 2 hours (1.622; 1.008 – 2.630; 0.048). Conclusion: The household environment could influence prevalence of pediatric AR. Nowadays decreasing household size could increase the prevalence. However, the daily natural home ventilation, more than 2 hours, could reverse the increase of pediatric AR.

» RHOP-07 11:40~11:50

» RELATIONSHIP BETWEEN ADENOID HYPER-TROPHY AND ALLERgIC RHINITIS IN LATE CHILDHOOD


KHUNG HEE UNIVERSITY OF MEDICINE,

KHUNG HEE MEDICAL CENTER

HEE-JIN KANG, OH-EUN KWON, JIN-YOUNG MIN, KUN-HEE LEE, SUNG WAN KIM

Objectives: Adenoid hypertrophy (AH) is usually ob-served in early childhood related with their lymphoid hyperplasia phase. However, AH is sometimes observed in late childhood, the mechanism has not been fully un-

April26(Fri)




allergen simultaneous tests (MAST), and immunoCAP tests for the representative allergen in Korean patients with symptoms of allergic rhinitis. Methods: We retro-spectively analyzed medical records of 698 patients with complaints of allergic rhinitis symptoms who visited Sev-erance Hospital from Jan 2015 to Nov 2017. All patients underwent SPT, MAST, and immunoCAP tests. We an-alyzed results of representative four antigens including Dermatophagoides pteronyssinus (Dp), Dermatophagoi-des farina (Df), cat, and dog. Positive ratio, accuracy, sensitivity, specificity positive predictive value, negative predictive value, the degree of agreement, correlations between diagnostic tests for allergic rhinitis were ana-lyzed. Results: The positive ratio was 9 ~ 47% according to the antigen, and that of SPT was generally more than MAST and immunoCAP tests. DP and DF showed simi-lar agreement in MAST and immunoCAP tests, but there was a difference in kappa value about Cat and Dog be-tween the two tests, which showed a statistical difference. Comparisons between SPT and MAST and between SPT and immunoCAP tests showed statistical differences in antigens except for DF. Conclusion: This study showed differences in positive ratio, agreement, and correlation between allergic tests according to allergens in allergic rhinitis patients. Therefore, it is necessary to take these points into account when interpreting the results of each antigen according to the test method and to consider the history of symptoms.

» RHOP-10 12:10~12:20

» NOvEL APPROACH IN ADDRESSINg OSSE-OUS TYPE OF INFERIOR TURBINATE HYPER-TROPHY- THE PRE-LACRIMAL APPROACH

DEP. OF OTORHINOLARYNGOLOGY, UNIV.

MALAYA1, DEP. OF OTORHINOLARYNGOLOGY,

HOSP. RAJA PERMAISURI BAINUN, IPOH2

HUI MON TEH1, HARVINDER SINGH2

Objectives: Nasal obstruction has been the commonest complaint among all nasal symptoms in allergic rhinitis resulting poor quality of life. There are numerous ther-apeutic methods in improving this symptom including the medical and surgical treatments. Whenever medical treatment fails, inferior turbinate (IT) surgery comes in consideration. Many surgical techniques have been described over the years. However, the evolution of the understanding of the IT anatomy and its physiology

KYUNG-SU KIM2

Objectives: Despite of numerous researches on the clini-cal features and pathophysiologic mechanisms of allergic rhinitis (AR), only a few studies have been published on characterization of AR in the aspect of aging. Therefore, we investigated the prevalence of AR in the elderly (≥ 65 years old) and compared the clinical features of the elder-ly with the younger adult participants (19-64 years old). Methods: Data from 35,714 participants who completed the 2008-2012 Korean National Health and Nutrition Examination Survey were analyzed. The prevalence of AR was assessed on the basis of three different methods: ques-tionnaire-based, physician-diagnosed, and serum specific IgE-tested. Clinical features of AR were compared in the aspects of socio-demographics, general health behaviors, clinical characteristics, and comorbidities of participants. Results: The prevalence of AR in all three diagnostic methods was significantly lower in the elderly than in the adult group (p < 0.0001). We observed a significant de-creased sensitization to Dermatophagoides farina in the elderly (p = 0.006), although it was not correlated with socio-economic status, mental health, and comorbidi-ties in regression analyses. According to nasal symptoms, rhinorrhea was more prevalent in the elderly group (p = 0.008), whereas nasal obstruction is a major problem in adult group (p = 0.018). Conclusion: These results suggest that elderly populations have distinct clinical pre-sentations from adult AR and the management for the elderly AR patients may require different or additional targeted therapies to control AR.

» RHOP-09 12:00~12:10

» CORRELATION BETWEEN SKIN PRICK TEST, MAST, AND IMMUNOCAP ASSAY IN ALLERgIC RHINITIS PATIENTS



THE AIRWAY MUCUS INSTITUTE,


SANG HYEON AHN1, JONG-GYUN HA1, JAE SUNG NAM1, JOO-HEON YOON1,2,

CHANG-HOON KIM1,2, HYUNG-JU CHO1,2

Objectives: The purpose of this study was to determine the correlation between skin prick test (SPT), multiple


April26(Fri)



nitis with anxiety score. Methods: A total of 24 adult allergic rhinitis patients were included in this study. The Hamilton Rating Scale for Anxiety was applied for the evaluation of anxiety score of the patients and a blood sample was taken to be examined levels of IL-4 by ELI-SA. Results: In total of 24 patients (19 women, 5 men) the increasing serum level of IL-4 in 2 allergic patients (8.33%). Ninety-one (91%) were found to have moder-ate anxiety score. The correlation between serum levels of IL-4 and anxiety score was negative (-0.91) and not signif-icant (p= 0.677). Conclusion: There was no significant correlation between serum levels of IL4 in patients with allergic rhinitis with anxiety score.

RHOP-3Room 2-2 (Skylark)

Chair : SANG CHUL IM, SHUHO TANAKA

Sinonasal Tumors

» RHOP-12 14:30~14:40

» SQUAMOUS CELL CARCINOMA ANTIgEN AS A MARKER OF SINONASAL INvERTED PAPIL-LOMA



UNIVERSITY BUNDANG HOSPITAL1, DEPARTMENT

OF OTORHINOLARYNGOLOGY-HEAD & NECK

SURGERY, SEOUL NATIONAL

UNIVERSITY HOSPITAL2

HYUNG GU KIM1, SUNG-WOO CHO1, TAE-BIN WON1, CHAE-SEO RHEE2,

JEONG-WHUN KIM1

Objectives: Squamous cell carcinoma(SCC) antigens are cytoplasmic proteins and they are found in normal squamous epithelia, and in elevated levels in the serum of patients with squamous cell carcinomas. And sinona-sal inverted papilloma(IP) is a proliferative lesion of the squamous epithelium lining the sinonasal tract. Recent studies have shown a close relationship between SCC antigen and sinonasal inverted papilloma. The aim of

leads us contemplating not only the efficacy of the sur-gical techniques. As such, maintaining the nasal function and minimizing complications are also the clear goals of the surgery. To date, only medial flap turbinoplasty and partial turbinectomy are described to address the osseous IT hypertrophy but both aggressive techniques are less favour due to complications such as bleeding, crusting, bone necrosis, synaechia, empty nose syndrome and atro-phy rhinitis. Hereby, we are introducing a novel approach in addressing the osseous type of IT hypertrophy using pre-lacrimal approach. Methods: A step-by-step ap-proaches of our method are presented in video. Results: The critical techniques started with a pre-lacrimal vertical flap incision, followed by the excision of the IT bone, identification and preservation of the nasolacrimal duct and haemostasis of the bleeding vessels. Lastly, reposi-tioning the tissue layer of IT with suturing of the flap. Conclusion: This pre-lacrimal approach of inferior turbi-nate excision preserves the both mucosal and submucosal layers of the IT without excessive reduction its surface area. This method is slightly technically demanding but it has its gradual learning curve like performing septoplasty. Long term efficacy for nasal obstruction symptom using this pre-lacrimal approach is expected to be promising without complications.

» RHOP-11 12:20~12:30

» CORRELATION BETWEEN IL-4 LEvELS AND ANxIETY SCORE IN ALLERgIC RHINITIS PA-TIENTS

DEP. OF OTORHINOLARYNGOLOGY UNIVERSITAS

MUHAMMADIYAH YOGYAKARTA UNIV. FACULTY

OF MEDICINE AND HEALTH SCIENCE

ASTI WIDURI

Objectives: Allergic rhinitis (AR) is a symptomatic dis-order of the nose characterized by high serum levels of IgE, overproduction of T helper type 2 (Th2) cytokines, and selective eosinophil accumulation in the nasal muco-sa. IL-4 and IL-13 cytokines are produced by Th2 cells and are capable of inducing isotype class switching of B cells to produce IgE. AR common nasal symptoms are sneezing, nasal itching, rhinorrhea, and nasal congestion that impact on quality of sleep, wake up feeling tired, they are exposed to a high risk of depression and anxi-ety. This study aimed at investigating the correlation of serum concentrations of IL4 in patients with allergic rhi-

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5-year periods. Results: Most common sinonasal malig-nancy was squamous cell carcinoma (37%), and olfacto-ry neuroblastoma (20%) and lymphoma (8%) followed. Thirty-five percent of sinonasal malignancy has various pathology, such as adenoid cystic carcinoma, adenocarci-noma, sarcoma, melanoma, and so on. With 5-year inter-val (2003~2008, 2009~2013, 2014~2018), there was no significant change in the proportion of pathology. As the initial treatment modality for squamous cell carcinoma, induction chemotherapy was most commonly applied (2004~2008: 50%, 2014~2018: 44%). Surgery was sec-ond most choice (2004~2008: 31%, 2014~2018: 37%). Regarding olfactory neuroblastoma, induction chemo-therapy was most used initial treatment (86% vs. surgery 14%) between 2004 and 2008; however, 10 years later (2014~2018), surgery was most common initial treat-ment modality (57% vs. induction chemotherapy 36%). This might be related to the development of endoscop-ic skull base surgery during recent years. However, the 5-year survival rates of squamous cell carcinoma and ol-factory neuroblastoma were not significantly changed be-tween different 5-year periods (squamous cell carcinoma, 50% (2004~2008) vs. 50% (2009~2013); olfactory neu-roblastoma, 80% (2004~2008) vs. 71% (2009~2013)). Conclusion: Over 15 years, there were no significant changes in the type of pathology and 5-year survival rates of squamous cell carcinoma and olfactory neuroblasto-ma, two most common sinonasal malignancy in SNUH. However, we could find the changing trend in the initial treatment modality for olfactory neuroblastoma due to the evolution of endoscopic skull base surgery.

» RHOP-14 14:50~15:00

» TREATMENT OUTCOMES OF RESIDUAL OR RECURRED NASOPHARYNgEAL CARCINOMA AND THE ROLE OF SURgERY



MEDICINE

SANG-YOON HAN, SUNG-WOO CHO, JUNG WHOON KIM, TAE-BIN WON

Objectives: The treatment of recurred nasopharyngeal cancer is currently a topic of controversy. In this study, we analyzed the treatment outcome of nasopharyngeal cancer patients with emphasis on the role of surgical treatment. Methods: Retrospective review of patients

present study is to investigate whether serum SCC an-tigen level has a correlation with disease status and its usefullness in the early detection of recurrent disease. Methods: A retrospective medical chart review was per-formed for patients diagnosed with sinonasal inverted papilloma or diffuse nasal polyposis, who underwent se-rum SCC antigen level test in Seoul National University Bundang Hospital. Serum SCC antigen level was mea-sured preoperatively, and in each case, we also analyzed the size, involvement and recurrence of lesion. Results: A total 30 pateints were analyzed. Serum SCC antigen was measured in 14 patients with inverted papilloma (IP group), and 16 patients with diffuse nasal polyposis (in-flammatory group). Overall, 64.3% (9 of 16 patients) in the IP group showed elevated serum SCC antigen levels, whereas only 6.2%(one of 16 patients) in the inflamma-tory group. Before surgery, the IP group had a mean se-rum SCC antigen level of 4.11ng/mL, whereas the mean serum SCC antigen level was 1.14ng/mL in the inflam-matory group. Conclusion: Serum SCC antigen level is a useful clinical marker to distinguish new and recurrent IP from inflammatory disease.

» RHOP-13 14:40~14:50

» CHANgINg TRENDS IN SINONASAL MALIg-NANCY SNUH ExPERIENCES




DEUKTAE CHO, DOO HEE HAN, HYUN JIK KIM, TAE-BIN WON,

CHAE-SEO RHEE, DONG-YOUNG KIM

Objectives: The sinonasal malignancy has various patho-logic types, and the trends in treating it might be chang-ing during recent years. So, we aimed to evaluate changes in the type of pathology, initial treatment modality, and treatment outcome during recent 15 years in Seoul Na-tional University Hospital (SNUH). Methods: We ret-rospectively reviewed medical records of patients, who were diagnosed with sinonasal malignancy (C300, C31 in ICD-10 code) and treated in SNUH ENT between 2003 and 2018. In this study, we investigated the type of pathology, and treatment modality and survival rates of two most common cancers (squamous cell carcinoma and olfactory neuroblastoma). In addition, changes in these parameters were compared according to different


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a 20-year period. Malignant tumors primarily arising on the nasal septum were identified and reviewed for pre-sentation symptoms, staging, treatment, recurrence pat-terns, and survival rates. Results: 33 patients were found to have primary malignant tumor of the nasal septum. The average age was 58.1±16.9 years The most common symptom was nasal bleeding (43.3%), followed by na-sal obstruction 23.3(%), and nasal cavity mass (16.7%). Nasal endoscopic finding included septal mass (30.0%), perforation(16.7%) and ulcer (13.3%). The pathologic finding revealed squamous cell carcinoma (33.3 %) to be the predominant cell type, with malignant melanoma (30%) and sarcoma (16.7%) being next in frequency. The patients underwent surgery with adjuvant radiotherapy (13patients), surgery alone (12 patients), and concur-rent chemoradiotherapy (8patients). The mean duration of follow-up was 44.2±42.1 months. The overall 5-year survival was 61.8% in early stage and 48.6% in advance stage. Conclusion: Nasal septum malignancies are highly treatable sinonasal malignancies with good prognosis in early stages. Early detection of septal malignancy increase the chance for successful treatment.

» RHOP-16 15:10~15:20

» THE INCIDENCE AND SURvIvAL RATE OF NASOPHARYNgEAL MALIgNANCY ACCORD-INg TO TREATMENT MODALITY FOR 12 YEARS IN KOREA


YONSEI UNIVERSITY COLLEGE OF MEDICINE1, THE

AIRWAY MUCUS INSTITUTE, YONSEI UNIVERSITY

COLLEGE OF MEDICINE 2, GRADUATE SCHOOL OF

PUBLIC HEALTH, YONSEI UNIVERSITY COLLEGE

OF MEDICINE3

HYUNG-JU CHO1,2, MIN KYUNG HAN3, JONG GYUN HA1, JAE SUNG NAM1,

JUNG JIN PARK1, CHANG-HOON KIM1,2, JOO-HEON YOON1,2

Objectives: Overall incidence rate for nasopharyngeal squamous cell carcinoma in Europe was reported as 0.33/100,000 and 2.31/100,000 in China. Until now, no epidemiologic studies have been conducted on Ko-reans, so we used a national database to investigate the incidence and survival rate of nasopharyngeal malignan-cy in Korea. Methods: We analyzed the database from

who had been diagnosed with nasopharyngeal carcinoma between January 2008 to January 2017 were performed. Patients’ demographics, cancer characteristics such as tumor stage, histology types, and outcomes and com-plications according to different treatment modalities were reviewed. Results: 490 patients (M:F = 380 : 110, mean diagnosis age : 52.81±11.31) were analyzed. 3.88% were in stage I, 21.02% in stage II, 36.94% in stage III, 23.67% in Stage IVA and 5.31% in stage IVB. Treatment modalities were 1) induction chemotherapy followed by definitive CCRT or radiation therapy(RT) 59.21%, 2) CCRT 27.63%, and 3) RT 3.95% 4)palliative chemo, palliatve RT, op 1.32% for each treatment. 90 (18.39%) patients had partial response to primary treatment or dis-ease recurrence in the primary site. For the recurred cases, 38 (42.86%) were treated with combination therapy with surgery. 32 (35.71%) was treated with palliative chemo and palliative RT, 13(14.29%) was treated with CCRT. Only 7(8.33%) patients showed complete remission af-ter 5 years. For recurrent cases, surgery for the primary site was performed in 19(13.30%). After surgery, there was no acute complication. For 33% of nasopharyngec-tomy patients, there was no residual tumor shortly after surgery. Conclusion: Outcome of residual or recurrent nasopharynx carcinoma after primary treatment showed poor outcome. The role of surgery needs to be further elucidated.

» RHOP-15 15:00~15:10

» CLINICAL MANIFESTATIONS AND PROgNO-SIS OF NASAL SEPTUM MALIgNANCY


ASAN MEDICAL CENTER, UNIVERSITY OF ULSAN

COLLEGE OF MEDICINE

DONG KYU LEE, YOO-SAM CHUNG, YONG JU JANG, JI HEUI KIM,

MYEONG SANG YU

Objectives: Primary malignant tumors of the nasal sep-tum are extremely rare and often misdiagnosed since its symptoms are usually confused with everyday rhi-nologic complaints. However, the understanding of the disease is limited due to its rarity. The purpose of this study was to analyse the clinical characteristics and treat-ment outcomes of patients with nasal septal malignancy. Methods: We retrospectively reviewed malignant tumors of the nasal septum treated at Asan Medical Center over

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sal and skullbase tumors. Methods: Retrospective chart review of all patients who underwent transpterygoid approach for tumor resection in our institute by single ENT surgeon from 2014 to 2018. Results: Thirty-sev-en consecutive patients with 28 benign tumors including 10 Schwannoma, 6 angiofibroma, 6 meningioma, and 6 others, and 9 malignant tumors including 4 nasopha-ryngeal malignancies, 2 osteosarcoma, 2 chondrosarcoma and 1 chordoma were treated with curative intent. Mean follow up period was 15.2 months (1-39 months). We performed endoscopic medial maxillectomy with inferior turbinate resection for 53.8% (21/39) patients. 84.6% (33/39) middle turbinates were also resected. Never-theless, there were just 2 patients complaining minimal empty nose symptoms. 64.1% (25/39) vidian nerves were sacrificed but, only 10 patients complained mild dry eye symptom. 35.9% (14/39) nasolacrimal ducts were re-sected but, just one patients who had previous radiation therapy complained epiphora. Conclusion: Although in-ferior turbinate, vidian nerve and nasolacrimal duct were sacrificed for approach to tumors in many patients, sub-jective symptoms are not prevalent. Larger case series and longer follow-up are needed to validate these outcomes.


Chair : JOSEPH K. HAN, JIN HYEOK JEONG

Rhinosinusitis

» RHOP-18 15:50~16:00

» THE COMPARISON OF SURgICAL OUTCOME IN SUBTYPES OF CHRONIC RHINOSINUSITIS, CLASSIFIED ACCORDINg TO HISTOLOgICAL FINDINgS AND JESREC SCORE


SEOUL NATIONAL UNIVERSITY HOSPITAL, SEOUL

NATIONAL UNIVERSITY COLLEGE OF MEDICINE,

SEOUL, KOREA

YUJU SEO, DOO HEE HAN, DONG-YOUNG KIM, HYUN JIK KIM, CHAE-SEO RHEE

Objectives: Several studies have indicated that eosino-

the Korean National Health Insurance (NHI) program which covers almost 100% of the Korean Population from 2005 through 2016. The definition of nasopharyn-geal malignancy for this study was ICD-10 code C11, plus a cancer RID code, plus at one of the following: in-patient admission, surgery, radiotherapy, or chemothera-py. The demographic characteristics, incidence, and prev-alence of nasopharyngeal malignancy were investigated. The incidence was analyzed by age group and geographic location. The treatment patterns for 2yrs after diagnosis and survival were also compared. Results: Totally 5459 subjects were identified. Male(n=4080) was more than female(n=1379). The overall incidence was 0.91/100,000 and the prevalence was 1.74/100,000. The incidence of age group greater than overall rate was from 45~49 age group and the highest incidence rate was indicated at the 65~69 age group(2.4/100,000). The treatment patterns for 2 yrs after diagnosis were classified into 4 categories and sub-classified according to Tx sequences. Survival rate according to first Tx were investigated and overall 5 and 10 yr survival rates were as follow; surgery (5yr; 63.2%, 10yr; 56.2%),radiotherapy (5yr; 61.7%, 10yr; 48.5%),chemotherapy (5yr; 61.9%, 10yr; 51.3%), CCRT (5yr; 68.5%, 10yr; 54.8%). Conclusion: We for the first time investigated the incidence, prevalence and prognosis of nasopharyngeal malignancy in Koreans and found similar characteristics to those reported previously in other countries. In order to develop the best treatment modality for Koreans according to histological type and stage, the current ICD code or national cancer registra-tion system should be modified.

» RHOP-17 15:20~15:30

» MORBIDITIES ASSOCIATED WITH ENDO-SCOPIC TRANSPTERYgOID APPROACH

1DEPARTMENT OF OTORHINOLARYNGOLOGY

HEAD & NECK SURGERY, SAMSUNG MEDICAL

CENTER, SUNGKYUNKWAN UNIVERSITY SCHOOL

OF MEDICINE, SEOUL, KOREA

JI-EUN CHOI1, YANGSEOP NOH1, HYO YEOL KIM1, SEUNG-KYU CHUNG1, HUN-JONG DHONG1, DOO-SIK KONG2,

DO HYUN NAM2, SANG DUK HONG1

Objectives: To analyze the morbidities associated with endoscopic transpterygoid approach for various sinona-


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SURGERY, BORAMAE MEDICAL CENTER3

DONG-KYU KIM1, JIN YOUP KIM2, DAE WOO KIM3

Objectives: Non-eosinophilic chronic rhinosinusitis with nasal polyp (CRSwNP) is more predominantin Asian countries. A few previous studies from Asia suggested that tissue neutrophilia may be associated with CRS re-fractoriness. The objective of this study was to investigate neutrophils-related biomarkers reflect in refractoriness of CRSwNP. Methods: Eosinophilic CRSwNP (ENP) was defined as more than 70 eosinophils/ high power field (HPF) and otherwise was defined as non-eosinophilic CRSwNP (NENP). Tissue neutrophilia (Neuhigh) was defined as human neutrophil elastase(HNE)-positive cells of more than 20 cells/HPF and otherwise was defined as without tissue neutrophilia (Neulow). The several neu-trophil markers were measured in the tissue homogenates using multiplex cytokine assay or ELISA and analyzed. The disease control status was determined at follow-up 1 year after surgery according to EPOS guideline and sub-classified into two groups: controlled group vs. refracto-ry group (partly controlled plus uncontrolled). Results: NENP-Neulow patients showed the highest rate of dis-ease control status (79%), followed by NENP-Neuhigh (51%), ENP- Neulow (50%), and ENP-Neuhigh (14%). On the multivariate analysis, a strongest predictor for CRS refractoriness was tissue neutrophilia (hazard Ratio [HR]:4.38, 95% confidence interval [CI]: 1.76-10.85). The others were Lund-Mackay score (HR: 1.14,95% CI: 1.04-1.23), age (HR:0.96, 95% CI:0.93-0.99), and tis-sue eosinophilia (HR:1.01, 95% CI:1.002-1.01). More-over, on the factor analysis, neutrophils-associated medi-ators had two different phenotypes in terms of disease refractoriness. Among these biomarkers, HNE-positive cells and IL-36ɑ level were significantly upregulated in the refractory group, whereas the levels of MPO and IL-18 were higher in the controlled group. Conclusion: Neutrophils may have different phenotypes according to CRS refractoriness. HNE-positive cells and IL-36ɑ level may be a cellular marker for predicting refractoriness in Asian CRSwNP.

» RHOP-20 16:10~16:20

» TREATMENT OF PARANASAL SINUS INDO-LENT MUCORMYCOSIS

philic chronic rhinosinusitis (ECRS) is associated with poorer treatment outcome, than non-eosinophilic chron-ic rhinosinusitis (NECRS). JESREC score, which consists of CT, endoscopic finding and blood eosinophil(%), had been introduced in Japan to clinically diagnose ECRS. In this study, we aimed to evaluate the practicability of JES-REC scoring system, and compare the surgical outcome of subtypes of CRS. Methods: We evaluated patients with CRS treated with endoscopic sinus surgery from 2015 to 2018. Nasal polyps were divided into histological ECRS and NECRS (h-ECRS vs. h-NECRS) based on tissue eo-sinophilic infiltration (10%), and also graded into 10%, 20%, and 30% depending on the degree of infiltration. In addition, they were clinically classified depending on JESREC score (11≥; j-ECRS, 11<; j-NECRS). Then, we investigated the improvement of nasal symptoms, the re-currence of nasal polyp, and the presence of revision sinus surgery as primary surgical outcome in subtypes of CRS. Results: h-ECRS showed significantly higher JESREC score (mean;12.8 vs. 9.8, p=0.004), and more comorbid-ity of asthma than h-NECRS(26.5% vs 4.5%, p=0.024). The proportion of h-ECRS was statistically significantly higher in j-ECRS than in j-NECRS (p=0.001), however JESREC score was not completely consistent with his-tological findings. 47.8% of j-NECRS was confirmed h-ECRS. The average J score of Grade 3 was significantly higher than that of Grade 0(9.15 vs. 13.6, p<0.001). On the other hand, the average J score of Grade 1-2 was not significantly different. There was a no significant differ-ence in primary surgical outcomes, between ECRS and NECRS, which were classified by both histologic finding and JESREC score. Conclusion: High JESREC score could be regarded as a good predictor of ECRS. Howev-er, mild to moderate ECRS may not be predictable with J score alone. ECRS and NECRS showed comparable surgical outcome and prognosis. ECRS could not be re-sponsible to the poor surgical outcome.

» RHOP-19 16:00~16:10

» NEUTROPHILS-ASSOCIATED BIOMARKERS REFLECT REFRACTORINESS IN ASIAN NASAL POLYPS


HEAD AND NECK SURGERY, CHUNCHEON

SACRED HEART HOSPITAL1, DEPARTMENT OF

OTORHINOLARYNGOLOGY, ARMED FORCES

CAPITAL HOSPITAL2, DEPARTMENT OF

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Objectives: The ability to taste the bitter compounds phenylthiocarbamide (PTC) is a classic inherited trait in humans. The bitter taste receptor TAS2R38, expressed in the tongue and nasal epithelium, has been shown to trigger sinonasal innate immunity contributing to the prevention of gram-negative upper airway bacterial infec-tions. Common polymorphisms of the TAS2R38 gene, correlating with bitter taste sensitivity to PTC, with spe-cific genotypes significantly more common in medically recalcitrant chronic rhinosinusitis(CRS) patients. The aim of this study was to investigate the relationship be-tween PTC taste sensitivity and postoperative results of chronic rhinosinusitis. Methods: Thirty-nine CRS pa-tients undergoing functional endoscopic sinus surgery were enrolled. Patients were categorized as nontasters, tasters, or supertasters by PTC detection threshold test with successive solutions, which comprised a total of 15 grades. Correlation was performed between PTC tast-ing ability and patient demographics, preoperative CT scores, olfactory function test scores, and postoperative endoscopy scores. Results: Twenty‐three percent were identified as nontasters, 54% as tasters, and 23% as su-pertasters. There were no other statistical differences in patients’ demographics, preoperative CT scores, and ol-factory scores when compared with patients’ oral PTC‐sensing ability. However, postoperative endoscopy scores were significantly lower in supertasters than other groups. Conclusion: This study shows that PTC taste sensitivi-ty may influence the postoperative results of CRS. The TAS2R38 gene has been shown to be applicable in the clinical setting with a testable PTC phenotype and may have a role in the prognostication in CRS patients under-going surgery.

» RHOP-22 16:30~16:40

» THE DEgREE OF STRESS IN PATIENTS WITH EMPTY NOSE SYNDROME, COMPARINg WITH CHRONIC RHINO SINUSITIS


NECK SURGERY, KOSIN UNIVERSITY

COLLEGE OF MEDICINE, BUSAN, KOREA1

CHANG HOI KIM1, JOOYEON KIM1, GIL SOON CHOI2, JAE HWAN KWON1

Objectives: Depression is mental health disease with in-creasing interest in public health entity because depres-sive mood affects daily life and is also associated with de-


NECK SURGERY, INJE UNIVERSITY HAEUNDAE

PAIK HOSPITAL, BUSAN, KOREA

YONG-WAN KIM, YEO MYEONG LEE, SEONG KOOK PARK

Objectives: Mucormycosis of the nasal cavity and para-nasal sinuses is a rare but highly aggressive in patients with diabetes or immunosuppressed patients. However, chronic indolent type of mucormycosis can be observed in immunocompetent patients. In this study, we investi-gated the clinical and radiological results of indolent mu-cormycosis of paranasal sinus in healthy patients treated by endoscopic sinus surgery(ESS) alone. Methods: A retrospective review of 9 patients with the diagnosis of indolent mucormycosis of paranasal sinus and treated by ESS alone between 2007 and 2017 was performed. The data were collected from the medical records: age, gender, clinical presentations, pre- and postoperative endoscopic findings, underyling diseases, pathology, pre- and post-operative radiologic findings. Radiologic images were re-viewd to assess the involved side and sinus, bony sinus wall changes. Results: The histopathologic findings showed mucormycosis with broad, non-septated, right-angled hyphae. In spite of diagnosis of mucormycosis, the pa-tients were not any antifungal agents after surgery. There was no progression and recurrence. Conclusion: In the case of paranasal sinus mucormycosis, endoscopic sinus surgery alone is thought to be sufficient for the treatment for indolent cases in immunocompetent patients without evidence of preoperative CT and endoscopic findings of invasion and antifungal treatment may not be necessary.

» RHOP-21 16:20~16:30

» THE CORRELATION OF PHENYLTHIO-CARBAMIDE TASTE SENSITIvITY WITH POST-OPERATIvE RESULTS OF CHRONIC RHINOSI-NUSITIS


CATHOLIC UNIVERSITY OF DAEGU,

COLLEGE OF MEDICINE

YOUNG-DO JUNG, BU-KWAN KIL, BYUNG-JUN KANG, SEUNG-HEON SHIN,

MI-KYUNG YE


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characteristics and prognosis of nasal polyp (NP) after endoscopic sinus surgery (ESS) according to different histological endotypes of eosinophil and neutrophil in-filtration. Methods: From 2014.08 to 2018.09, total of 228 patients, who were diagnosed with chronic rhi-nosinusitis with nasal polyp(CRS c NP) and underwent ESS were included in this study. NPs were classified based on tissue eosinophil and neutrophil percentages. The demographic data, Japanese epidemiological survey of refractory eosinophilic chronic rhinosinusitis(JES-REC) scores, Lund-Mackay(L-M) score, Lund-Ken-nedy(L-K) endoscopic scores and Sinonasal outcome test(SNOT-22) were analyzed according to different histologic types. Results: Eosinophilic polyp(EP) group (n=99)had significantly higher incidences of asthma, as-pirin exacerbated respiratory disease(AERD), and atopy than non eosinophilic polyp(NEP) group (n=129), and also showed higher levels of IgE and blood eosinophils. The proportion of moderate and severe eosinophilic chronic rhinosinusitis(ECRS) according to JESREC score was significantly higher in the Eosinophilic polyp group(p=0.001). The histologic types are also classified into four groups; both eosinophil and neutrophil group (n=46), eosinophil dominant group (n=53), neutro-phil dominantgroup(n=74), and non-eosinophilic and non-neutrophilic group (n=55). The SNOT-22 scores and Lund-Kennedy polyp score was significantly higher in both eosinophil and neutrophil group than those of other groups(p=0.042 and p=0.02, respectively ), sug-gesting that combination of eosinophilic and neutrophil-ic inflammation had significantly higher inflammatory state. However, there was no significant difference in pre-operative Lund-Mackay scores among different histologic groups. Conclusion: Eosinophilic infiltration influenced prognosis of ESS of CRS c NP. EP group had significant worse prognosis after ESS compared to NEP group. Both eosinophil and neutrophil group had significantly worst prognosis among all groups.

cline in productivity of the individual. Depression caused by other diseases or substances is referred to secondary depression, which has importance in terms that cure of underlying cause could lead to regulation of depressive mood. The prevalence of empty nose syndrome(ENS), major symptom of the disease is difficulty in breathing despite of enough area to breathe, or 'paradoxical ob-struction of nose', has been increased in Korea reflect-ing on author's experience. We found that the patient with this disease entity has tendency to show depressive mood, which results in attempting to suicide, tragic con-sequence of depression. That lead us to investigate the psychological burden of the patients with empty nose syndrome. Methods: We divided the patients into four groups; Group A. empty nose syndrome(ENS), Group B. chronic rhinosinusitis without polyp(CRS s polyp), Group C. chronic rhinosinusitis with polyp(CRS c pol-yp), group D. allergic rhinitis. And we analyze BDI-II score among four groups, and investigate the relationship between index of depression and area of nasal cavity mea-sured by acoustic rhinometry in the patients with empty nose syndrome. Results: ENS group (group A) showed 74% of varying severity of depression compared with group B 19%, group C 20%, group D 26%, respectively. The correlation between nasal cavity volume measured by acoustic rhinometry and BDI-II score of ENS group showed no statistically significance Conclusion: The de-gree and severity of depression of ENS patient is higher than that of patients with CRS or allergic rhinitis. We should be careful not to dismiss the accompanying men-tal health problem of the ENS patients.

» RHOP-23 16:40~16:50

» CLINICAL CHARACTERISTICS OF CHRONIC RHINOSINUSITIS WITH NASAL POLYP AC-CORDINg TO HISTOLOgIC TYPES


AND NECK SURGERY, DANKOOK UNIVERSITY

COLLEGE OF MEDICINE1, BECKMAN LASER

INSTITUE KOREA, DANKOOK UNIVERSITY2, LASER

TRANSLATIONAL CLINICAL TRIAL CENTER,

DANKOOK UNIVERSITY HOSPITAL3

KWANG-HYUN BYUN1,2,3, SANG-HYUB KIM1,2,3, YOUNG-JUN CHUNG1,2,3, JI-HUN MO1,2,3

Objectives: In this study we investigated the clinical

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was no significant difference in age, sex, tumor size and using the nasoseptal flap reconstructions between two groups. Although subjective olfaction in before and after the surgery is not significantly different, group 2 showed better olfactory function in CC-SIT(p=0.045, 8.75 ± 2.58 vs 9.81 ± 1.38) and Butanol threshold test(p=0.018, 4.72 ± 0.62 vs 5.02 ± 0.33) in 3 months after surgery. There was no significant difference in SNOT-22 between both groups (p > 0.05). Conclusion: This study showed better olfactory outcomes in collaborative surgery be-tween neurosurgeon and ENT surgeon. This result signi-fies the necessity of collaboration between neurosurgeon and ENT surgeon in endoscopic pituitary surgery.

» RHOP-25 17:00~17:10

» CLINICAL CHARACTERISTICS AND MAN-AgEMENT IN PATIENTS WITH OCULAR SYMP-TOMS CAUSED BY SINONASAL DISEASES




YOONJAE SONG, DEUKTAE CHO, DOO HEE HAN, HYUN JIK KIM,

CHAE-SEO RHEE, DONG-YOUNG KIM

Objectives: Sinonasal diseases can cause various ocular symptoms. The purpose of this study is to evaluate the clinical characteristics of patients with a sinonasal disease accompanied by orbital complications and assess the fac-tors related to the therapeutic outcome in those patients. Methods: A retrospective chart review was performed on 57 patients during the period between January 2008 and December 2017. The inclusion criteria for the study were: (1) computed tomography (CT)-proven sinonasal diseases; and (2) ocular symptoms examined by an oph-thalmologist. The clinical factors were analyzed according to age, gender, clinical symptoms (ocular, nasal), under-lying diseases, and radiologic findings (orbital or sinona-sal involvement). Results: Patients were comprised of 37 male (64.9%) and 20 female (35.1%), with a mean age of 62.5±16.4 years (18–82 years). Proptosis (39, 68.4%) was the most common ocular manifestation, and opthal-moplegia (28, 49.1%), visual loss (21, 36.8%), diplopia (17, 29.8%) and ptosis (2, 3.5%) followed. Most patients (47, 82.5%) showed orbital involvement on CT scan; however, ten patients (17.5%) had ocular symptoms without orbital involvement. Maxillary sinus (30, 56.7%)


Chair : IBRAHIM CUKUROVA, MYUNG GU KIM

Endoscopic Sinus Surgery

» RHOP-24 16:50~17:00

» A COMPARISON OF OLFACTION AND NA-SAL SYMPTOMS BETWEEN COLLABORATIvE AND SINgLE SURgEON APPROACH IN ENDO-SCOPIC PITUITARY SURgERY


HEAD AND NECK SURGERY1 AND

NEUROSURGERY2, SAMSUNG MEDICAL CENTER,

SUNGKYUNKWAN UNIVERSITY

SCHOOL OF MEDICINE, SEOUL, KOREA

YANGSEOP NOH1, JI-EUN CHOI1, DOO-SIK KONG2, DO-HYUN NAM2,

HYO YEOL KIM1, HUN-JONG DHONG1, SEUNG-KYU CHUNG1, SANG DUK HONG1

Objectives: Endoscopic pituitary surgery usually requires collaborative work between neurosurgeon and rhinolo-gists for optimal outcomes. However, sometimes neu-rosurgeon may carry out surgery solely without ENT surgeon. The aim of this study is to compare the post-operative sinonasal quality of life and olfactory functions between patients performed by neurosurgeon and by collaborative work between neurosurgery and otolaryn-gology. Methods: A retrospective review was performed of prospectively collected data. Patients who underwent an endoscopic pituitary surgery for pituitary adenoma or Rathke’s cleft cyst from January 2016 to April 2018 were included. Included patients were divided into two groups; group 1 underwent surgery by single neurosur-geon, group 2 underwent by collaborative surgery group. Both groups checked their olfaction (Subjective visual an-alog scale (VAS ; 0-100), Cross-Cultural Smell Identifi-cation Test(CC-SIT) and Butanol threshold test) and an-swered questionnaire about sinonasal quality of life using SNOT-22 in before and 3months after surgery. Results: 149 patients were included in this study. There were 35 patients in group 1 and 114 patients in group 2. There


April26(Fri)



seemed to feel slightly better with regard to nasal ob-struction, facial pain, headache, and overall discomfort, although there were no statistically significant differences between the groups. The cotton ball packing was asso-ciated with significantly less pain during postoperative debridement, therefore less time was needed to perform debridement. The cotton ball packing appears to improve wound healing within the sinus cavities up to 1 month postoperatively. Conclusion: The use of the cotton ball packing after ESS results in significantly less formation of crusts and adhesions, leading to decreasing pain and time during postoperative debridement and promoting faster wound healing.

» RHOP-28 17:30~17:40

» WHAT AFFECTS POSTOPERATIvE SINUS-ITIS AND IMPLANT FAILURE AFTER DENTAL IMPLANT A META-ANALYSIS



CHONBUK NATIONAL UNIVERSITY1

JONG SEUNG KIM1, SAM HYUN KWON1

Objectives: The dental implant is an innovative instru-ment that enables the edentulous patient to chew. There are many factors that have a bearing on the success of dental implantation. There are also many complications after dental implant. In this meta-analysis, we investigat-ed which factors increase the risk of postoperative sinus-itis and implant failure after dental implant for the first time. Methods: Included data was searched through the Pubmed, EMBASE, and Cochrane library databases. We followed the PRISMA guidelines and two authors (JSK, SHK) independently extract data by multiple observers. We used random effects model considering the variation between and within the included studies. Results: Twen-ty-seven papers were included in our final meta-analysis. The proportion of sinusitis using the single proportion test was 0.05 (95% CI: 0.04-0.07). The proportion of si-nusitis using the single proportion test was 0.17 (95%CI: 0.13-0.22). The proportion of implant failure using the single proportion test was 0.05 (95% CI: 0.04-0.07). The only factors that affected postoperative sinusitis were pre-operative sinusitis and intraoperative perforation of the Schneiderian membrane (p<0.01, p<0.01, respectively). The only factors that affected dental implant failure were smoking and residual bone height of the maxilla (p<0.05,

was the most commonly involved sinus in all patients. In terms of the visual disturbance, sinonasal tumor, orbital involvement, advanced age, and diabetes mellitus were significantly related to the symptom. Visual acuity was significantly improved in 5 of the 14 patients, and 3 of them had mucocele. The time interval between symptom onset and surgery, and diagnosis of mucocele were signifi-cantly related to the surgical outcome (p=0.032, p=0.029 respectively). Conclusion: Based on our findings, we could conclude that sinonasal tumor is the most com-mon etiology of ocular symptoms, and an old ages with diabetes who have an orbital involvement may present a visual disturbance. This study also demonstrated that an early surgical intervention might be required for the patients with a visual disturbance caused by a mucocele.

» RHOP-26 17:10~17:20

» EFFECTIvENESS OF COTTON BALL PACK-INg AFTER ENDOSCOPIC SINUS SURgERY A PROSPECTIvE, RANDOMIzED, CONTROLLED TRIAL


PUSAN NATIONAL UNIVERSITY SCHOOL OF

MEDICINE PUSAN HOSPITAL1 DEPARTMENT

OF OTOLARYNGOLOGY PUSAN NATIONAL


YANGSAN HOSPITAL2

SEON-LIN KIM1, MIN-KYU CHO1, SUNG-DONG KIM1, JAE-WOOK KIM1,

KEUN-IK YI1, SUE-JEAN MUN2, KYU-SUP CHO1

Objectives: The blocking of airflow into sinonasal cavity may decrease postoperative crusting and the development of adhesions. The purpose of this study was to investigate the efficacy of cotton ball packing in patients following endoscopic sinus surgery (ESS). Methods: Thirty three patients with chronic rhinosinusitis requiring the same extent of ESS were included. As a part of postoperative care, the patients were instructed to perform a nasal sa-line irrigation and apply a nasal spray in each nostril, and then informed to put a cotton ball in a one side of nostril, and the other side was kept to be empty as a control. Patients’ subjective symptoms, patients’ pain while per-forming sinonasal cavity debridement, time required to perform debridement, and postoperative wound healing were evaluated. Results: The cotton ball packing group

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zontal line parallel to nasal spine and a line passing from the columella to NFB was 65.3° ± 6°. Angle between a horizontal line parallel the nasal spine and a line pass-ing from ANS to NFB was79.9° ± 6.8°. Angle between a horizontal line parallel the nasal spine and a line passing from the columella to sphenoid sinus ostium was 28.7° ± 3.7°. Angle between a horizontal line parallel the na-sal spine and a line passing from ANS to sphenoid sinus ostium was 34.6° ± 5.1°. Conclusion: The results of this study should aid the otolaryngologist in evaluating pedi-atric patients for endonasal endoscopic sinus surgery or skull base procedures and provide a basis for continued anatomic study of sinus or skull base surgery

p<0.01, respectively). Conclusion: Two factors affect postoperative sinusitis after implant surgery: preoperative sinusitis and Schneiderian membrane rupture. It should also be noted that the factors affecting implant failure are residual bone height and smoking. These findings will have a significant impact on the counseling and treat-ment policy of patients who receive dental implant.

» RHOP-29 17:40~17:50

» ANALYSIS OF INTRANASAL DISTANCE OF FRONTAL AND SPHENOID SINUS OSTIUM US-INg MULTIDETECTOR COMPUTED TOMOg-RAPHY IN CHILDREN


SOONCHUNHYANG UNIVERSITY COLLEGE OF

MEDICINE

JAE-YEOP JUNG, SANG-BIN KIM, GWANG-HEE YOO, BYOUNG-JOON BAEK

Objectives: Children may be more prone to compli-cations than adults because of the variability of devel-opmental changes of paranasal sinuses and skull base. Knowledge of the average columellar distance in relation to age in addition to anatomical landmarks is an import-ant guide in endoscopic sinus surgery. The object of this study are to identify average distances from columella and anterior nasal spine to the anterior and posterior bor-der of frontal and sphenoid sinus ostiums in children. Methods: Subjects who are older than 4 year and young-er than 17 years who had undergone a head-and-neck, maxillofacial bone region high resolution computed tomography scan during the last 2 years were obtained from radiological database. The distances from columella and anterior nasal spine to the anterior and posterior bor-der of frontal and sphenoid sinus ostiums were measured and nasofrontal and nasosphenoid angles were calculat-ed. Results: Seventy patients with the mean age of 11 ± 4 years entered this study. The mean distances from columella to NFB(nasofrontal beak) was 50.4 ± 7 mm, columella to ASB(anterior skull base) was 56.4 ± 7.4 mm, ANS(anterior nasal spine) to NFB was 46.2 ± 5.5 mm , and ANS to ASB was 50.3 ± 6 mm. The mean distances from columella to the anterior border of sphenoid sinus ostium was 64 ± 7.3 mm , anterior border of sphenoid sinus ostium to the posterior wall of sphenoid sinus was 20.3 ± 6.9 mm , ANS to the anterior border of sphenoid sinus ostium was 51.9 ± 4.7 mm. Angle between a hori-


April26(Fri)



HNOP-1Room 4-3 (Convention C)

Chair : YOUNG HO JUNG, SEI YOUNG LEE

Oral Cavity

» HNOP-01 08:00~08:10

» NOT CD68 BUT STABILIN-1 ExPRESSION IS ASSOCIATED WITH THE RISK OF RECUR-RENCE IN PATIENTS WITH ORAL CAvITY SQUAMOUS CELL CARCINOMA


EULJI MEDICAL CENTER, EULJI UNIVERSITY


OTORHINOLARYNGOLOGY, GYEONGSANG

NATIONAL UNIVERSITY SCHOOL OF MEDICINE2

MINSU KWON1, JUNG JE PARK2

Objectives: The aim of this study was to evaluate the expressions of tumor- associated macrophages (TAMs) represented by CD68 and stabilin-1, the scavenger recep-tor of TAMs, in specimens from patients with oral cavity squamous cell carcinoma (OCSCC) and subsequently analyze their impact on the clinical courses and survivals of the patients. Methods: Stabilin-1 and CD68 immu-nohistochemical staining was conducted in samples from patients with OCSCC who underwent curative surgery in our institute. We retrospectively analyzed patients’ clinical information. We investigated the relationship be-tween CD68 and stabilin-1 expression levels and their effect on prognostic factors and survival. Results: Fif-ty-four patients’ data were analyzed. CD68 and stabilin-1 expressions were positively correlated (p=0.008). CD68 and stabilin-1 expressions were not correlated with other prognostic factors (e.g., T classification or lymph node metastasis). Stabilin-1 expression and tumor recurrence risk were positively correlated (p=0.015). CD68 ex-pression was neither associated with recurrence-free nor OCSCC-specific survival. Conclusion: CD68 and sta-bilin-1 expressions in OCSCC were positively correlat-ed. Stabilin-1 expression was significantly associated with OCC recurrence risk, but the prognostic value of CD68 was not confirmed.

» HNOP-02 08:10~08:20

» USEFULNESS OF BIPEDICLED MUCOSAL ADvANCEMENT FLAP IN LOWER LIP CANCER SURgERY



BUNDANG HOSPITAL

YOUNG SEOK KIM, SE JIN HYUN, MINHYUNG LEE, WOO-JIN JEONG,

YOUNG HO JUNG

Objectives: Unlike other oral cavity cancer, clinical be-havior of lip cancer is similar to that of skin cancer. Early stage lip cancer is known to be well treated by surgery or radiotherapy. When defect is between half and two third of the lip, full-thickness pedicled flap such as Abbe flap and Estlander flap could be applied. Here, we introduce bipedicled mucosal advancement flap of the lower lip and its advantages over other flaps. Methods: Techniques of bipedicled mucosal advancement flap of lip will be de-scribed. Key surgical step is undermining labial mucosa deep to minor salivary glands and superficial to the pos-terior aspect of the orbicularis oris. It has its advantage in restoration of the vermilion and removal of all the lower lip mucosa with actinic keratosis. Results: Totally 3 cases of early lip cancer (T1N0M0, biopsy proven squamous cell carcinoma) will be presented. Excision with margin and bipedicled mucosal advancement flap reconstruction were performed. Satisfactory reconstruction of lower lip was possible without microstomia. Until now there was no evidence of recurrence. Conclusion: Excision and bi-pedicled mucosal advancement flap reconstruction could be a treatment of choice for lower lip cancer.

» HNOP-03 08:20~08:30

» CLINICOPATHOLOgICAL FACTORS OF CON-TRALATERAL NECK RECURRENCE FOR ORAL SQUAMOUS CELL CARCINOMA RETROSPEC-TIvE STUDY OF SINgLE INSTITUTE




ASAN MEDICAL CENTER

April26(Fri)




PERTH, WA

THOMAS HENDRIKS

Objectives: Oral cavity cancers (OCC) account for a sig-nificant proportion of head and neck malignancies. Al-though there has been a decline in incidence over the past three decades, OCC poses a significant disease burden giv-en poor quality of life outcomes and high mortality rates. Our aim was to evaluate the outcomes of OCC treated at a large tertiary hospital in WA. Methods: A retrospective cohort study of patients diagnosed with OCC between January 2012 and December 2016 was performed. OCC recurrences were excluded. The hospital-based cancer reg-istry was analysed as a primary source of data, in addition to review of clinical charts for those patients with missing data. The study was approved by the Institutional Safety Board. Results: A total of 101 patients with primary di-agnosed OCC received treatment during the period (see table patient characteristics). The majority of patients were male and most were treated primarily with surgery. 26 patients (25.7%) developed recurrence during follow up, with a median time to recurrence of 10.5 months. Of the patients with recurrence, 73% (19/26) died because of their recurrence. A total of 38 patients died during fol-low up (37.6%), with a 3-year overall survival of 66.3% (IC95% 55.2%-75.2%). In patients without metastatic lymph-nodes, the 3-year disease-specific survival (DSS) was 89.5%, whereas that for patients with metastatic lymph-nodes was 56.4%. Conclusion: OCC continues to be a therapeutic challenge for the head and neck sur-geon. Incidence is slowly decreasing however there has been little improvement in mortality over the past 20-30 years. Given the relatively asymptomatic nature of early disease, oral cavity cancer diagnosed at a late stage is not uncommon therefore positive lymph-nodes are import-ant when evaluating survival. These results highlight the importance of regular oncological surveillance in otolar-yngology.

» HNOP-05 08:40~08:50

» CLINICAL OUTCOME OF MINOR SALIvARY gLAND CANCERS IN THE ORAL CAvITY AND OROPHARYNx




OF MEDICINE, SEOUL, REPUBLIC OF KOREA

WON KI CHO, AH RA JUNG, JONG-LYEL ROH, SEUNG-HO CHOI, SANG YOON KIM,

SOON YUHL NAM

Objectives: The prognosis of patients with OSCC with neck recurrence is poor, especially with contralateral neck metastasis. Few large studies have reported the risk factors of contralateral neck recurrence (CLNR). In this study, we aimed to identify clicopathological factors of recur-rence of contralateral neck for planning further treat-ment. Methods: We retrospectively reviewed the medical records of 345 patients who underwent curative resection of tumor and metastatic nodes Jan. 2006 ~ Dec. 2015 in Asan medical center. Previously untreated, pathologically proven oral cavity cancer with or without pathologically neck metastasis were included. Exclusion criteria were pa-tients with distant metastasis at initial staging (palliative treatment), referral patients with recurrent tumors, prior history of RT or neck dissection for other HNCs, fol-low-up duration less than 2 years. Patients' demograph-ics, prognosis were reviewed. 5-yr CLNR and survival outcomes were analyzed. Results: The median age was 55.5 years with a mean follow-up period of 45.2 months. Of 345 patients, 101 (28.9%) had recurrence on observa-tion period, 16 (4.6%) had contralateral neck recurrence. Of 15 CLNR patients, 11 patients had only CLNR, but 5 patients had both local and regional failure. 5-year DSS is 72.1%, 5-year DFS is 70.8%, 5-year CLNR is 94.4%, all of CLNRs have occurred in 14.8 month. In univariate analyses, tumor thickness, depth of invasion, tumor size, and total involved LN showed relation of contralateral neck recurrence (P < 0.05). Multivariate analyses showed that tumor thickness, depth of invasion, tumor size, total involved LN were independent variables affecting CLNR (P < 0.05). DSS were influenced by presence of CLNR, (P < 0.05), mean survival time of CNLR was 23.0 mo. Conclusion: CLNR is an independent predictor for the long-term survival of patients with OSCC. Largest meta-static tumor size, depth and thickness of tumor and total involved LN were found to be independent variables as-sociated with CLNR in OSCC

» HNOP-04 08:30~08:40

» ORAL CAvITY CANCER OUTCOMES IN WESTERN AUSTRALIA (WA)

DEPARTMENT OF EAR, NOSE AND THROAT

SURGERY, SIR CHARLES GAIRDNER HOSPITAL,


April26(Fri)



HNOP-2Room 3-3 (Diamond)

Chair : DONG YOUNG KIM, JEONG KYU KIM

Salivary Gland

» HNOP-06 08:00~08:10

» ENDOSCOPE-ASSISTED TRANSORAL AC-CESSORY PAROTID MASS ExCISION MUL-TICENTER PROSPECTIvE OBSERvATIONAL STUDY

1DEPARTMENT OF OTOLARYNGOLOGY,

GYEONGSANG NATIONAL UNIVERSITY HOSPITAL,

CHANGWON, 2INSTITUTE OF HEALTH SCIENCES,

GYEONGSANG NATIONAL UNIVERSITY, JINJU, 3DEPARTMENT OF OTOLARYNGOLOGY-HEAD

AND NECK SURGERY, DONG-A UNIVERSITY

COLLEGE OF MEDICINE, BUSAN, 4DEPARTMENT

OF OTORHINOLARYNGOLOGY, 5DEPARTMENT OF

SURGERY, DANKOOK UNIVERSITY COLLEGE OF

MEDICINE CHANAN, KOREA, 6DEPARTMENT OF



CHANAN, KOREA

JIN PYEONG KIM1,2, DONG KUN LEE3, JEONG HWAN MOON4, JUNWON MIN5,

SEUNG HOON WOO6

Objectives: Transoral surgery is gaining favor because it has the advantage of leaving no scar after surgery. The aim of this study was to evaluate the technical feasibility, and safety of endoscope-assisted transoral accessory pa-rotid mass excision. Methods: This study was designed as a 7-year, prospective, multicenter evaluation of endo-scope-assisted transoral accessory parotid mass excision. Clinical outcomes and complications related to proce-dures were evaluated in patients. Results: Twenty pa-tients underwent endoscope-assisted transoral accessory parotid mass excision and 22 patients underwent con-ventional parotidectomy approach excision. There was no significant differences with respect to overall demo-graphic characteristics of between groups. However, the

WOORI PARK, JOONG BO SHIN, SUNGYONG CHOI, JONGWON PARK,

MAN KI CHUNG, YOUNG-IK SON, CHUNG-HWAN BAEK, HAN-SIN JEONG

Objectives: Salivary gland cancer arising from the mi-nor salivary gland in the oral cavity and oropharynx has been less studied, in comparison with squamous cell car-cinomas in the oral cavity. This study aimed to identify the clinical characteristics and outcomes of salivary gland cancers in the oral cavity and oropharynx. Methods: The medical records of the patients who had salivary gland cancers in the oral cavity and oropharynx were reviewed retrospectively(1995 to 2018). The clinical and patho-logical factors, and the outcomes of the patients were analyzed to determine risk factors for poor prognosis. Results: Total 79 patients were enrolled in this study. Most common pathology was mucoepidermoid carcino-ma(39.2%). Most patients underwent surgery and 43 of 79 patients(54.4%) had postoperative radiation therapy. 5 patients experienced locoregional recurrence and the distant metastases were detected in 16 patients. All the patients with locoregional recurrence had undergone sal-vage surgical treatments and 4 of them were free of ma-lignancy. Distant metastases were found in patients ex-clusively with adenoid cystic carcinoma; 9 patients with distant metastasis died with disease and 4 patients were alive with disease. Only 3 patients were free of disease with surgery for metastatic diseases. Mean survival peri-od was 60 months. Node metastasis at diagnosis showed positive correlation with poor prognosis. However, the status of close and positive resection margin showed no significant difference in survivals compared with negative resection margin, although these patients were indicated to the post-operative adjuvant treatments. Conclusion: Patients with minor salivary gland cancers in the oral cavity and oropharynx survived approximately 87.2% in 5 years. The status of resection margin did not have negative impact on patient prognosis, suggesting that the postoperative adjuvant radiation treatment could play a role in suppression of minimal residual diseases.

April26(Fri)




cal T size may help clinician decide the necessity of neck dissection.

» HNOP-08 08:20~08:30

» INCIDENCE OF POSTOPERATIvE FACIAL WEAKNESS IN PAROTID TUMOR SURgERY - A TUMOR SUBSITE ANALYSIS IN 794 PAROTI-DECTOMIES





HOKYUNG JIN, BO YOUNG KIM, HEEJUNG KIM, EUNKYU LEE, SUNGYONG CHOI,

JONGWON PARK, MAN KI CHUNG, YOUNG-IK SON, CHUNG-HWAN BAEK,

HAN-SIN JEONG

Objectives: Functional preservation of the facial nerve is essential in parotid surgery for benign and some malig-nant tumors. Reported incidence of facial weakness im-mediately after parotid tumor surgery ranged from 4.7 to 46.1%. In this study, we aimed to provide additional in-formation about risk factors for postoperative facial weak-ness in parotid tumor surgery, particularly focusing on the tumor subsites. Methods: We retrospectively reviewed 794 cases with parotidectomy for benign and malignant tumors arising from the parotid gland (2009-2016). Pa-tients with pre-treatment facial palsy were excluded from the analyses. Tumor subsites were determined according to their relations to the facial nerve plane: superficial, deep and combined. Multivariable logistic regression analyses were conducted to identify risk factors for post-operative facial weakness. Results: Overall incidences of temporary and permanent (> 6 months) facial weakness were 9.2% and 5.2% in our series. In primary parotidec-tomies (N=753), temporary and permanent facial weak-ness occurred in 8.2% and 4.4%. However, the rates of temporary facial weakness increased to 26.8% for revi-sion surgery, 23.8% for malignancy, 29.8% for tumors in both superficial and deep lobes, and 35.2% for cases with total parotidectomy. Multivariable analysis revealed that tumors in both superficial and deep lobes and total parot-idectomy were statistically significant independent risk factors for temporary postoperative facial palsy, as well as revision surgery, and malignant tumors. Conclusion:

operation time was shorter with the transoral approach group (P = 0.001) and cosmetic satisfaction was much better in the transoral group (P< 0.001). Conclusion: Endoscope-assisted transoral accessory parotid mass ex-cision is a potentially safe and effective procedure with excellent outcomes.

» HNOP-07 08:10~08:20

» PREvALENCE, PATTERNS AND PREDIC-TORS OF LYMPH NODE METASTASIS IN PA-ROTID MALIgNANCIES

DEPT. OF HEAD & NECK SURGERY NARAYANA

CANCER INSTITUTE & SUPERSPECIALITY HOSP

HOWRAH1, DEPT. OF HEAD & NECK SURGICAL

ONCOLOGY HOMI BHABHA CANCER HOSPITAL

VARANASI2, DEPT. OF HEAD & NECK SURGERY

TATA MEMORIAL HOSP. MUMBAI3

APURVA GARG1, SWAGNIK CHAKRABARTY2, PANKAJ CHATURVEDI3, DEEPA NAIR3,

SUDHIR NAIR3, PRATHAMESH PAI3, DEVENDRA A CHAUKAR3,

GAURI PANTVAIDYA3, ANUJA DESHMUKH3, ANIL K DCRUZ3

Objectives: This study aims to analyze the prevalence, patterns and predictors of nodal metastases in parotid malignancy. Methods: A retrospective study of 215 pa-tients, of whom 86 patients underwent neck dissection (24 selective neck dissection (SND) levels II-IV, 62 mod-ified neck dissection (MND) levels I-V) and 129 had lev-el II sampling only. Results: While 35.8% patient had clinically palpable nodes, only 27.4% had pathologically proven metastases. Level II was most commonly (88.4%) involved by metastases followed by levels III, I, IV, and V. Occult metastases were seen in 11.6% patients and majority of these were in level II (83.3%). Skip metasta-ses (involvement of level IV/V in the absence of level II) were seen in 9.3%. The factors that predicted nodal me-tastases were age, clinical facial nerve involvement, clin-ical T size and lympho vascular emboli. Clinical T size was the only significant factor predicting occult metas-tases. Conclusion: Nodal metastases are not infrequent in parotid malignancy. MND I-V is advised for patients with palpable nodes. SND I-III is advised in those with non-palpable nodes having T3/T4 tumors and/or high grade histology. Age, facial nerve involvement and clini-


April26(Fri)



» HNOP-10 08:40~08:50

» SURgICAL MANAgEMENT FOR PAROTID CANCER RETROSPECTIvE STUDY


NECK SURGERY, COLLEGE OF MEDICINE, THE

CATHOLIC UNIVERSITY OF KOREA1

DONG-HYUN LEE1, KWANG-JAE CHO1, MIN-SIK KIM1

Objectives: Management of parotid cancer is mainly sur-gical approach and effort is made to preserve the facial nerve. But, in cases of advanced disease, a radical parot-idectomy with facial nerve resection may be required to obtain the free surgical margins. In this study we present our experience utilizing the parotid cancer operation to outcomes and function. Methods: The study included patients treated at the Seoul St. Mary’s hospital from 1994 to 2018 using a combined approach. A retrospective analysis was performed to collect data about demograph-ic characters, TNM staging, Tumor grade, Postoperative complications, adjuvant therapy, facial nerve function and recurrence. Results: 65 patients with malignancies (30 male, 35 female; 8 to 86yr old) underwent 20 par-tial, 24 near total and 21 extended parotidectomy. There were 19 Mucoepidermoid carcinoma(MEC), 11 Adenoid cystic carcinoma(ACC), 12 Malignant mixed tumor, 8 Acinic cell carcinoma, 4 Adenocarcinoma, 6 Salivary duct carcinoma and 5 Squamous cell carcinoma. Most of MEC, ACC was low-intermediate grade tumor(84%, 82%). On Pearson correlation coefficient, tumor grade is a substantially stronger predictor than other factors. On survival rate, there was a significant result in tumor grade (Low 93.9%, Intermediate 71.4%, High 55.6%) (p = 0.001). 6 of 43 patients had occult metastasis. They were had extended parotidectomy. On pearson chi-square test, there were significant results in tumor size, high grade pa-thology and FN paralysis. 3 of 6 were expired by distant metastasis. Conclusion: If you plan to operate extended parotidectomy, it should be considered to have large tu-mor size, postop RTx, CTx and high tumor grade and the presence of perineural invasion, facial nerve invasion and supraomohyoid neck dissection. High grade tumor is a substantially stronger predictor and the knowledge of the risks with occult metastasis is relevant for preopera-tive planning. If you are planning the high grade parotid cancer surgery.

Postoperative facial weakness is more frequent in parotid surgery for tumors located in both superficial and deep parotid gland. Thus, preoperative counselling with these patients and delicate manipulation of the facial nerve seems to be necessary.

» HNOP-09 08:30~08:40

» ULTRASONOgRPAHIC FEATURES OF PA-ROTID gLAND STONES


HEAD AND NECK SURGERY

DONG WON LEE, JEONG KYU KIM

Objectives: To investigate ultrasonographic features and their correlation with clinical outcomes in the parotid gland stones. Methods: The medical records of a total of 36 patients who had been treated for parotid gland stones were retrospectively reviewed. Four (11.1%) of patients had multiple stones and a total of 40 stones were iden-tified. Mean size of stones was 4.4 mm (range 2-13.5). Acute infection was combined in 14 (38.9%) patients. Stones were removed by transoral approach in 12 (33.3%) patients, by transfacial approach in 14 (38.9%) patients, by sialendoscopy in 7 (19.5%) patients, and by combined approach in 3 (8.3%) patients. Results: Ultrasonography could localize 39 stones except 1 small stone in the orifice of Stensen’s duct. The location of stones was distal in 17 (42.5%) stones, middle in 7 (17.5%) stones, proximal in 16 (40.0%) stones. Acoustic shadow was identified in 25 (62.5%) stones. Stensen’s duct was dilated in 26 (72.2%) patients and mean diameter of the dilated duct was 3.5 mm (range 0.8–7.3). Parenchymal echogenicity in stone side was more hypoechoic compared with normal side in 15 (41.7%) patients. The distal stones were treated by transoral approach in 13 (76.5%) stones, the middle stones were treated by sialendoscopy in 4 (57.1%) or by transfacial approach in 3 (42.9%) stone, and the proximal stones were treated by transfacial approach in 12 (75.0%) stones. The surgical approaches were significantly different in relation to the location of stones (P=0.000). Stensen’s ductal dilatation was significantly correlated with presence of acute infection (P=0.022), the ductal diameter more than 3.6mm could predict the presence of infection with 88.9% sensitivity and 94.4% specificity. Conclusion: Ul-trasonographic assessment of the location of stones and the diameter of Stensen’s duct provides useful clinical in-formation for the management of parotid gland stones.

April26(Fri)




OTPX


Poster Exhibition

» OTPX-01

» CAPOS SYNDROME WITH BILATERAL SEN-SORINEURAL HEARNg LOSS A CASE RE-PORT


HEAD AND NECK SURGERY, COLLEGE OF

MEDICINE, CHONBUK NATIONAL UNIVERSITY,

JEONJU, KOREA

SU GEUN KIM1, JONG HWAN LEE2 , CHA DONG YEO3, EUN JUNG LEE4

The cerebellar ataxia, areflexia, pes cavus, optic atrophy, and sensorineural hearing loss are the clinical phenotypes of CAPOS syndrome. It is caused by the single mutation E818K of the α3-isoform of Na+,K+-ATPase. It is a rare disorder so far described in only eight families since its initial description in 1996. The typical CAPOS pheno-type is characterized by acute neurological deterioration manifesting in infancy and triggered by stressful episodes, such as a febrile illness. These episodes may be recurrent and accompanied by symptoms that may partially dis-appear thereafter, including ataxia, acquired are flexia, ophthalmoplegia, hypotonia, weakness, lethargy, and comatose state suggestive of encephalitis. Sensorineu-ral deafness and optic atrophy may develop at that time or appear after the acute event and progress slowly over time. We herein describe a case of Koarean patient whose sensorineural hearing impairment represented at late age.

» OTPX-02

» SWEETS SYNDROME IN A PATIENT WITH BILATERAL SUDDEN SENSORINEURAL HEAR-INg LOSS-FULLY RECOvERED CASE



CHONBUK NATIONAL UNIVERSITY

YEON-SEOK YOU1, EUN-JUNG LEE2

Objectives: We report a case of fully recovered bilateral sudden hearing loss due to Sweet’s syndrome. Results: A 43 year-old woman who had never been diagnosed with Sweet's syndrome visited our hospital due to bilateral hearing loss associated with symptoms of Sweet's syn-drome. She received immediate steroid treatment. Three months after treatment, symptoms of Sweet’s syndrome, including hearing loss, were completely restored. Con-clusion: Time appropriate treatment is crucial for hear-ing recovery, and patients who are suspicious of Sweet’s syndrome should undergo a thorough history and phys-ical examination (including a hearing test) for early di-agnosis.

» OTPX-03

» A CASE OF ISOLATED CONgENITAL STA-PES SUPRASTRUCTURE FIxATION

DEPARTMENT OF OTORHINOARLYNGOLOGY,

ILSAN PAIK HOSTPIAL, INJE UNIVERSITY

COLLEGE OF MEDICINE

TAEK YOON CHEONG, YONG SEOK JO, BYUNG HYUN HAN, JEON MI LEE

In minor congenital ear anomalies, stapes is the most commonly affected structure. While the stapes footplate fixation is frequently encountered, the stapes suprastruc-ture fixation is an extremely rare entity. It is distinguished from the stapes footplate fixation by the different pa-thology and surgical considerations. Here we present a case of isolated stapes suprastructure fixation with nor-mal footplate mobility. A 60-year-old female visited the clinic for non-progressive hearing loss in her right ear since childhood. A pure-tone audiogram showed a severe conductive hearing loss, whereas examination of the ears and the temporal bone CT detected no abnormalities. A stapedial fixation was suspected, and an exploratory tympanotomy was conducted. It was apparent that the posterior crura of the stapes showed bony synostosis to the promontory. Division of the bony synostosis between the posterior crura and promontory led to mobility of the stapes footplate. A piston-type prosthesis was placed between the long process of incus and the mobile foot-plate for hearing gain. A month after surgery, follow up

April26(Fri)



April 26(Fri) OtologyApril 26(Fri) Otology

Unlike chondroma, CC does not originate from the un-derlying periosteum. Here, we report the two cases of patients with heterotopic cartilaginous mass in the bony external auditory canal in a 11-year-boy and 27-year-men successfully excised under oto-microscopic guidance without traumatic injury to the tympanic membrane.

» OTPX-06

» POSTAURICULAR DERMOID CYST CASE RE-PORT

DEPARTMENT OF OTOLARYNGOLOGY-HNS,

INSTITUTE FOR MEDICAL SCIENCE, CHONBUK

NATIONAL UNIVERSITY- CHONBUK NATIONAL

UNIVERSITY HOSPITAL, CHONBUK

EUN JI KIM1, YEON SEOK YOU2, JI SEOB YOO3, EUN JUNG LEE4

Dermoid cysts are congenital anomalies that arise from trapped pouches of the ectoderm near the normal fold or from the surface ectoderm that has failed to separate from the neural tube. Dermoid cysts of head and neck area are relatively rare, whereas those located in the postauricular area are extremely rare. Although rare, it should always be considered as a possible cause of a postauricular lump. In this article, we report a case of postauricular dermoid cyst in a 41 year-old woman.

» OTPX-07

» A CASE OF SEBACEOMA OF THE CAvUM CONCHA



MEDICINE, CHONBUK NATIONAL UNIVERSITY

JI-SEOB YOO1, YEON-SEOK YOU2, EUN-JI KIM3, EUN-JUNG LEE4

Sebaceoma is a rare, benign adnexal neoplasm with which usually presents in the head and neck. It can occur in any location containing hair and sebaceous gland. These neoplasms occur primarily, but it may occur in associ-ation with other sebaceous neoplasm and Muir-Torre syndrome. We met a case of sebaceoma on cavum con-cha, typically rare. A 35 year-old men presented with a

pure-tone audiogram revealed an improvement of hear-ing. This case report presents a new entity of a middle ear anomaly which has not been reported previously, and suggests a possibility of mobile footplate even a stapedial fixation was suspected preoperatively.

» OTPX-04

» CORRECTION OF THE AURICULAR MALFOR-MATION IN A PATIENT WITH NEUROFIBROMA-TOSIS




HO-JUN JIN, JEONG-HOON OH

Neurofibromatosis is one of the most destructive and de-bilitating disease affecting the skin, muscle, mucosa, and the skeletal systems. Involvement of the ear increases the dimensions of the auricular skin and underlying tissues, and therefore, produces severe abnormality in size, shape and position of the auricle. Not only is there rare reports of surgical correction of the affected auricles in neurofi-bromatosis in the literature, but it is difficult to obtain favorable results. We present a case of successful manage-ment of the auricular tumor in type- 1 neurofibromatosis using titanium miniplates.

» OTPX-05

» TWO CASES OF CARTILAgINOUS CHORISTO-MA OF BONY ExTERNAL AUDITORY CANAL


GYEONGSANG NATIONAL UNIVERSITY SCHOOL

OF MEDICINE, GYEONGSANG NATIONAL


MIN JI KANG1, HYUN WOO PARK1

Cartilaginous choristoma(CC) of external auditory canal(EAC) is uncommon. CC is defined as a benign tumor-like growth of normal tissue at an abnormal lo-cation. Most CCs occur in the medial portion of the anterior wall of the bony EAC. Because it has the same histologic findings as chondroma, it is difficult to distin-guish it from chondroma only by histologic examination.

Withdrawal

April26(Fri)




medications(OM) and intravenous fluid injection(IV) including dexamethasone is compared against ITD, OM and IV alone as treatments for acute low fequency sen-sorineural hearing loss (ALHL). Methods: Retrospective medical record reviews of the patients who received com-bination and alone therapy for ALHL between December 2010 and December 2018 were analyzed. 413 patients diagonosed with ALHL were divided into four groups ;1) those treated with ITD, OM (2combination group; 210 patients), 2) those treated with OM (only OM group; 161 patients), 3) those treated with ITD (only ITD group; 21 patients), 4) those treated with ITD, OM, IV (3combination group; 21 patients). Treatment outcomes were analyzed using subjective improvement and audiometric changes. Results: The cure rate of the combination groups was significantly higher than that of the ITD, OM only groups (ITD, OM, IV 3combination group; 95% and ITD, OM combination group; 83%, vs only ITD group; 33% and only OM group; 22% ) Con-clusion: According to the results of this study, there is a significant difference in treatment effect between combi-nation groups and alone groups. Therefore, the combina-tion therapy maybe preferred as my first choice of therapy for acute low frequency sensorineural hearing loss.

» OTPX-10

» DIAgNOSIS WITH SPONTANEOUS PERILYM-PHATIC FISTULA - A CASE REPORT


INSTITUTE FOR MEDICAL SCIENCE, CHONBUK

NATIONAL UNIVERSITY- CHONBUK NATIONAL

UNIVERSITY HOSPITAL, CHONBUK, KOREA

JONG HWAN LEE1, SU GEUN KIM2, CHA DONG YEO3, EUN JUNG LEE4

Perilymphatic fistula(PLF) is defined as an abnormal communication between the fluid (perilymph)-filled spaced of the inner ear and the air-filled space of the middle ear and mastoid, or cranial spaces. PLF is located in the round or oval window, fractured bony labyrinth, microfissures, anomalous footplate, and can occur after head trauma or barotrauma, chronic inflammation, or in otic capsule dehiscence. The symptoms of perilymphatic fistula vary in severity and complexity and can range from very mild to completely incapacitating. When a fistula is present, changes in barometric pressure such as when flying or diving, will directly affect the inner ear stimulat-

right auricle mass which had grown over the past several months. Excision of auricle mass was done and patho-logical findings was consistent with sebaceoma. Cases of sebaceoma in the external auditory canal and auricle were rarely reported in domestic and foreign literature. Only one cease has been reported in Korea before. So, we de-scribe this case with a review of the literature.

» OTPX-08

» ENDOSCOPIC FACIAL NERvE DECOM-PRESSION IN TEMPORAL BONE FRACTURE

DEPT OF OTOLARYNGOLOGY,

SINGAPORE GENERAL HOSPITAL

JIA HUI NG, BARRIE YB TAN

The patient is a 37 year old Chinese male who was brought to the emergency department after being assaulted. He was intubated in the emergency department for a GCS drop to 7. After he was extubated 4 days later, a complete right facial palsy was noted. A high resolution CT TB scan found a complex TB fracture with a possible bony fragment impinging on the geniculate and tympanic seg-ment of the right facial nerve. An electroneuronography of the facial nerve done a week post injury showed absent facial nerve response on the right. The patient underwent endoscopic facial nerve decompression with cartilage tympanoplasty. Intraoperatively, a bony fragment was found impinging on the proximal tympanic segment of the facial nerve and was removed. At 3 months post-op-eratively, the patient continues to show improvement of his facial function with full eye closure and good smile symmetry.

» OTPX-09

» MY FIRST CHOICE OF THERAPY FOR ACUTE LOW FREQUENCY SENORINEURAL HEARINg LOSS

MIRAE OTORHINOLARYNGOLOGY CLINIC,

KANG-DONG KU, SEOUL, SOUTH KOREA

HYUNG-BECK KIM

Objectives: The effectiveness of the combination therapy of intratympanic dexamethasone injections(ITD), oral

Withdrawal

April26(Fri)





JI-SEOB YOO1, YEON-SEOK YOU2, EUN-JI KIM3, EUN-JUNG LEE4

The tympanic membrane develops frim the mesenchyme positioned between the first branchial groove and the first pharyngeal pouch. We met some cases of ear drum anomaly that typically rare. There were 3 cases of a mem-branous bands between the tympanic membrane and the external auditory canal. In the first case, An 18-years-old man complained of bilateral hearing impairment and had this structure in otoscopic evaluation. In the second case, A 7-years-old girl complained of right otalgia and had same structure in otoscopic evaluation. In the last case, a 2-year-old girl had mass like lesion in left ear drum, suspected of cholesteatoma. Surgical treatment was per-formed and partially duplicated drum was found during the procedure. This case also showed a web-like lesion. Although, A memebranous attachment between was observed 10% of cases of first branchial cleft anomaly, So far, our cases of ear drum anomaly have not found suspicious lesions to first branchial cleft anomaly. So, we describe these cases with a review of the literature.

» OTPX-13

» PULSATILE TINNITUS RELATED WITH ID-IOPATHIC INTRACRANIAL HYPERTENSION A CASE REPORT AND LITERATURE REvIEW


HEAD AND NECK SURGERY, SCHOOL OF

MEDICINE, KYUNGPOOK NATIONAL

UNIVERSITY HOSPITAL, DAEGU, KOREA

DA JUNG JUNG, MYUNG HOON YOO, KYU-YUP LEE

Idiopathic intracranial hypertension is a disorder charac-terised by raised intracranial pressure that predominantly affects young, obese women. Pathogenesis has not been fully elucidated, but several causal factors have been proposed. Symptoms can include headaches, visual loss, tinnitus, and back and neck pain, but the clinical presen-tation is highly variable. Studies have established weight loss as an eff ective disease-modifying treatment and ben-eficial effects of acetazolamide. We recently experienced a case of a 33 -year-old female complaining of right-sided

ing the hearing and balance structures. These symptoms include dizziness, vertigo, balance problems, nausea and vomiting. Tinnitus and hearing loss are also common-ly associated with perilymphatic fistulas. We report our experience of a 57-year-old male patient who present-ed with unilateral tinnitus, disequilibrium and SHL. In our case, PLF occurred without any other special vector such as trauma. In addition, enhanced MRI and non-en-hanced MRI were reviewed and compared at different time points.

» OTPX-11

» TWO CASES OF PULSATILE TINNITUS CURED BY SIgMOID SINUS RESHAPINg EvI-DENCE OF PROgNOSTIC vALUE OF WATER OCCLUSION TEST



CATHOLIC UNIVERSITY OF KOREA

HO JOON JIN, HYUN-IL SHIN, JUNG MEE PARK, SHI NAE PARK

Pulsatile tinnitus due to vascular anomalies are charac-terized by rhythmic sounds often heard in time with the subject’s heartbeat. Various vascular pathologies that are known to cause pulsatile tinnitus include sigmoid sinus wall dehiscence, diverticulum, and arteriovenous malfor-mation. The exact pathophysiology of tinnitus caused by these vascular pathologies is still unclear. “Water occlu-sion test” tests whether pulsatile tinnitus disappears after the ear canal is filled with water and then reappear when the water is removed. The positive result of the test in-dicates that pulsatile sound has originated from sigmoid sinus dehiscence as the water in the ear canal would pro-hibit the transmission of reverberating sounds through the tympanic membrane. Here, we report 2 cases of pul-satile tinnitus successfully diagnosed with sigmoid sinus dehiscence through the “water occlusion test” and treated by sigmoid sinus reshaping surgery.

» OTPX-12

» CASES OF EAR DRUM ANOMALY



April26(Fri)




SHENG-CHIA JOU

Introduction: Neuroendocrine neoplasms of the ear are uncommon neoplasms, accounting for < 2% of primary ear tumors. Their clinical and paraclinical presentation is non-specific since they were first described by Hyams and Michaels in 1976. We report the unique histopatho-logical findings of a neuroendocrine adenoma of the middle ear in a 26-year-old female who present to our institute with acute otalgia and asymmetric hearing loss. A otoscopic examination of the left tympanic membrane revealed a bulging of the posterior superior quadrant with 30 percentage perforation. The CT depicted focal soft tissue of the middle ear at left Prussak space without obvious bony erosion.The patient underwent endoscopic mastoidectomy , tympanoplasty type I and canaloplas-ty with tragal cartilage. The final histologic examination revealed a well differentiated neuroendocrine tumor. An immunohistochemical evaluation showed strong positivi-ty for synaptophysin and focal positive for chromogranin A. CD56 showed strong positivity and a low proliferation index of < 3% (Ki-67).

» OTPX-16

» CHRONIC OTITIS MEDIA WITH CHOLESTE-ATOMA DIAgNOSTIC AND MANAgEMENT IN vIET NAM

DA NANG FACULTY OF MEDICINE AND

PHARMACY, DA NANG UNIV.

B TAN HUYNH

Objectives: This study describes the clinical characteris-tics of COMC and CT findings to guide the examina-tion, diagnostic and management in Viet Nam. Meth-ods: Rretrospective review of clinical characteristics, CT findings, surgical and histopathological reports in 128 patients with middle ear cholesteatoma ( 70 males, 58 females; age range 5- 80 years, mean age 22 years ) among 1253 patients with COM. Otoscopy and CT scans were evaluated for the presence of cholesteatoma in middle ear and mastoid bone and surgery assessment. Results: Patients aged 20- 35 years are predominate. Intratem-poral complications: Facial paralysis 26 cases {20.31%): Supperative Meningitis: 8 cases (6.25%}, Bbrain abscess: 4 cases 3.12%, Ssigmoid sinus thrombosis: 02 cases {1.56%) in both congenital and acquired forms of the

pulsatile tinnitus. Two weeks later, headache with accom-panying nausea and blurred visions were developed. Pa-pill edema of her both eyes was observed in opththalmic examination and increased CSF opening pressure was checked. Symptoms such as headache, pulsatile tinnitus and blurred visions were much improved after she had started acetazolamide and weight loss.

» OTPX-14

» COCHLEAR IMPLANTATION IN PATIENTS WITH COCHLEAR NERvE DEFICIENCY


ISTANBUL TRAINING AND RESEARCH HOSPITAL

OZGUR YIGIT, CIGDEM KALAYCIK ERTUGAY, AYSE PELIN YIGIDER, ECEM SEVIM LONGUR

A deficient cochlear nerve was defined as a cochlear nerve that is smaller in diameter when compared with the ad-jacent facial nerve in the midportion of the internal au-ditory canal. The cochlear nerve was considered absent if there was no imaging evidence of a cochlear nerve. On the other hand, cochlear nerve absence or deficiency is not an uncommon cause for profound sensorineural hearing loss and presents a challenge in the decision-making process regarding whether to proceed with a cochlear implant or auditory brain stem implant. There is no consensus on this issue. Some authors think that auditory brain stem implant is most suitable for these cases whereas others suggest that they can benefit from cochlear implantation. In this report, we presented 4 patients with bilateral total-ly hearing loss who performed cochlear implantation de-spite of cochlear nerve deficiency on magnetic resonance imaging and computed tomography. We performed uni-lateral implantation in 3 patients and bilateral implanta-tion in 1 patient. We aimed to identify the children who benefit from cochlear implantation by evaluating the all literature review about this issue.

» OTPX-15

» A RARE NEUROENDOCRINE TUMOR OF THE MIDDLE EAR


AND NECK SURGERY, TRISERVICE GENERAL

HOSPITAL, NATIONAL DEFENSE MEDICAL CENTER

April26(Fri)




» OTPX-18

» A CASE OF TRAUMATIC STAPEDIO-vESTIB-ULAR DISLOCATION PRESENTINg WITH CON-DUCTIvE HEARINg LOSS



MEDICINE, CHUNGNAM NATIONAL UNIVERSITY,

DAEJEON, KOREA1

GEONHO LEE1, JIN WOONG CHOI1, YONG-HO PARK1, BONG JIK KIM1

A 27 year-old man complaining of non-progressive hear-ing loss on the right side for more than 20 years, visited otology clinic to figure out the possibility of hearing re-covery. He had a traffic accident at the age of five and remembered that he had bloody otorrhea at that time. Although the exact onset was not clear, hearing loss seemed to have existed since then. Audiologic assessment demonstrated a conductive hearing loss with Air-Bone conduction gap of 50dB on the right side. Physical exam-ination showed an intact tympanic membrane with the slight dislocation of Malleus handle and temporal bone CT revealed the disruption of ossicular chain involving Mallues, Incus and Stapes, otherwise normal finding. An exploratory tympanotomy was performed, which identified dislocated Malleus, Incus, Stapes, and rubbery membrane replacing the space where footplate used to be. To restore the ossicular chain, enabling the efficient sound transmission, a piece of cartilage was tailored to fit the space of missing footplate and a total ossicular re-placement prosthesis of titanium (4.0 mm) with cartilage interface was positioned between the underlying cartilage and the tympanic membrane and secured with soft tissue, gelfoam and glue. The patient did not complain of any surgery-related complications and a follow-up audiogram showed a complete recovery of hearing loss with no Air-Bone conduction gap. Here we report a very rare case of external stapedio-vestibular dislocation due to trauma ending up with successful surgical outcome from the per-spective of hearing recovery.

» OTPX-19

» A CASE OF NODULAR FASCIITIS IN SU-PRAAURICULAR REgION

disease. Conclusion: COMC is a distinct clinical char-acteristics by the otoscopy and CT findings. Mastoid surgery and Tympanoplasty surgery could get good re-sult in # 80% of the cases, hearing gained post-opera-tion:20-30dB. Vietnamese bioceramics is good for ossic-ular chain reconstruction in tympanoplasty surgery and other medical fields.

» OTPX-17

» ISOLATED CONgENITAL CHOLESTEATOMA OF THE MASTOID CAvITY WITHOUT INvA-SION OF MIDDLE EAR




SEOUL SAINT MARY HOSPITAL

SEON IK KIM1, JUNG MEE PARK2, JUNG JU HAN3, KYOUNG HO PARK4

Congenital cholesteatomas are often found under an intact tympanic membrane in the absence of prior sur-gical procedures or perforation. The commonly report-ed sites of origin within the temporal bone include the middle ear, petrous apex, and external auditory canal, rarest in the mastoid cavity. Congenital cholesteatoma of the mastoid cavity is considered as stage IV due to the highest risk of residual disease after surgical removal. A 15-year-old male patient was presented with hearing loss of the right ear since childhood. Otoscopic examination revealed a normal tympanic membrane. Pure-tone au-diometry demonstrated a conductive hearing loss of 45 dB. A high-resolution CT showed an extensive and de-structive mass-like lesion located in the mastoid cavity with an absence of stapes. On MRI, the lesion appeared hypointense on T1-weighted images and hyperintense on T2-weighted images, findings that strongly suggested cholesteatoma. A simple mastoidectomy was performed for the analysis of the lesion. The mass like lesion was limited to the antrum of the mastoid cavity. Subsequent exploratory tympanotomy showed a complete absence of supra-structure of stapes, without invasion into the mid-dle ear space. Pathological evaluation confirmed choles-teatoma. Congenital cholesteatoma solely located in the mastoid is very rare. Here, we report a patient presented with isolated congenital cholesteatoma of the mastoid cavity treated with simple mastoidectomy and TORP os-siculoplasty.

April26(Fri)




to include safety margins in excision of SCC. Here, we report a case with a literature review to present a diagno-sis and treatment process of SCC of the external auditory canal.

» OTPX-21

» A CASE OF MIDDLE EAR MENINgIOMA



HALLYM UNIVERSITY

GEON WOO KIM, HWI KYEONG JUNG, JAE MOON SUNG, CHANG WOO KIM

Meningioma is a common intracranial tumor involving the meninges. Extracranial meningioma is uncommon, particularly those extending into the middle ear. The present study reported a case of meningioma extending into the middle ear cavity from the cerebellopontine an-gle. The clinical and pathological characteristics, as well as the outcome of the patient, were presented.

» OTPX-22

» A CASE OF RECURRENT gLOMUS JUgU-LARE TYMPANICUM


NECK SURGERY, DONG-A UNIVERSITY

COLLEGE OF MEDICINE

EUNSOO LEE, MYUNG-KOO KANG

Gloumus jugulare tympanicum is most common primary neoplasm of middle ear. Glomus jugulare tympanicum is slowly growing, but locally destructive, spreading along paths of least resistance. Glomus jugulare can cause con-ductive hearing loss, pulsatile tinnitus, also facial palsy. We report a 49-year-old woman who underwent Novalis radiosurgery and recurred after 10years. Canal wall down with Tympanoplasty 0 and partial glomus tumor removal were performed. There was no case report that reccurent glomus jugulare tympanicum was managed by Canal wall down. It can be another treatment of choice available, We report this case report

Withdrawal



UNIVERSITY YANGSAN HOSPITAL, PUSAN


DONGJO KIM, SUNGWUK KIM, ILWOO LEE, HYUNMIN LEE

Nodular fasciitis is a benign reactive myofibroblastic proliferative lesion. It can mimic a malignancy due to its rapid growth rate and histologic appearances. The pa-tient was 30-year-old male, who had left supraauricular round mass for 3 months. Contrast-enhanced computed tomography of temporal bone revealed oval, cystic mass with peripheral enhancement. The mass was completely removed by surgery. And nodular fasciitis was confirmed by histological examination. Two months after the surgi-cal excision, there was no complication or recurrence. We report this case with related literature reviews.

» OTPX-20

» SQUAMOUS CELL CARCINOMA OF THE Ex-TERNAL AUDITORY CANAL A CASE REPORT WITH A REvIEW OF LITERATURE

SEOUL ST MARYS HOSPITAL,


DO YEON KIM1, JUNG MEE PARK2, JUNG JU HAN2, KYOUNG HO PARK2

Squamous cell carcinoma (SCC) of the external auditory canal is a rare malignant disease with an annual incidence of one per one million inhabitants. Common tumor pro-gression sites are periauricular soft tissues, parotid gland, temporomandibular joint, and mastoid. SCC of the exter-nal auditory canal may be an aggressive disease even at an early stage. Prognosis depends on the stage of the disease as well as the primary treatment. A 73-year-old woman with the left side ear discharge and mass visited our out-patient clinic. On otoscopic examination, a 1cm diame-ter mass was observed at the entrance of the left external auditory canal. Magnetic resonance imaging (MRI) scan of temporal bone showed focal thickening along the left external auditory canal entrance. The pathologic result of the biopsy revealed squamous cell carcinoma, moderately differentiated. The patient underwent subtotal petrosec-tomy, total auriculectomy, and superficial parotidectomy

April26(Fri)




sa with pneumatic mastoid and normal middle ear. The patient had no otologic or neurologic symptom, and the mass was found incidentally on brain MR included in a regular medical checkup. The mass was removed via com-bined transmastoid and suboccipital approach without any complications, and showed characteristic pathology finding which was diagnosed as cholesterol granuloma.

» OTPX-25

» ECCRINE HIDROCYSTOMAS IN ExTERNAL AUDITORY CANAL A CASE REPORT


AND NECK SURGERY SANGGYE PAIK HOSPITAL,

COLLEGE OF MEDICINE, INJE UNIVERSITY

YOUNG NAM KIM1, JEONG HWAN CHOI2

In this report, we describe a case of Eccrine Hidrocysto-mas in External auditory canal. A 42-year-old women who got a EAC mass about 3~4 years ago visited our de-partment of Otorhinolaryngology-Head and Neck Sur-gery at the Sanggye Paik Hospital(Seoul, Korea). Clinical examination, contrast enhanced CT was done and had operated on Excisional biopsy for an EAC mass which was confirmed as Eccrine Hidrocystoma. Eccrine hidro-cystomas are benign tumors of the eccrine sweat glands that arise from cystic dilatation of the excretory duct.

» OTPX-26

» A CASE OF SEMICIRCULAR CANAL DEHIS-CENCE TREATED BY SURgERY vIA MIDDLE CRANIAL FOSSA APPROACH

A CASE OF SUPERIOR SEMICIRCULAR CANAL

DEHISCENCE SURGICALLY TREATED VIA THE

MIDDLE CRANIAL FOSSA APPROACH

HYUN-IL SHIN, JUNG MEE PARK, JAE SANG HAN, SHI NAE PARK

Superior semicircular canal dehiscence (SSCD) is a rare disease of an absence of the bone overlying the superior semicircular canal. Patients with SSCD may show dif-ferent extents of symptoms related to impaired hearing and balance. Here, we report a case of SSCD successfully treated via the middle cranial fossa approach. A 41-year-

» OTPX-23

» ACELLULAR DERMAL MATRIx MIMICKINg RECURRENCE OF MALIgNANCY THROUgH PET/CT FOLLOWINg LATERAL TEMPORAL BONE RESECTION



UNIVERSITY HOSPITAL

SEOK-HWAN LEE, SUNG-WON CHOI, SOO-KEUN KONG, SE-JOON OH

A 71-year-old woman who was diagnosed as Basal cell carcinoma of external acoustic canal, had undergone Lt. lateral temporal bone resection with reconstruction using acellular dermal matrix(ADM). after 9 months of surgery, F-18-FDG-PET/CT revealed highly increased FDG activity(SUV max : 12.8) in operation site and it was considered to be a recurrence of malignancy con-sidering other radiologic findings. In the operation per-formed to confirm recurrence, the lesion was histolog-ically identified as chornic inflammation of ADM. We report a case of ADM that showed false positivity in PET / CT even after 9 months of surgery, because it has not been reported so far in all clinical deparments, including otorhinolaryngology.

» OTPX-24

» A CASE OF TEMPORAL BONE CHOLESTER-OL gRANULOMA ExTENDINg TO POSTERIOR CRANIAL FOSSA WITHOUT MIDDLE EAR IN-vOLvEMENT

1DEPARTMENT OF OTORHINOLARYNGOLOGY-


MEDICINE, KYUNGPOOK NATIONAL UNIVERSITY

MIN CHUL GO, MYUNG HOON YOO

Cholesterol granuloma of the temporal bone may occur in the petrous apex, middle ear, and mastoid cavity. Al-though cholesterol granulomas in the petrous apex often extend to the middle cranial fossa, cholesterol granulo-mas in the middle ear and mastoids rarely invade cranial cavity with bony erosion. Here we report a case of large cholesterol granuloma involving the posterior cranial fos-

April26(Fri)




old male who suffered from vertigo and left side tinnitus visited our outpatient clinic. He had a trauma history of his left temporal area at age 5. For the last 20 years, he felt intermittent vertigo especially aggravated by large sounds as well as hyperacusis, autophonia, ear fullness, and mild hearing impairment. With normal tympanic membranes, the threshold of bone conduction in the left side was decreased, and the air conduction threshold was increased in contrast. The VEMP test showed a decreased threshold of the left ear. Computer tomography image from the local medical center showed dehiscence of the left superior semicircular canal. After a failure of medical treatment, the surgery to occlude the dehiscence of the left superior semi-circular canal was decided. In cooper-ation with the Department of Neurosurgery, SSCD was approached via middle cranial fossa. By using autologous temporalis fascia, autologous bone chips, bone cement, and surgical glue, the dehiscence was successfully occlud-ed. The patient is currently completely free of symptoms after surgical treatment.

April26(Fri)




OTTPP 1Room 2-4 (Swan)

Chair : SOO KEUN KONG, HUN YI PARK

Teaser Poster Presentation

» OTTPP-01 11:50~11:54

» EFFECT OF PREgNANCY ON HEARINg

DEP. OF OTORHINOLARYNGOLOGY, LADY

HARDINGE MEDICAL COLLEGE, DELHI UNIV.

DEVANSHU KWATRA

Objectives: To see the changes in hearing thresholds in pregnancy. Methods: A prospective hospital based ob-servational study was performed with total 69 subjects in age group of 18-40 years. Subjects underwent hearing assessment twice during the study period. Conventional pure tone audiometry and impedance audiometry was performed, first during the antepartum period (28-32 weeks of gestational age) and second time during the postpartum period (6 weeks postpartum). Results: Sig-nificant difference was seen between the average of air conduction threshold values at speech frequencies when antepartum values were compared with postpartum val-ues. Conclusion: The alterations in hearing sensitivity in pregnant females which improved during the postpartum period can be attributed to pregnancy.

» OTTPP-02 11:54~11:58

» A POLYMORPHISM AT LOxL2 gENE AF-FECTS SUDDEN DEAFNESS IN KOREAN POP-ULATION


SCHOOL OF MEDICINE

SEOK YUN LEE, TAE WOO KIM, KIHO BAE, JUN WAN PARK, SUNG IL NAM

Objectives: The cochlear basilar membrane forms the floor of the organ of Corti. When a sound wave is trans-mitted into the cochlear. The bailar membrane vibrates.

The constituent collagen fibers of the basilar membrane affect its stiffness. LOXL2 gene encodes the Lysyl oxi-dase homolog 2 enzyme. The prototypic member of the lysyl oxidase gene family is essential to the biogen-esis of connective tissue, encoding an extracellular cop-per-dependent amine oxidase thatcatalyses the first step in the formation of crosslinks in collagen and elastin. This present study aimed to investigate the association of polymorphism at LOXL2 sudden deafness in Kore-an population. Methods: Study Design: Case-control study. Eighty one Korean SD patients and 455 normal patients (controls) were used in this study. Methods: Single nucleotide polymorphism (SNP) of LOXL2 gene (rs101****, rs1422*****, rs101*****, rs70*****) was an-alyzed. Results: At rs101**** and rs 101*****, SNP de-crease risk of SD(p<0.05). At rs1442***** and rs 70*****, SNP increased risk of SD(p<0.05). Conclusion: These results suggest that SNP of LOXL2 gene closely related to affects sudden deafness risk.

» OTTPP-03 11:58~12:02

» A STUDY ON LOgARITHMIC DISTANCES OF HEARINg FREQUENCIES BASED ON THE KOREAN NATIONAL HEALTH AND NUTRITION ExAMINATION 2010-2012 SURvEY


COLLEGE OF MEDICINE, EWHA WOMANS

UNIVERSITY, SEOUL, KOREA

SO JEONG LEE, SOO JIN KIM, MI SUN CHUN, JU HYUN YOON, SEUNG-HO SHIN,

SUNG WAN BYUN

Objectives: Recently, we have reported on the relation-ship between the threshold at 3 kHz and average of thresholds at 2 kHz and 4 kHz to obtain statistical evi-dence for the guidelines from the AAO–HNS Commit-tee on Hearing and Equilibrium (1995). In the course of the research, we have questioned which of 2 kHz and 4 kHz is more likely to affect the 3 kHz. We have extended this concept and tried to measure 'logarithmic distances of hearing frequencies' which indicates the magnitude of interaction among frequencies measured in KNHANES 2010-2012 survey. Methods: We have evaluated how a certain frequency was influenced by the other frequencies with multiple linear regression analyses using each fre-quency (500, 1k, 2k, 3k, 4k, and 6k Hz) as a dependent

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were positive prognostic factor for hearing recovery. Oth-er characteristics were not significant. Conclusion: The results of this study suggest that good hearing recovery in children may be associated with early time of initial treatment and accompanying tinnitus. Also, NLR value might be useful readily accessible prognostic markers in pediatric ISSNHL patients. Further studies are required to confirm prognostic factors useful to predict prognosis and treat ISSNHL in pediatric patients.

» OTTPP-05 12:06~12:10

» A CORRELATION OF SYMPTOM OF vERTI-gO AND vESTIBULAR FUNCTION TESTS WITH HEARINg LOSS SEvERITY AND TREATMENT OUTCOME IN SUDDEN SENSORINEURAL HEARINg LOSS PATIENTS


KOREA UNIVERSITY COLLEGE OF MEDICINE1

MUN SOO HAN1, YONG JUN JEONG1, MIN KYU LEE1, SEONGBIN PARK1,

YOUNG-SOO CHANG1, YOON CHAN RAH1, JUNE CHOI1

Objectives: We conducted a retrospective study of sud-den sensorineural hearing loss(SSNHL) patients to com-pare presence of vertigo symptom and vestibular function test results (Caloric test, C-VEMP and O-VEMP) with initial hearing loss severity and hearing recovery after treatment. Methods: The study population consisted of 142 patients with SSNHL with or without vertigo, who had undergone bithermal caloric test, C-VEMP and O-VEMP. The hearing loss severity and hearing outcomes were analyzed to find out statistical correlation with pres-ence of vertigo, loss of caloric responses, and abnormal C-VEMP and O-VEMP results. Results: Presence of ver-tigo symptom was significantly associated with severity of hearing loss at presentation (p=0.023) but not associated with treatment outcome. Analysis of caloric response and C-VEMP showed abnormal results of the tests are not significantly associated with either hearing loss severity or hearing recovery. However, patients with abnormal O-VEMP results were significantly associated with more severe hearing loss at initial presentation. Conclusion: From the study, we found that the symptom of vertigo and abnormal result of O-VEMP test are more associat-ed with hearing loss severity at initial presentation. None

variable and the other five frequencies independent vari-ables. R 3.2.2 was used as the statistical program. Results: As expected results, the influence of adjacent frequencies was strongest at all frequencies. The relative values of the correlation coefficients and logarithmic plots for frequen-cies(Hz) showed a linear relationship. The 1 kHz and 2 kHz have almost as much effect on the adjacent frequen-cy as logarithmic distance of hearing frequency. The effect of 1 kHz on 500 Hz was stronger than expected and so was the effect of 3 kHz on 4 kHz. The effect of 2 kHz and 4 kHz on 3 kHz was estimated to have a smaller effect than expected. Conclusion: The clinical significance of logarithmic distance of hearing frequency would be re-viewed.

» OTTPP-04 12:02~12:06

» PREDICTIvE vALUES OF NEUTROPHIL TO LYMPHOCYTE RATIO (NLR), PLATELET TO LYMPHOCYTE RATIO (PLR), AND OTHER PROgNOSTIC FACTORS IN PEDIATRIC IDIO-PATHIC SUDDEN SENSORINEURAL HEARINg LOSS


HEAD AND NECK SURGERY, GIL MEDICAL

CENTER, SCHOOL OF MEDICINE,

GACHON UNIVERSITY, INCHEON, KOREA

JU HYOUNG LEE1, DONG HYUN KIM2, RYUN HA3, CHANG HYUN CHO4

Objectives: No consensus has been reached regarding the optimum treatment or factors affecting prognosis in pedi-atric idiopathic sudden sensorineural hearing loss (ISSN-HL) due to its rarity. In the present study, treatment out-comes and prognostic factors of ISSNHL were investigat-ed in pediatric patients who underwent steroid therapy. Methods: Forty-two patients diagnosed with ISSNHL were enrolled in this retrospective study and compared with 39 normal healthy controls with respect to demog-raphy and complete blood cell count test results. In ad-dition, prognosis factors were sought by dividing the 42 ISSNHL patients to 3 groups according to their response to the treatment. Results: Neutrophil-to-lymphocyte ra-tio (NLR) value in the ISSNHL group were significant-ly higher than in the control group. NLR value in the three treatment response groups differed significantly. Early treatment with steroid and accompanying tinnitus

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UNIVERSITY SCHOOL OF MEDICINE1

HO YOUNG BAE1, HANTAI KIM1, HUN YI PARK1

Objectives: Recently, several radiologic abnormalities in a patient’s temporal bone CT have been noticed as the cause of pulsatile tinnitus, and some of the radiologic problems could be treated by a surgical method such as transmastoid reshaping of the sigmoid sinus. Therefore, in clinical field, we are now confronting a decision of sur-gical management for the pulsatile tinnitus. In this study, the association between the tinnitus and its radiologic findings was investigated, and we suggest some consid-erations for the treatment. Methods: Data of 43 patients who were suffered from pulsatile tinnitus were enrolled. All the subjects performed temporal bone CT with or without contrast. Basic demographics and the results of pure tone audiogram of the subjects were compiled together. Twelve non-pulsatile patients without hearing problem were sampled as a control group. Results: Of the 43 subjects, radiologic abnormalities were exhibited in 26 (60.5%). Sigmoid sinus dehiscence was the most common (25.6%). Twenty-four were identified the ab-normalities in the ipsilateral side of tinnitus but 2 in the counterlateral side. Increased threshold in 250 Hz in sub-jects with abnormal findings was noteworthy. Further-more, hearing threshold in 2,000 Hz was high in patients showing high jugular bulb, and 4,000 Hz was likely to be related with sigmoid sinus diverticulum. Conclusion: The association between the radiologic abnormalities and pulsatile tinnitus was relatively distinct and considerable. Therefore, radiologic evaluation may be recommended for pulsatile tinnitus, especially in a patient presenting worse hearing in lower frequency.

» OTTPP-08 12:18~12:22

» vARIOUS POSTOPERATIvE INTRACOCHLE-AR EABR RESULTS DEPENDINg ON THE ETI-OLOgY

DEPARTMENT OF OTORHINOLARYNGOLOGYHEAD

AND NECK SURGERY, SEOUL NATIONAL


GOUN CHOE, SANG-YOUP LEE, BYUNG-YOON CHOI

Objectives: The electrical auditory brainstem response

of the vestibular function tests and vertigo symptom presence showed association with treatment outcome in SSNHL patients.

» OTTPP-06 12:10~12:14

» THE vARIATION OF BERA (BRAIN EvOKED RESPONSE AUDIOMETRY) THRESHOLDS BASED ON THE HOSPITALS AND DEvICES


COLLEGE OF MEDICINE, EWHA WOMANS

UNIVERSITY, SEOUL, REPUBLIC OF KOREA

SOO JIN KIM, MI SUN CHUN, SO JEONG LEE, SUNG WAN BYUN, JU HYUN YOON,

SEUNG-HO SHIN

Objectives: To compare and validate on thresholds in brain evoked response audiometry (BERA) for single pa-tient based on the performed hospitals and used devices. Methods: The data was obtained in evaluating hearing disability of medical consultation for patients with noise induced hearing loss from 2016 to 2018. They under-went two or more BERA tests at the different hospitals and consisted of 42 males, so that the number of ears were 84. The average age was 62.5 (STD 5.0) years old. The test results were analyzed based on the test-per-formed 6 hospitals and used devices. Those 5 devices were navigator pro, Eclipse, Audera, Viking, and Smart EP. Results: The maximum difference of the thresholds between two hospitals was 35dB. The number of the dif-ference over 30dB, 20 to 30dB, 10 to 20dB and less than 10dB was 1, 11, 23 and 49. Three of 6 hospitals showed a skewed thresholds distribution. Four of 5 devices had an even thresholds distribution. However, one device tend-ed to show the better thresholds than the other devices. Conclusion: Based on our analysis, it is concluded that the BERA thresholds were affected by some of used de-vices and performed hospitals. To standardize the BERA thresholds, the device and its usage should be investigated in the future.

» OTTPP-07 12:14~12:18

» CLINICAL IMPLICATION OF PURE TONE AU-DIOMETRY AND TEMPORAL BONE CT IN PUL-SATILE TINNITUS PATIENTS

April26(Fri)




JUNHUI JEONG1, TAEMI YOUK2, CHANG EUI HONG1, KYUIN LEE1,

HYUN SEUNG CHOI1

Objectives: The incidence of hearing loss in neonates is 1-3 per 1,000, and it is 2-5 percent in neonates who had risk factors. In this study, we analyzed risk factors of hearing loss in infant using Korean National Health Insurance Service data. Methods: We included neonates who were born from 2007 to 2013 (n=3,280,030) from the whole data of National Health Insurance Service and they were tracked until 2015. The hearing loss patient group was composed of people who were graded as hear-ing impairment by the Ministry of Health and Welfare or recipients of cochlear implantation (n=1,556). The control group was composed of people with similar pro-pensities of demographic characteristics (n=4,668). Next, we matched individual neonates with their mothers, and ‘hearing loss patient matched with mother group’ was es-tablished (n=847) and control group was re-established with similar propensities of demographic characteristics (n=2,508). Risk factors which were reported by Joint Committee on Infant Hearing (JCIH) were analyzed by means of diagnostic code, treatment code, and medica-tion code during neonatal period for infant and twelve months prior to patient’s birth for mother’s infections. Results: Low birth weight (170 versus 142), use of ami-noglycosides and loop diuretics (324 versus 215), and hospitalization in neonatal intensive care unit (NICU) for more than five days (256 versus 108) were significant-ly higher in patient group than in control group. In the analysis of mother-matched group, low birth weight (103 versus 77), use of aminoglycosides and loop diuretics (184 versus 117), and hospitalization in NICU for more than five days (153 versus 59) were also significantly higher in patient group than in control group.Conclusion: Low birth weight, use of aminoglycosides and loop diuretics, and hospitalization in NICU for more than five days were significant risk factors of hearing impairment in in-fant. This study has significance because it was based on population-based big data of long-term period.

» OTTPP-10 12:26~12:30

» COMPARISONS OF AUDITORY BRAINSTEM RESPONSE IN TINNITUS EARS AND NON- TINNITUS EARS IN UNILATERAL TINNITUS PA-TIENTS WITH NORMAL AUDIOgRAMS ALONg THE DURATION

(EABR), which is performed to evaluate auditory func-tion in hearing loss patients, has been performed by promontory stimulation. This is mainly used for the pre-diction of the cochlear implant outcomes preoperatively, but the results are unsatisfactory in terms of accuracy and reproducibility. In this study, postoperative intracochlear EABR results were compared with those of conventional testing methods and CI outcome. This study shows that postoperative intracochlear EABR can be more effective than conventional EABR methods for prediction of CI outcome. Methods: A retrospective study is performed based on the medical records of patients who under-went cochlear implants with hearing loss at Seoul Na-tional University Bundang Hospital. The medical records confirm the patient's etiology, preoperative pure tone audiometry test, promontory stimulation EABR, post-operative electrically evoked compound action potential (ECAP), postoperative EABR, and speech evaluation re-sults after cochlear implantation. Results: A total of six patients were analyzed in this study. Two of the congen-ital hearing loss patients were auditory neuropathy spec-trum disorder, two were cochlear nerve aplasia and one was cochlear aplasia. The other one had deafness due to labyrinthine infarction. In patients with cochlear nerve aplasia, cochlear aplasia and labyrinthine infarction, ECAP and postop EABR results predicted CI outcomes relatively well. On the other hand, the results of ECAP and postop EABR in patients with ANSD did not agree with the outcome of CI. Conclusion: ECAP and postop intracochlear EABR may be useful in predicting CI out-come in patients with cochlear nerve disorder and inner ear anomaly. On the other hand, in two patients with ANSD with anatomically intact cochlear nerve, ECAP, postop EABR and CI outcomes were inconsistent. There is a large difference in deaf duration between these two patients, and further studies are needed to determine the cause of the discrepancy.

» OTTPP-09 12:22~12:26

» ANALYSIS OF RISK FACTORS OF HEARINg LOSS IN INFANT BASED ON KOREAN NATION-AL HEALTH INSURANCE SERvICE DATA


NATIONAL HEALTH INSURANCE SERVICE ILSAN

HOSPITAL1, DEPARTMENT OF POLICY RESEARCH

AFFAIRS, NATIONAL HEALTH INSURANCE

SERVICE ILSAN HOSPITAL2

April26(Fri)





Chair : SUNG IL CHO, SU KYOUNG PARK


» OTTPP-11 13:30~13:34

» HEARINg PRESERvATION IN COCHLEAR IMPLANTATION WITH LATERAL WALL ELEC-TRODE



MEDICINE, CHUNGNAM NATIONAL UNIVERSITY,

DAEJEON, KOREA1

GEONHO LEE1, SEULGI LEE1, JAE-YOON KANG1, BONG JIK KIM1,

YONG-HO PARK1, JIN WOONG CHOI1

Objectives: The purposes of this study were to investigate the hearing preservation rate of cochlear implantation (CI) with lateral wall electrode and to find out association factors of hearing preservation (HP). Methods: Patients undergoing CI with lateral wall electrodes and air-con-duction thresholds ≤85 dB HL at 250 Hz preopera-tively were included. HP was defined as air-conduction thresholds ≤85 dB HL at 250 Hz. The following clinical parameters were analyzed in patients with and without HP. Demographics, sex, hearing loss etiology, duration of hearing loss, implantation side, surgical approach (round window approach or cochleostomy), angular insertion depth, preoperative hearing and perioperative use of steroid. Results: Thirty-four ear (32 patients) met inclusion criteria. HP was achieved in 14 (41.1%) ears. There was no significant difference in demographic, etiol-ogy, implantation side, duration of hearing loss, surgical approach, angular insertion depth and administration of steroid between the two groups. However, hearing was better preserved in patients with preoperative air-conduc-tion threshold ≤60 dB HL at low frequency compared to those with threshold >60 dB HL, which was statistically significant (P = 0.036). Conclusion: HP rate was 41.1% when performing CI using lateral wall electrodes. The HP was significantly associated with better preoperative

Withdrawal


NECK SURGERY, KOREA UNIVERSITY COLLEGE

OF MEDICINE, ANSAN HOSPITAL

YONG JUN JEONG, MUN SOO HAN, MIN KYU LEE, SEUNG BIN PARK, KUK JIN NAM, KANG HYEON LIM,

YOUNG SOO CHANG, YOON CHAN RAH, JUNE CHOI

Objectives: Pathophysiology of tinnitus has not been precisely established until now. “Hidden hearing loss” with cochlear synaptopathy(CS) was suggested as a po-tential pathophysiology of tinnitus with normal hearing threshold. Several studies have demonstrated that sub-jects with tinnitus and normal audiograms show signifi-cantly reduced auditory brainstem response (ABR) wave I amplitudes compared with control subjects, but normal or increased wave V amplitudes, suggesting increased central auditory gain. To our knowledge, little studies of ABR change along duration of tinnitus have been re-ported. We aimed to research about the “hidden hearing loss” theory along the duration. Methods: In the current study, 84 subjects (31 males, 53 females) who had unilat-eral tinnitus with normal hearing were included between Jan. 2016 and Oct. 2017. The amplitude of wave I and V, The latency of wave I, III, V were checked at 90dB nHL. Inter-peak latency (IPL) was calculated between wave I and III, wave I and V, wave III and V, respectively. The ratio of amplitude of wave V and I was calculated also. Those data was compared between Tinnitus ear(TEs, Ip-si-lesion) and Non-tinnitus ear(NTEs, Contra-lesion). Results: The within-subject comparison between TEs and NTEs showed no significant differences in amplitude of wave I and wave V, wave V/I ratio, or latency of wave I, III, V, and IPLs along the duration(acute, subacute, chronic). All other data were not statistically significant, but latency of wave III of TEs are longer than NTEs in acute group. Conclusion: Our ABR data represent do not meaningful evidence supporting the hypothesis of cochlear synaptopathy with increased central gain in tin-nitus subjects with normal audiograms. More subjects are needed.

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ficient channels and effective speech therapy.

» OTTPP-13 13:38~13:42

» A CRITERION OF CANDIDACY FOR PEDIAT-RIC COCHLEAR IMPLANT BASED ON SPEECH PERFORMANCE OF CHILDREN WITH HEAR-INg AIDS



CENTER, UNIVERSITY OF ULSAN COLLEGE OF


MIN YOUNG KWAK, YEHREE KIM, JI WON SEO, WOO SEOK KANG, JOONG HO AHN, JONG WOO CHUNG, HONG JU PARK

Objectives: There have been no domestic evidence-based reports for a criterion of candidacy for pediatric cochle-ar implant (CI). We aimed to analyze the speech perfor-mances of children with hearing aids (HA) and compared the resultswith those from children with CI. Methods: We classified the hearing-impaired children with hear-ing aids according to their degrees of hearing loss and evaluated the best monosyllabic word recognition scores (WRS) from their medical records. We compared WRS of the prelingually deaf children with CI. The aim was to calculate the unaided pure-tone average(PTA) hearing level at which a child has odds of 4:1 of a better outcome with implants than with hearing aids. Results: WRSs reached their plateau (maximum level) at 3 years of age in normal hearing children. The group with PTA of 41-50 and 51-70 dB HL reached their plateau at 6 and 8 years of age. The best WRSs of children with PTA of 31-40 and 41-50 dB HL were 97±5% and 89±9%. The best WRSs of children with PTA of 51-60, 61-70, and 71-80 dB HL were 77±18%, 69±21% and 52±16%. None of the children with hearing loss more than 51 dB showed WRS of 100%. The best WRS of the children with CI was 88±6%, which was similar to the group with PTA of 41-50 dB HL. Odds of 4:1 of a better outcome with CI were associated with PTA of 76 dB HL for WRS in quiet. Conclusion: Children with an unaided four-frequency PTA of 73 dB HL or poorer may be considered candi-dates for cochlear implantation. We identified how the WRSs varied with thedegree of hearing loss and age. Our data would be helpful in counselling the parents with a deaf child and providing the appropriate auditory reha-

hearing status of less than 60 dB HL at low frequency.

» OTTPP-12 13:34~13:38

» COMPARISON OF MULTIMODAL SPEECH PERCEPTION AFTER COCHLEAR IMPLANTA-TION BETWEEN PRE- AND POST-LINgUAL HEARINg LOSS IN ADULTS




JUNG JU HAN, JUNG MEE PARK, JAE SANG HAN, SEON IK KIM,

SO YOUNG PARK, SHI NAE PARK

Objectives: This study was performed to compare the multimodal speech perception of cochlear implantation (CI) in adult patients of prelingual and postlingual hear-ing loss. Methods: The present study enrolled prelingual and postlingual deaf adults who underwent unilateral CI between 2003 and 2017 in Seoul St. Mary’s Hospital. Only subjects without surgical complications and who were followed up for more than 1 year to complete the postoperative outcome assessment were included in the study. Speech test battery consisted of open-set spoken words (1- or 2-syllable words) and open-set sentences in a quiet environment under auditory-only (AO) and auditory-plus-visual (AV) conditions. Various clinical and audiologic factors were compared between the two groups: age, sex, duration of deafness, duration of hear-ing aid use, hearing levels, speech discrimination scores, number of channels, number of speech therapy, and fi-nally, patient’s motivation to speech perception. Results: Among 60 subjects (aged 18 to 86 years, 36 men and 24 women), 7 patients (11.7%) belonged to the prelin-gual group. Preoperative word and sentence recognition scores were lower in the prelingual group compared to the post-lingual group (p < 0.05). Other clinical factors including the hearing levels and speech discrimination scores showed no significant differences between the groups. The number of CI channels used were directly correlated with the degree of postoperative hearing im-provement (p = 0.014). Conclusion: Most of CI recipi-ents showed a good speech performance regardless of the different onset of hearing loss. This study suggests that prelingual hearing loss patients show similar speech per-formance as postlingual patients when provided with suf-

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fixed length (28 mm) of electrode might show best post-CI performance when the total CLs and the diameters of basal turn were 31-35.2 mm and 8.5-9.5 mm, which covers most deaf adults. A shorter electrode might get a better WRS when the total CL is less than 31 mm.

» OTTPP-15 13:46~13:50

» LONg TERM FOLLOW UP RESULTS OF CO-CHLEAR IMPLANT SURgERY IN CHILDREN WITH INNER EAR ANOMALY




MEDICAL CENTER1, DEPARTMENT OF


SURGERY, SUNGKYUNKWAN UNIVERSITY

SCHOOL OF MEDICINE,

SAMSUNG CHANGWON HOSPITAL2

MIN-JO KWON1, YOUNG SANG CHO1, IL-JOON MOON1, YANG-SUN CHO1,

SUNG-HWA HONG2, WON-HO CHUNG1

Objectives: The purpose of this study was to examine the auditory performance after cochlear implantation(CI) in children with Inner ear anomalies(IEA) according to the IEA type. Methods: We included 150 patients (mean age=3.38±3.30 years at the time of operation, range 0.9-16.4 years) who underwent CI surgery at Samsung Medi-cal Center between April 2003 and December 2018. IEA was categorized into 7 groups by detailed structure (1. Cochlear hypoplasia(CP), 2. Common cavity(CC), 3. Incomplete partition(IP)-I, 4. IP-II, 5. IP-III, 6. Semicir-cular canal(SCC) dysplasia & Enlargement of vestibular aqueduct(EVAS), 7. Narrow IAC). In addition, these 7 groups were categorized into 3 groups according to the severity (A. Mild to moderate IE dysplasia: IP-II, IP-III, SCC hypoplasia, EVAS, B. severe IE dysplasia : CC, CP, IP-1, C. Narrow IAC). Up to 2 years, postoperative per-formance was analyzed using the Categories of auditory performance (CAP) of the patients who could be followed up. Results: In the group according to the detailed struc-ture, group 4 (n=60, 45%) was the most common, and group 2 (n=3, 2%) was the least. In the group according to the severity, group A (n=100, 67%), group B (n=32, 21%), group C (n=18, 12%) was in order, respectively. In each group, CAP score increased over time. Group C

bilitation according to their degree of hearing loss.

» OTTPP-14 13:42~13:46

» COCHLEAR DUCT LENgTH ESTIMATION TO-WARD PERSONALIzED COCHLEAR IMPLANT SELECTION





JA YOON KU, JE YEON LEE, YEHREE KIM, MIN YOUNG KWAK, JI WON SEO,

WOO SEOK KANG, JOONG HO AHN, JONG WOO CHUNG, HONG JU PARK

Objectives: There is a trend toward patient-specific selec-tion of electrode length according to the cochlear length (CL), possibly resulting in optimal audiologic outcomes. Too deep electrode insertion may entail a greater risk of trauma. We aimed to investigate the distribution of CLs in postlingually deaf adults and correlation with CLs and audiologic outcomes. Methods: The cochlear length and the diameter of basal turn were estimated using Otoplan, a surgical planning software, and a conventional two-di-mensional method using temporal bone CT scans in 38 postlingually deaf adults who underwent cochlear im-plant (MEDEL FLEX28) surgery with audiological eval-uation more than 1 year. They were correlated with the word recognition scores by CI with a straight electrode (MEDEL FLEX28). The distribution of the CLs to get WRS > 70% was extrapolated using the quadratic poly-nomial regression. Results: Using OTOPLAN, estimated CLs were 33.6 ±1.7 (30.8-37.1) mm for total lengths and 19.8 ±1.0 mm, 25.5±1.3 mm, and 29.9±1.6 mm, for 1, 1.5, and 2 cochlea turns. The diameter of basal turn by OTOPLAN was significantly correlated with total CLs (R-sq=0.995) and the diameter of basal turn (R-sq=0.34) measured by a conventional method. The age-corrected best WRSs were 66±24% and did not show any correla-tion with the CLS using linear regression. The distribu-tion of the total CLs and the diameters of basal turn to get age-corrected WRS > 70%, which is extrapolated using the quadratic polynomial regression, were 31-35.2 mm and 8.5-9.5 mm. Conclusion: The estimated total cochlear lengths by OTOPLAN were 33.6 ±1.7 (30.8-37.1) mm in postlingual deaf adults. A commonly used

April26(Fri)




group; (P>0.05). hearing gain for PTA of each frequen-cy were 17.9 ± 22.4 dB at 500Hz, 19.7±20.2 dB at 1K, 16.4±22.4 dB at 2K and 16.1±21.3 dB at 3K in ITS alone group. In SS alone group, hearing gain for PTA of each frequency were 23.6±22.7 dB at 500Hz, 22.2± 22.6 dB at 1K, 18.4±20.5 dB at 2K and 14.5±18.4 dB at 3K. The analysis of hearing gain for each frequency revealed no significant difference, either (P>0.05). Conclusion: There was no significant difference in frequency-specific hearing improvement between SS alone and ITS alone group. There was also no significant difference in hearing outcomes between ITS and SS group.

» OTTPP-17 13:54~13:58

» CLINICAL FEATURES OF OTOMYCOSIS CO-OCCURRINg WITH CHRONIC OTITIS ME-DIA AND THE CAUSATIvE FUNgI



CATHOLIC UNIVERSITY OF DAEGU

BU-KWAN KIL, BO-MUN KIM, YEE-HYUK KIM

Objectives: Otomycosis is a fungal infection that com-prises 7~10% of outer ear infections. Although the occur-rence is higher in humid climates, relatively few studies have investigated otomycosis occurrences in humid envi-ronments. While recurrent chronic otitis media discharge in the ear creates a milieu in which otomycosis is likely to occur, investigations of otomycosis co-occurring with chronic otitis media have been rare. The purpose of this study is to examine the characteristics of patients with otomycosis co-occurring with chronic otitis media and identify causative fungi. Methods: The study included 60 patients with chronic otitis media who presented typical otomycosis findings in the outer ear canal and the pres-ence of fungi. Patients were treated in the department of otolaryngology, Daegu Catholic University Medical Center, between July 2011 and June 2018. Results: The mean patient age was 57.77 years, and our study includ-ed 20 men and 40 women (p=0.010). The lesion was on the right in 39 patients and on the left in 21 (p=0.020). Ear discharge was the most common chief complaint at diagnosis. Of the 54 patients over age 19, 10 had dia-betes (18.5%). Aspergillus was causative in 29 patients and Candida in 31. Aspergillus niger was identified in 15 patients, Aspergillus sp. in 14, Candida parapsilosis in 12, Candida sp. in six, and Candida albicans in five.

showed the lowest performance. When comparing CAP among group A, B, C, there were significant differences between group A and C at 6 months (p<0.01), as well as 1 and 2 years (p<0.05). Conclusion: The prevalence of IEA in this study was 29% (150 of 512). In this study, the mean score of CAP increased to 4.7points in average at group A (max=7). But group C showed the lowest per-formance. These results will help predict long-term out-comes of CI in children with IEA.

» OTTPP-16 13:50~13:54

» COMPARISON OF THERAPEUTIC EFFI-CACY BETWEEN SYSTEMIC STEROID AND INTRATYMPANIC STEROID INJECTION FOR SUDDEN SENSORINEURAL HEARINg LOSS


NECK SURGERY, INCHEON ST MARYS HOSPITAL,


UNIVERSITY OF KOREA

HYUN JIN LEE, EUN-JU JEON

Objectives: Steroid is used as a main treatment modal-ity for sudden sensorineural hearing loss (SSSHL). The therapeutic efficacy of intratympanic injection of ste-roid (ITS) has been reported as being comparable to the systemic steroid administration (SS). The objective of this study is to compare the therapeutic effect of each treatment. Methods: Retrospective chart review was performed for 145 patients with SSNHL. The patients were divided into 2 groups according to the method of treatment (ITS vs. SS groups). The inclusion criteria were initiation of treatment within 7 days of hearing loss and consistent with the definition of SSNHL. Hear-ing gain for pure tone threshold of each frequency and average of 4 frequencies (500 Hz, 1000 Hz, 2000 Hz, 3000 Hz) at 1 month follow up period were compared between both groups. We used the outcomes assess-ment in the Clinical Practice Guideline: Sudden Hear-ing Loss from the American Academy of Otolaryngolo-gy–Head and Neck Surgery (AAO-HNS) Results: The age of onset between ITS (61.2±11.5 years old) and SS (51.8±14.8) was significantly different (P<0.001).After 1 month, the hearing gain was not significantly different between the two groups (19.6±21.0 dB HL in the ITS group and 19.7±19.5 dB HL in the SS group), (P>0.05). Treatment response was also not significantly different, shown in 63.6% of the ITS group and 65.9% of the SS

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clinic for management of drain. Therefore the manage-ment of PAF using this drainless minimal supra-auricular techniques can achieve a high rate of success in terms of reducing the recurrence & increasing the patient’s com-fort & satisfaction.

» OTTPP-19 14:02~14:06

» FOREIgN BODIES OF THE ExTERNAL AU-DITORY CANAL IN CHILDREN AND ADOLES-CENT



COLLEGE OF MEDICINE

KEON-HO KIM1, JAE HO CHUNG2, HA YOUNG BYUN3, SEUNG HWAN LEE4,

CHUL WON PARK5, SEOK HYUN CHO6

Objectives: Foreign bodies in the external auditory canal (EAC) are common in otolaryngology and emergency de-partment. The aim of the study was to evaluate the clini-cal characteristics of EAC foreign body and discuss prop-er management. Methods: A retrospective medical chart review was done with patients under 20 years of age, who presented with EAC foreign body in otolaryngology out patient’s department or emergency department from Jan 2007 to Dec 2017. Results: Two hundred ninety-eight patients with EAC foreign body was identified. The inci-dence of EAC foreign body peaked between ages 3 years and 7 years, dropping abruptly afterward and then in-cidence increases in ages of 17~18 years. Insect, air-gun bullet, marble, cotton ball and ear ring were frequently observed in EAC. 38 (12.7%) EAC foreign bodies were removed with the naked eye in emergency department and 250 (83.9%) patients were referred to otolaryngol-ogy and removed under microscope. Among them. 10 patients needed general anesthesia. 46 patients suffered complications related to EAC foreign body. EAC abra-sion was the most common complication (44, 14.7%) and traumatic tympanic membrane perforation was iden-tified in 2 cases (0.7%). Conclusion: Various materials and insects were identified in EAC as the foreign body. To minimize complications, appropriate removal methods according to the foreign body type must be emphasized.

» OTTPP-20 14:06~14:10

» ASSOCIATION BETWEEN HIgH NEUTRO-

Conclusion: Otomycosis and chronic otitis media co-oc-currences increase with age. The Aspergillus and Candida genera were similar in proportion. A. niger was the most common Aspergillus species, while C. parapsilosis was the most common Candida.

» OTTPP-18 13:58~14:02

» CLINICAL EFFICACY OF DRAIN-LESS AND SUBCUTANEOUS SUTURE TECHNIQUE IN PREAURICULAR FISTULA

DEAPRTMENT OF OTOLARYNGOLOGY HEAD &

NECK SURGERY, THE CATHOLIC UNIVERSITY OF

KOREA, COLLEGE OF MEDICINE

MOHSEN HUSSAIN KHARDALI, SUNIK KIM, HO JOON JIN, SEOUNG MIN LEE, JUNG JU HAN, JEONG MI PARK,

KYOUNG HO PARK

Objectives: The purpose of this study was to share our review of surgical strategies and outcomes in the man-agement of preauricular fistula and evaluate the advan-tages of using drainless & subcutaneos suture technique. Methods: This was a retrospective study was performed for all patients who had undergone excision of preauric-ular fistula (PAF) between January 2008 and end of De-cember 2018. Medical records of 206 patients with 256 PAF were analyzed for site of PAF, surgical procedure, postoperative infection presence, and recurrence rate and rate of postoperative outpatient clinic visit. Results: A single‐stage procedure was adopted in 247 (96.5%) PAF. 79 men and 127 women were included; their mean age was 24.5 years Of all directions right, left and both ears with PAF, we found 75 (36.4%), 81 (39.3%),and 50 (24.3%), respectively. 206 patients (256 ears) had no drain inserted after the surgery but had meticulous subcutaneous suturing of dead space of the postoperative defect. Sixteen (6.2%) PAF had postoperative infection and 9 (3.5%) involved recurrence rate for excision of PAF using minimal supra-auricular with elliptical inci-sion around the sinus opening and dissection of the tract and no postoperative drain approach was used in all cases. Conclusion: A thorough understanding of minimal su-pra-auricular techniques and a logical decision‐making to produce minimum dead space process and eliminate the use for postoperative drain so reduce hospital stay and patient’s discomforts of frequent visiting to outpatient

April26(Fri)




chemotherapy and results in inadequate treatment of malignant tumors. This study aimed to investigate the protective effects of ferulic acid on cisplatin-induced oto-toxicity. Methods: HEI-OC1 cells were exposed to 30 μM of cisplatin for 24 h with or without pretreatment with ferulic acid. Cell viability was determined using the WST assay. Apoptotic cells were identified using TUNEL assay. Western blot analysis was performed to examine the change in expression of cleaved caspase, cleaved PARP, Nrf2, and catalase. Intracellular reactive oxygen species (ROS) were determined by flow cytometry. Real-time PCR analyses were performed to examine the mRNA levels of antioxidant enzymes including Gclc, Gpx2, cata-lase, and SOD2. Phalloidin staining of the organ of Corti was performed to determine hair cell survival or degener-ation. Results: Pretreatment with ferulic acid before cis-platin exposure significantly increased cell viability, levels of antioxidant enzymes, and hair cell survival. In addi-tion, pretreatment with ferulic acid significantly reduced apoptotic cells, levels of cleaved caspase, levels of cleaved PARP, and intracellular ROS production. Conclusion: Our results demonstrated that ferulic acid inhibited cis-platin-induced cytotoxicity by preventing ROS forma-tion and inducing the production of endogenous anti-oxidants and indicated that ferulic acid might be used as a protective agent against cisplatin-induced ototoxicity.

» OTTPP-22 14:14~14:18

» MICRORNA ExPRESSION IN THE COCHLE-AR NUCLEUS AFTER NOISE-INDUCED HEAR-INg LOSS

INTERDISCIPLINARY PRO OF NATURAL

SCIEGRAM IN NEUROSCIENCE, SEOUL NATIONAL

UNIVERSITY COLLEGENCES1, DEPARTMENT OF




SOHYEON PARK1,2, NA HYUN KIM2, BYEONG GON KIM2, MYUNG-WHAN SUH2,

JUN HO LEE2, SEUNG HA OH2, MOO KYUN PARK2

Objectives: Noise-Induced Hearing Loss (NIHL) causes damage in the cochlea and damaged cochlea cause chang-es in neuroplasticity in the Cochlear Nucleus (CN). This study is aimed to identfy the role of microRNAs (miR-

PHIL TO LYMPHOCYTE RATIO AND DELAYED RECOvERY FROM BELLS PALSY



MEDICINE, KYUNG HEE UNIVERSITY

HYUNG-SIK KIM, SUNG HWA DONG, SANG HOON KIM, JAE YONG BYUN,

MOON SUH PARK, SEUNG GEUN YEO

Objectives: Factors predictive of the severity of and recov-ery from Bell’s palsy remain unclear. This study evaluated the association between neutrophil to lymphocyte ratio (NLR) and the severity of and recovery from Bell’s palsy. Methods: This retrospective study included 51 patients who were hospitalized with Bell’s palsy from 2015 to 2017. Degree of paralysis was assessed by House- Brack-mann (H-B) grade. Patients with H-B grades 2–4 were classified as having mild to moderate palsy and patients with H-B grade 5 or 6 were classified as having severe pal-sy. Patients were evaluated for obesity, hypertension and diabetes mellitus, and blood tests were performed to de-termine NLR and platelet to lymphocyte ratio. Patients were treated with steroids and antiviral agents. H-B grade was assessed 1 week, 1 month, and 3 months after treat-ment. Results: NLR was significantly higher in patients with severe than with mild to moderate palsy (P=0.048). Recovery time was significantly longer in patients with high NLR than low NLR (P=0.045). Conclusion: High-er NLR in patients with Bell’s palsy was associated with longer recovery time. NLR may be prognostic of recovery time in patients with Bell’s palsy.

» OTTPP-21 14:10~14:14

» THE PROTECTIvE ROLE OF FERULIC ACID AgAINST CISPLATIN-INDUCED OTOTOxICITY


NECK SURGERY, CHOSUN UNIVERSITY

COLLEGE OF MEDICINE

DO YOON JEONG, EU-RI JO, JI-HYE HAN, SUNG IL CHO

Objectives: While cisplatin is an effective chemothera-peutic agent, it can cause irreversible hearing loss. Oto-toxicity leads to dose reduction during the cisplatin

April26(Fri)




one method to image the inner ear with MRI. If the gad-olinium can be delivered through a vehicle that lasts lon-ger in the middle ear, more gadolinium may be delivered into the inner ear. In this study we tested the amount of perilymphatic enhancement with gadolinium deliv-ered via three different vehicles. Methods: Gadolinium (Gd-DTPA, Magnevist® or Gd-DO3A-butrol, Gado-vist®) was injected into the middle ear in 13 SD rats via the transtympanic route. Three different vehicles were used: SURDEN01 (hyper-viscous vehicle), Low viscos-ity vehicle, and saline. MR images of the inner ear were acquired at 1. 0, 1. 5, 2. 0, 2. 5, 3. 0, and 3. 5 after IT injection using an 9. 4T Agilent MRI system. As for SURDEN01, MR images were acquired up to day 10. The normalized signal intensity (SIs) was quantitatively analyzed at the scala vestibuli (SV), scala media, and sca-la tympani (ST). Then the SIs were compared. Results: When SURDEN01 and Low viscosity vehicle were com-pared, SI was greater in the ears injected with SURD-EN01. This difference was most pronounced in the SV of the apical turn at 1. 5 hr (normalized SI 3. 3 vs. 1. 0). The same pattern of difference was identified through out the whole cochlea (apical to basal) in both perilymphat-ic spaces (ST and SV) from post injection 1. 0 to 3. 5 hr. When SURDEN01 and saline was compared, SI was greater in the ears injected with SURDEN01. This differ-ence was most pronounced in the SV of the basal turn at 3. 5 hr (normalized SI 7. 20 vs. 3. 81). More importantly, the high SI lasted for 7 days in the ears injected with SURDEN01 in the basal turn (normalized SI 2. 10 vs. 1. 18). Conclusion: MRI gadolinium enhancement of the inner ear was greater when SURDEN01 was used as the IT drug delivery vehicle. Also, it seems that SURDEN01 can deliver gadolinium into the inner ear for a longer du-ration into the inner ear compared to saline. This may demonstrate that SURDEN01 can be an effective vehicle for inner ear drug delivery.

» OTTPP-24 14:22~14:26

» ROUND-WINDOW DELIvERY OF LITHIUM CHLORIDE USINg P407 REgENERATES CO-CHLEAR SYNAPSES AFTER ACOUSTIC OvER-ExPOSURE



DANKOOK UNIVERSITY, CHEONAN, SOUTH

KOREA1, BECKMAN LASER INSTITUTE KOREA,

NAs) in some regulation mechanisms of hearing loss by observing the changes of miRNAs in the CN. Methods: The 6 weeks old SD rats were divided into four groups. 1 day control group (n=12), 3 day control group (n=12), 1 day after noise exposure group (n=12), 3 days after noise exposure group (n=12). The animals were exposed to white band noise (2-20kHz) at 115 dB for 2 hours in a sound-proof chamber under anesthesia. Auditory Brainstem Response (ABR) was measured using Smart EP system and both side of CN were harvested at 1 day and 3 days after the noise exposure. Microarray analysis of the miRNAs in the CN was performed. A morpholog-ical evaluation of organ of corti was performed by par-affin section and also the whole mount hair cell count-ing was observated by phalloidin staining. Results: The ABR threshold of 1 day and 3 day control group showed normal hearing level. 1 day after noise exposure group demonstrated NIHL with highly increased ABR thresh-old shift, whereas 3 days after noise exposure group ex-hibited recovery with improved hearing ability than 1 day noise exposure group. Candidate miRNAs were selected by fold change of 1.5 with p<0.1. and miR-183-5p and miR-20b-5p are estimated to have an important charac-ters in modulation of auditory neural pathway. Moderate to severe amount of hair cell loss was observed in the out-er hair cells and also abnormal structure of organ of corti was noticed in the cochlea. Conclusion: Considering the given results, even the short term acoustic stimulation can cause hearing loss, which can leads to changes in neuro-plasticity. Further study is required, but miR-183-5p and miR-20b-5p might have the key roles in neuroplasticity of auditory pathway. Moreover, these miRNAs could be useful for early diagnosis of hearing loss and treatment for acute hearing loss.

» OTTPP-23 14:18~14:22

» HYPER-vISCUS vEHICLE (SURDEN01) CAN ENHANCE THE QUALITY OF INNER EAR MRI IMAgINg



YU-JUNG HWANG, MINA PARK, HYE LEE, TAE-SOO NOH, MOO KYUN PARK,

JUN HO LEE, SEUNG-HA OH, MYUNG-WHAN SUH

Objectives: Intratympanic (IT) gadolinium delivery is

April26(Fri)




DEPARTMENT OF OTOLARYNGOLOGY, COLLEGE

OF MEDICINE, THE CATHOLIC UNIVERSITY

JOOIN BANG, DOHEE LEE, YUPYO HONG, DONG-KEE KIM

Objectives: The purpose of this study was to analyze how acoustic brainstem response (ABR) changes in pa-tients with Sudden sensorineural hearing loss (SSNHL), and whether these changes are related to prognosis, as-suming that retrocochlear site lesions occur in SSNHL. Methods: Data for 43 patients diagnosed with unilater-al SSNHL between Feb 2016 and Feb 2018 and whose ABR waveform is measured at 90dBHL, were collected by retrospective medical chart reviews. If the damage to the auditory nerve is occurred in SSNHL patients as our study assumes, the amplitude and latency of waveform 1 of the ABR, which is known to be originated from co-chlear nerve, be affected. We measured the amplitude and latency of ABR waveform 1, and the amplitude of waveform 5 at 90dBHL at both ear and compared these parameters between the patient's affected and unaffected ear and analyzed whether the degree of changes in these parameters affect the treatment outcome. Results: In to-tal, 43 patients, including 22 men and 21 women with a mean age of 57.5±14.1 years, were included in this study. The initial mean pure tone audiometry (PTA) average of the affected and the unaffected ear is 72.2±17.8dBHL and 21.4±12.4dBHL, respectively. In the comparison be-tween affected ear and unaffected ear, the mean latency of ABR Wave 1 was significantly longer in the affected ear than unaffected group (p=0.003). In the comparison be-tween good and poor response groups, the mean latency of ABR wave 1 was significantly shorter (1.50±0.20 ms VS 1.77±0.26 ms) and the mean amplitude of ABR wave 1 was significantly larger (0.15±0.08㎶ VS 0.10±0.06 ㎶) in the good response group. In forward, condition-al logistic regression analysis, ABR Wave 1 latency was the independent predictor of good response (Odds ratio 34.37, 95% confidence interval: 1.56-757.15, P= 0,025). Conclusion: In patients with SSNHL, the latency of waveform 1 of the ABR is significantly increased, which is related to prognosis, and these results suggest that ret-rocochlear lesions may be associated with sudden hearing loss.

COLLEGE OF MEDICINE, DANKOOK UNIVERSITY,

CHEONAN, SOUTH KOREA2

NATHANIEL CARPENA1,2, JAE-HUN LEE2, SO-YOUNG CHANG2, MIN YOUNG LEE1,2,

JAE YUN JUNG1,2, JI EUN CHOI1,2

Objectives: Certain degree of acoustic overexposure can cause hearing problems without the permanent change of hearing threshold. Cochlear synaptopathy happens when the communication between the sensory inner ear hair cells and cochlear nerve fibers are permanently interrupted which manifests as difficulty in speech per-ception in noise and temporal processing. Meanwhile, recent studies show that lithium exerts a neuroprotective effect from diverse insults via multiple signaling path-ways. Two key factors to this effect of lithium involves the; inhibition of GSK-3 reducing cell death due to ex-citatory neurotransmission; and the downregulation of NMDA receptor reducing oxidative stress and protect-ing against glutamate induced excitotoxicity. Thus, the aim of this study was to evaluate the therapeutic effect of lithium on noise-induced neurodegeneration. Methods: In this study, we showed the round-window delivery of low and high- doses of lithium chloride using P407 in noise-exposed rats and compared to confirmed transient threshold shift (TTS) model as well as sham OP. Tone-burst ABR was done for baseline and 3, 7 and 14 days after noise exposure. Cochleae from rats at 7 and 14 days after noise exposure were also harvested and examined as whole-mounts stained for MyosinVIIa and CtBp2. Results: Results showed faster recovery in hearing thresh-old in both low and high dose of lithium chloride treated rats compared to the sham OP group. This functional recovery is also seen in the suprathreshold amplitude of auditory brainstem response Wave 1. Immunostaining showed the regeneration of synapses at the hair cell / co-chlear nerve interface. Conclusion: Cochlear delivery of lithium chloride demonstrated in the present study may play an important beneficial role in its therapeutic actions in acquired hearing loss due to noise exposure. Further work is needed to determine the specific pathway respon-sible for this effect of lithium in hearing recovery.

» OTTPP-25 14:26~14:30

» ANALYSIS OF THE RELATIONSHIP BE-TWEEN CHANgES IN THE AUDITORY BRAIN-STEM RESPONSE AND PROgNOSIS IN PA-TIENTS WITH SUDDEN HEARINg LOSS

April26(Fri)




not only significantly lower than SSNHL (p=0.003) but also the solitary gain which showed abnormality. Also, average gain of affected anterior semicircular canal (AC) in both group showed significant differences but within normal gain (p=0.028) However, average gain of lateral semicircular canal (LC) between SSNHL and SSNHL with vertigo showed no significant difference. There was no difference between affected and unaffected site LC as well. Conclusion: SSNHL with vertigo showed signifi-cant involvement of PC, mainly, and AC suggesting that caloric test may not be suitable for evaluating vestibular dysfunction in SSNHL whether with or without vertigo.

» OTTPP-27 14:34~14:38

» PREvALENCE OF BONY COCHLEAR NERvE CANAL STENOSIS IN LABYRINTHINE ANOMA-LIES IN BILATERAL PRELINgUAL DEAF CHIL-DREN




COLLEGE OF MEDICINE

YEHREE KIM, JEE YEON LEE, WOO SEOK KANG, JOONG HO AHN,

JONG WOO CHUNG, HONG JU PARK

Objectives: Bony cochlear nerve canal (BCNC) stenosis is related to the deficiency of cochlear nerve, resulting in impaired speech discrimination after cochlear implant (CI). We aimed to investigate the prevalence of bony co-chlear nerve canal (BCNC) stenosis according to the dif-ferent types of labyrinthine anomalies in bilateral prelin-gual deaf children. Methods: We retrospectively reviewed the medical chart of all children who received cochlear implants between March 1995 and January 2016 at Asan Medical Center. All subjects underwent high res-olution computed tomography (HRCT) and magnetic resonance (MR) images of the temporal bone. Children with bilateral prelingual deafness that was associated with labyrinthine anomalies were included in the study. The types of associated anomalies were classified according to Sennaroglu’s classification. Results: In total, we identified 294 patients with labyrinthine anomalies. Forty patients presented with bilateral BCNC stenosis and 8 with uni-lateral BCNC stenosis (16.33%). Twenty-seven (56%) had an isolated BCNC stenosis without any accompa-


Chair : IN SEOK MOON, KYE HOON PARK


» OTTPP-26 14:30~14:34

» vESTIBULAR CHARACTERISTICS OF SUD-DEN SENSORINEURAL HEARINg LOSS WITH OR WITHOUT vERTIgO IN ASPECT OF SEMI-CIRCULAR CANAL FUNCTION


AND NECK SURGERY, CHONNAM NATIONAL

UNIVERSITY MEDICAL SCHOOL, CHONNAM

NATIONAL UNIVERSITY HOSPITAL1

EUN KYUNG JUNG1, JONG MIN PARK1, HYONG-HO CHO1

Objectives: In order to evaluate vestibular function of sudden sensorineural hearing loss (SSNHL), caloric test has been used along with other measurements. Caloric test stimulates the lateral semicircular canal (LC) and evaluates superior vestibular integrity in lower frequency range. Though video head impulse test (vHIT) is per-formed in much higher frequency, it can evaluate all three semicircular canal function. Therefore, we investigated vestibular characteristics of SSNHL and SSNHL with vertigo through vHIT. Methods: Chart review of patients who visited Chonnam national university hospital and diagnosed as SSNHL or SSNHL with vertigo from May 2017 to January 2019 were conducted. Patients with dis-eases which may have affect on vestibular function such as schwannoma, vestibular neuritis or BPPV were excluded. vHIT gain of affected and unaffected site of the patients were used for evaluation. Normal range of gain was be-tween 0.8 and 1.2. Results: Among 83 patients, 33 male and 31 female patients with 52.36±16.02 (mean ± SD) years old had SSNHL(n=64). SSNHL with vertigo pa-tients(n=19) were comprised with 7 male and 12 female with 60.26±14.81 (mean ± SD) years old. Average gain of affected site posterior semicircular canal (PC) of SSN-HL and SSNHL with vertigo were 0.95 and 0.72, each. Average gain of affected PC in SSNHL with vertigo was

April26(Fri)




Hearing recovery rate was significantly lower in patients with dizziness. However, simultaneous oral/ITD,glucose level,and HbA1C, averaged blood sugar level during steroid treatment were not significantly associated with hearing recovery rate. Conclusion: SSNHL with DM had more hearing loss than previously studies without DM. High level of NLR resulted in less degree of hearing loss, but glucose or HbA1C level had no significant asso-ciation with degree of hearing loss. Hearing recovery rate was lower in our study than previously reported in SSN-HL patients without DM, but glucose levels did not sig-nificantly affect hearing recovery rate. Also, simultaneous oral/ITD had no additional benefit for hearing recovery compared to sequential regimen.

» OTTPP-29 14:42~14:46

» vITAMIN D DEFICIENCY AS A POSSIBLE CAUSE OF TINNITUS AND HEARINg LOSS



CATHOLIC UNIVERSITY OF KOREA1,

DEPARTMENT OF PREVENTIVE MEDICINE,

COLLEGE OF MEDICINE,

THE CATHOLIC UNIVERSITY OF KOREA2

HAMZAH KHALIL AL SHAIKH1, JUNG MEE PARK1, JAE SANG HAN1,

JAMIL AL-SWIAHB1, HYUN YONG LEE2, HYUN WOO LIM2, SHI NAE PARK1

Objectives: To evaluate the causal relationship between vitamin D, which has been known to be one of the vi-tamins affecting auditory function, and tinnitus/hearing loss. Methods: A community-based cross-sectional sur-vey in the adult population was performed to evaluate the correlation between subjective tinnitus/hearing loss and serum vitamin D level. Various clinical parameters were statistically evaluated to prove their association between vitamin D and tinnitus/hearing loss. Serum level of vita-min D was specifically assessed in the subjects enrolled in this study and was statistically analyzed to investigate its possible role as a causal factor for tinnitus and hearing loss. Results: The study subjects included 16408 subjects (9379 females and 7029 males), the mean(SD) range of the age was 44.57 years (0.24). Sociodemographic and lifestyle factors among the study subjects revealed that there were significant differences in the gender, econom-

nied anomalies. Ten had BCNC stenosis associated with isolated vestibular/semicircular canal dysplasia (25%, 10 out of 40). Seven had BCNC stenosis associated with in-complete partition type II (7%, 7 out of 95). Four had BCNC stenosis (18%, 4 of 22) accompanied by cochlear hypoplasia. BCNC stenosis was not observed in patients with isolated enlarged vestibular aqueduct. Conclusion: BCNC stenosis can be an isolated anomaly but also be accompanied by other labyrinthine anomalies, including vestibular dysplasia, incomplete partition type II, and cochlear hypoplasia. Therefore, a thorough evaluation of the radiograph is mandatory before planning CI in pre-lingual deaf children with labyrinthine anomalies.

» OTTPP-28 14:38~14:42

» CLINICAL FEATURES OF SUDDEN SENSORI-NEURAL HEARINg LOSS(SSNHL) IN DIABETIC PATIENTS


HEAD AND NECK SURGERY, DANKOOK


YEO RIM JU1, JI EUN CHOI1, MIN YOUNG LEE2, JAE YUN JUNG2

Objectives: To elucidate the clinical features of SSNHL in diabetic patients and to evaluate the factors influencing hearing deficits and recovery. Also, compare the efficacy of simultaneous and sequential oral and intratympanic dexa-methasone(ITD) for diabetic patients. Methods: Clinical characteristics, initial laboratory findings (cholesterol,H-bA1C,glucose,Neutrophil-lymphocyte ratio;NLR, plate-let- lymphocyte ratio;PLR, lymphocyte-monocyte ra-tio;LMR), and initial and last audiograms were reviewed. The degree of hearing loss was defined as the difference between the affected and unaffected hearing thresholds. One group received simultaneously ITD with oral steroid treatment. The other group received sequential ITD after oral steroid treatment. Results: 77 patients were includ-ed.The degree of hearing loss was 61dB for averaged 4 frequencies.Regardless of clinical characteristics, glucose level, and HbA1C, there was no significant difference in the degree of hearing loss. However, degree of hearing loss in patients with high NLR was significantly lower than those in patients with normal NLR. According to Sigel’s criteria, the overall recovery rates were 39%. In fol-low-up, the low and middle tone hearing thresholds im-proved significantly more than that at high frequencies.

April26(Fri)




with tinnitus severity in only males (r=0.463, p <0.01). A multiple regression analysis revealed that effect of tinnitus on life, depressive symptoms, and stress were significantly associated with tinnitus severity in males, whereas only tinnitus annoyance and depressive symptoms were asso-ciated with tinnitus severity in females. Conclusion: Tin-nitus severity was significantly correlated with depressive symptoms and stress, and there were gender differences in the relationship between tinnitus severity and psychiatric components. It is necessary to be vigilant of psychiatric symptoms among patients with tinnitus who visit the otology outpatient clinic, especially for male patients.

» OTTPP-31 14:50~14:54

» ExPRESSION, DISTRIBUTION, AND ROLE OF C-TYPE LECTIN RECEPTORS IN THE HUMAN AND ANIMAL MIDDLE EAR AND EUSTACHIAN TUBE A REvIEW




DAE WOONG KANG, SUNG HWA DONG, SANG HOON KIM, JAE YONG BYUN,


Objectives: Otitis media (OM) is a group of inflamma-tory diseases of the middle ear (ME), regardless of cause or pathological mechanism. Methods: Among the mo-lecular biological studies assessing the pathology of OM are investigations into the expression of C-type lectin re-ceptors (CLR) in the ME and Eustachian tube (ET). To date, nine studies have evaluated CLR expression in the ME and ET. Results: The expression of individual CLRs in mammalian ME and ET varies by species and model of OM. Assessments have shown that the patterns of CLR expression in the ME and ET vary; that CLR expression may vary by type of OM; and that the distribution and levels of expression of CLRs may depend on the presence or absence of inflammation, with variations even within the same species and same tissue. Infection of the ME and ET with various pathogens is a common cause of all types of OM, with host responses to pathogens mediated initially by the innate immune system. CLRs are import-ant factors in the innate immune system because they act as both adhesion molecules and as pathogen recognition receptors. Conclusion: The expression of CLRs in OM

ic status, educational level, sun exposure (>5hr/day) be-tween subjects with and without tinnitus, whereas, no significant differences in serum Vitamin D level, BMI, regular exercise and history of lifetime alcohol or tobac-co use. However, the results from the logistic regression models with serum vitamin D quartile and tinnitus as a dependent variable demonstrated that serum vitamin D deficiency and short duration of sun exposure significant-ly increased the risk of tinnitus.Conclusion: Vitamin D insufficiency seems to be related to subjective tinnitus or hearing loss, which indicates its possible role as a caus-al factor for these two common ontological symptoms. More distinct causal relationship needs to be investigated in further case-control studies.

» OTTPP-30 14:46~14:50

» gENDER DIFFERENCES AFFECTINg PSY-CHIATRIC DISTRESS AND TINNITUS SEvERITY



CATHOLIC UNIVERSITY OF KOREA1, DEPARTMENT

OF PSYCHIATRY, COLLEGE OF MEDICINE, THE


JAE SANG HAN1, JUNG MEE PARK1, TAE SUN HAN2, JO-EUN JEONG2,

JUNG JIN KIM2, SHI NAE PARK1

Objectives: This study evaluated gender differences in the relationship between psychiatric distress and subjective tinnitus severity. Methods: This cross-sectional study in-cluded 134 female and 114 male patients who visited the otology outpatient clinic at Seoul St. Mary’s Hospital for tinnitus from February to July 2015. Patients completed a series of instruments, including the Tinnitus Handicap Inventory, Beck Depression Inventory, Korean version of Brief Encounter Psychosocial Instrument (BEPSI-K), and visual analogue scales assessing various tinnitus char-acteristics (loudness, awareness, annoyance, and effect on life). Results: Tinnitus severity did not significantly differ between the gender groups ( p =0.632), and it correlated significantly with tinnitus characteristics and psychiatric distress. Partial correlations between tinnitus severity and depressive symptoms were stronger in males (r=0.411, p <0.01) than in females (r=0.304, p <0.01) while con-trolling for duration of tinnitus and tinnitus characteris-tics. However, stress (BEPSI-K) was positively correlated

April26(Fri)




MEDICINE

DONG-HEE LEE

Objectives: Recently, the number of registered hear-ing-disabled persons for hearing and the amount of reim-bursement paid for hearing aids were increasing rapidly. Because the official documentation foams of National Health Insurance System was changed, otolaryngologists who prescribe and examine a hearing aid for registered disabled persons for hearing should know how to veri-fy/validate a hearing aid and document it. Methods: At first, I reviewed how the official documentation foams of National Health Insurance System (NHIS) was changed. And then, I searched and reviewed how to verify and val-idate a hearing aid. Considering the clinical situations and hearing aid dispensing system of South Korea, I in-tended to find out proper way to validate a hearing aid and document it in medical records for revised official documentation foams. Results: New prescription foam requires that otolaryngologists decide that the usage of a hearing aid may be helpful for hearing-impaired persons in their daily life. To do this, audiologic tests and phys-ical exam by otolaryngologists are essential. For young children, ABR or ASSR threshold is also avaialble. New examination foam requires that otolaryngologists ex-amine a hearing aid after the fitting period of 1-month. And it also requires that otolaryngologists decide that a hearing aid improves the ability to hear and communi-cate. Methods for performance test include REM-REIG and sound-field audiogram-functional gain. Validation measures provide invaluable information regarding the benefit patients receive from a hearing aid and 3 areas of hearing aid outcome are aided & unaided speech tests; daily use time; and benefit & satisfaction assessment. The benefit & satisfaction assessment for performance includes COSI, APHAB, and IOI-HA. Conclusion: In conclusion, otolaryngologists who prescribe and confirm a hearing aid for registered disabled persons for hearing should know how to make official documentation foams of NHIS and how to examine and document the valida-tion of a hearing aid.

» OTTPP-34 15:02~15:06

» CHEMICAL LABYRINTHECTOMY MODEL EvALUATION BASED ON PAW DISTANCE

RESEARCH INSTITUTE FOR AEROSPACE

MEDICINE, INHA UNIVERSITY1, DEPARTMENT

tissues suggests that CLRs are associated with the patho-genesis of various types of OM.

» OTTPP-32 14:54~14:58

» A REvIEW ExPRESSION OF AQUAPORINS IN OTITIS MEDIA




HYE KYU MIN, SUNG HWA DONG, SANG HOON KIM, JAE YONG BYUN,


Objectives: Otitis media (OM) refers to inflammatory diseases of the middle ear (ME), regardless of cause or pathological mechanism. Methods: Among the molecu-lar biological studies assessing the pathology of OM are investigations of the expression of aquaporins (AQPs) in the ME and Eustachian tube (ET). To date, fifteen stud-ies have evaluated AQPs expression in the ME and ET. The review showed that: (1) various types of AQPs are expressed in the ME and ET; (2) AQP expression may vary by species; and (3) the distribution and levels of ex-pression of AQPs may depend on the presence or absence of inflammation, with variations even in the same species and same tissue. Results: Although the expression of in-dividual AQPs varies by species and model, eleven types of AQP, AQP1 to AQP11, were found to be expressed in mammalian ME and ET. Fluid accumulation in the ME and ET is a common pathological mechanism for all types of OM, causing edema in the tissue and inducing inflammation, thereby possibly involving various AQPs. Conclusion: The expression patterns of several AQPs, especially AQP1, 4 and 5, were found to be altered in response to inflammatory stimuli, including lipopolysac-charide (LPS), suggesting that AQPs may have immuno-logical functions in OM.

» OTTPP-33 14:58~15:02

» REvIEW ON HOW TO DOCUMENT THE vAL-IDATION IN HEARINg AIDS REIMBURSEMENT SYSTEM OF SOUTH KOREA

DEPARTMENT OF OTORHINOLARYNGOLOGY, THE

CATHOLIC UNIVERSITY OF KOREA, COLLEGE OF

April26(Fri)





CATHOLIC UNIVERSITY, COLLEGE OF MEDICINE,

SEOUL, KOREA

BEOMCHO JUN, SEUNGMIN LEE, YESUN CHO

Objectives: Generally three gates are required for the electrodes to pass through space during cochlear implan-tation. Surgical procedures for making the gates are Mas-toidectomy, posterior tympanotomy and cochleostomy (Round window approch). The purpose of this study is to determine the surgical landmarks and consideration of cochlear implantation with a view of portal of entry of electrode with pre and postoperative CT scan. Methods: Five cases of chronic otitis media with intact tympanic membrane, partial ossification of cochlear basal turn, previous canal wall down mastoid surgery, normal tem-poral bone in the preoperative CT scan were evaluated in this study. 3D reconstructed images were obtained using V-works 4.0 (Cybermed, Seoul, Korea) with axial scan-ning of high-resolution temporal bone CT images preop-eratively. Results: For the 1st door, cortical mastoidecto-my, Sclerotic cases have narrow mastoid space surround-ed by dura, sigmoid sinus, and posterior wall of EAC. Surgical attention is necessary not to damage the these landmarks. In the case of well aerated cases with thin air cell septa may have thin facial bony canal, Attention is necessary drilling around the facial canal not to uninten-tional damage of facial nerve. For the 2nd door, posterior tympanotomy, It is necessary to identify facial canal not damage the facial sheaths to identify chorda tympani. For the 3rd door, (cochleostomy or round window approach) Preoperative CT evaluation of shape or position of round window, cochlear ossification, and small dimension with narrow turns could be considered. Conclusion: The goal of cochlear implant surgery is to prevent unintended sur-gical complications such as facial paralysis, to reduce the damage of the cochlear for preserve remnant hearing as much as possible, and to stably insert the electrodes. Be-cause of the feature of surgical microscope using straight line of sight, the narrow field of view of the previous step makes the next step difficult.

» OTTPP-36 15:10~15:14

» DEvELOPINg A RESIDENT QUALITY AND SAFETY CURRICULUM INTEgRATINg PA-TIENT SAFETY LESSONS INTO RESIDENCY TRAININg

OF OTOLARYNGOLOGY, INHA UNIVERSITY

HOSPITAL2,

GYUTAE KIM1, NGUYEN NGUYEN1,2, KYU-SUNG KIM1,2

Objectives: The evaluation of animal model is mandatory for the study of the functional disorders, which are gen-erally done by various static and dynamic behavior tests. In this study, we suggest one of static methods to iden-tify the animal model with the unilateral destruction in the inner ear. Methods: Chemical labyrinthectomy (CL) was conducted to develop an animal model with the hair cell loss in the inner ear, using SD rats (300-450g, M). CL was completed by injecting the iron-chloride (70% FeCl3, 50μl)solution into the unilateral intratympanic area. Thirty minutes after the injection of the solution, the animal was placed in a transparent box, and the posi-tions of its feet were detected. The paw distance was de-fined as the distance between two front or hind feet. The distances were presented in a bar chart to identify a possi-ble width by two feet, and the normal width was assessed by measuring the largest and the smallest values (1-15cm for front & 1-10cm for hind). Each foot was identified by the attached colors (green for front & orange for hind), and the paw distances were assessed with a range, instead of averaged values. Results: Seven animals were used to measure the paw distances, and all animals’ paw distanc-es were measured before and after CL. The range of the distance before CL were 1.0-14.93 and 1.0-6.19 cm, and that after CL were 1.0-14.99 and 3.27-7.57 cm for front and hind, respectively. The obtained results indicated the paw distance was longer after CL than before CL. Also, the paw distance from the hind showed the clear change by CL. Conclusion: The suggested method showed a clear difference between the paw distances of control and experimental groups. Based on our current results, the paw distance was a critical indicator to evaluate the animal model with a vestibular dysfunction. [This re-search was supported by Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education (NRF-2016R1D-1A1B03930657 & 2018R1A6A1A03025523).]

» OTTPP-35 15:06~15:10

» SURgICAL LANDMARKS AND CONSIDER-ATIONS OF COCHLEAR IMPLANTATION WITH STEPS OF ELECTRODE ENTRANCE

April26(Fri)




HEAD & NECK SURGERY, SAMSUNG CHANGWON




SURGERY, SCHOOL OF MEDICINE, KYUNGPOOK

NATIONAL UNIVERSITY2, DEPARTMENT OF


SURGERY, ASAN MEDICAL CENTER, UNIVERSITY

OF ULSAN COLLEGE OF MEDICINE3

JIWON SEO1, MYUNG HOON YOO2, WOO SEOK KANG3, JOONG HO AHN3, HONG JU PARK3, JONG WOO CHUNG3

Objectives: To investigate the association between hear-ing impairment and cognitive function using health screening data. We hypothesized that greater hearing loss is associated with lower cognitive test scores on tests of memory and executive function. Methods: Data were collected for the people who received health screening at Asan Medical Center from January 2011 to November 2014. Hearing loss was defined by an average of hearing thresholds at 0.5, 1, 2, and 4kHz in the better hearing ear. K-MMSE and Korean version of 7-Minute Screen for the detection of early-stage Alzheimer’s disease were used for the cognitive test. Results: Of a cohort of 791 patients, 755 were eligible for analysis. Of these, 412 had normal hearing, 284 had mild hearing loss, 58 had moderate hearing loss, and only 1 had severe hearing loss. Hearing loss had a significant negative association with cognitive test scores. Conclusion: Hearing loss is a possible bio-marker and modifiable risk factor for cognitive decline. Additional research is needed to examine implications of treatment for cognition impairment and to explore possi-ble causal mechanisms underlying this relationship.

» OTTPP-38 15:18~15:22

» FRAMINgHAM RISK SCORE IS ASSOCIATED WITH OUTCOMES IN PATIENTS WITH SUD-DEN SENSORINEURAL HEARINg LOSS



COLLEGE OF MEDICINE, KOREA UNIVERSITY

ANSAN HOSPITAL, ANSAN

YOUNG-SOO CHANG, KANG HYEON LIM, KUK JIN NAM, YOON CHAN RAH,



COLLEGE OF MEDICINE

DONG-HEE LEE

Objectives: Patient safety must be an important concept in resident education. To date, few teaching hospitals in Korea have assessed resident perceptions of patient safety in otolaryngology specialty. It has been know that res-idents are aware of threats to patient safety and have a unique perspective compared with other health care pro-fessionals. Transitions of care and communication prob-lems have been known to be the most common safety threats identified by the residents. However, the first and main problem is that proper education curriculum does not exist in the training program of otolaryngology in most hospitals in Korea. Methods: Since 2018, my de-partment started the education about patient safety les-sons on orientation program for first degree residents. Included topics were 1) efforts on patient safety and common safety threats, 2) reporting of patient safety ac-cidents/issues/concerns, 3) hospital hygiene and infection control, 4) ways to improve communication in health-care system, 5) informed consent, and 6) legal and social issues regarding to medical records. Results: Residents have a unique perspective on patient safety, and resident involvement in efforts to improve the safety of healthcare will benefit care in teaching hospitals and in the settings in which graduates will practice after completing train-ing. Patient safety should be evident at all levels of the health care system and should be valued and modeled by all participants, including residents. Conclusion: Patient safety is an important aspect of health care education. Residents are not fully aware of all potential risks of their work and of their own role in patient safety. This under-lines the need for an explicit focus on patient safety issues during their training. I think that we have come to the time to develop a patient safety course for residents based on the views of medical residents and their supervisors.

» OTTPP-37 15:14~15:18

» STUDY ON THE RELATIONSHIP OF HEAR-INg LOSS AND COgNITIvE FUNCTION - A RETROSPECTIvE STUDY USINg HEALTH SCREENINg DATA


April26(Fri)




possible correlations among SHL, VN, Bell’s palsy and epidemics of viral disease. Methods: A retrospective case review was performed to determine the weekly, monthly and seasonal incidence of SHL, VN and Bell’s palsy over a 10-year period in Chonbuk national university hospi-tal, Jeonju, Korea. The incidence of viral disease from the Disease web statistic system of Korea Center for Disease Control & Prevention(KCDC) were used for correlation test. Incidence values were complied, and the one-way ANOVA test and Pearson correlation test for used to as-sess for correlation and seasonality, respectively. Results: We analyzed the data using the one-way ANOVA test, and the results showed the seasonality was significantly associated with the incidence of SHL, with the incidence decreasing during summer(p=0.027). By contrast, no sig-nificant relationship was found between seasonality and either VN or Bell’s palsy. The positive statistical correla-tion was found between SHL and VN using the Pearson correlation test(coefficient = 0.136, p=0.02). No relation-ship was found among viral disease epidemics, SHL, VN and Bell’s palsy(p>0.05).Conclusion: The present study found a correlation between SHL and VN and seasonali-ty in the incidence of SHL decreased during summer. No association emerged among SHL, VN, Bell’s palsy and epidemics of viral diseases.

» OTTPP-40 15:26~15:30

» COMPARISON OF POSTOPERATIvE RE-SULT BETWEEN LASER STAPEDOTOMY AND NON-LASER STAPEDOTOMY

SOREE EAR CLINIC

SEONG-CHEON BAE, YOU-REE SHIN, KWANG SUN LEE, YOUNG-MYOUNG CHUN

Objectives: Stapedotomy fenestration techniques have a risk to damage an inner ear. Recently, Laser is adapt-ed to stapedotomy to prevent inner ear damage. Our clinic introduced Laser equipment before 3 years. So we can compare postoperative result between Laser stapedotomy and non-Laser stapedotomy Methods: We reviewed 106 patients of stapedotomy. All surgery performed by one surgeon. We checked pure tone au-diogram(0.5,1K,2K,3kHz) preoperatively and postop-eratively. And we calculated postoperative air-bone gap. We defined a best result as air-bone gap≤10dB and good result as air bone gap ≤20dB. Results: 10 patients had revision surgery(2 - Laser stapedotomy 8 - non-Laser

JUNE CHOI

Objectives: The Framingham Risk Score (FRS) is a wide-ly-accepted formulation for predicting cardiovascular dis-ease. The present study applied the FRS in predicting the prognosis of ISSHL patients. Methods: We reviewed the medical documents between January 2010 and October 2017 and all patients affected by unilateral ISSHL were surveyed. We calculated the hearing gain (hearing gain (dB) = (initial PTA) – (PTA one month after commencing treatment)) and the evaluation of audiological improve-ment according to the criteria of Siegel. We calculated the 10-year risk of developing cardiovascular disease, adopt-ing the equation which incorporates multivariate analysis and the regression coefficient of each possible risk factor. After FRS calculation, we subdivided into the groups ac-cording to; 1) Group I (FRS < 10 %), 2) Group II (10 % ≤ FRS < 20 %), 3) Group III (FRS ≥ 20%). Results: The mean FRS score of the study population was 11.19 (± 13.76, range 0.8 to 56.9). The initial PTA and FRS scores did not show a significant association (p = 0.32). The overall successful recovery rate (complete + marked recovery) of this study was 48.71 %. None of the pa-tients in group II and III showed complete recovery and no recovery rate was 70 % (7 / 10), however, 13 patients in group I showed complete recovery (46.43 %) and no recovery rate was 25 % (7 / 28) (p = 0.008, Chi-square’s test). Conclusion: Evaluation using FRS may be useful in predicting outcomes for ISSNHL patients. Patients with higher FRS scores showed poorer hearing gain.

» OTTPP-39 15:22~15:26

» IS THERE ANY RELATIONSHIP AMONg SUD-DEN SENSORINEURAL HEARINg LOSS, vES-TIBULAR NEURITIS AND BELLS PALSY_A TEN-YEAR ExPERIENCE




JEONJU, KOREA1

CHA-DONG YEO1, JI-SEOB RYU1, SU-GEUN KIM1, EUN-JUNG LEE1

Objectives: To determine the relationship among sudden sensorineural hearing loss(SHL), vestibular neuritis(VN) and Bell’s palsy and seasonal variations. To investigate

April26(Fri)




neural hearing loss (SSNHL), 99 were Meniere’s disease (MD), 123 were vestibular migraine (VM), 48 were oti-tis media with effusion (OME), 22 were patulous E-tube (PE), 54 were recurrent vestibulopathy (RV), 31 were su-perior canal dehiscence syndrome (SCDS), and 106 were vestibular neuritis (VN). We assessed the prevalence of ear fullness and correlated the presence of ear fullness and hearing thresholds, pure-tone averages (PTA). Results: Ear fullness was present most frequently in MD (83.8%), followed by OME (79.2%), PE (77.3%), SCDS (67.7%), SSNHL (49.7%), COM (29.7%), RV (22.2%), VM (16.3%), VN (7.5) and FNP (0%). Among patients with SSNHL, those who complained of ear fullness showed statistically more severe hearing loss (61±29 dB HL) than those without ear fullness (48±25 dB HL, p=0.004). The prevalence of ear fullness in patients with low tone hear-ing loss was 36% (6 out of 17), which was not statisti-cally different from others. Conclusion: The prevalence of ear fullness varied among the otologic disorders and more common in disorders associated with hearing loss. Ear fullness should not be considered as a simple otologic symptom and should be carefully examined along with other accompanying symptoms.

» OTTPP-42 15:54~15:58

» SKULL BASE OSTEOMYELITIS 16- CASE SE-RIES IN A SINgLE CENTER




HOSPITAL, DAEGU, KOREA

DA JUNG JUNG, MYUNG HOON YOO, KYU-YUP LEE

Objectives: Skull base osteomyelitis (SBO) is a complex and fatal clinical entity that is often misdiagnosed for oth-er diseases such as malignancy. SBO typically evolves as a complication of malignant otitis externa (MOE) in dia-betic or immunocompromised patients and involves the temporal bone. We investigated a group of patients with SBO and studied the clinical course of SBO. Methods: Medical records of patients who were diagnosed with SBO were retrospectively analyzed from 2014 to 2018. Results: Mean age of 16 patients was 73.9 years (male; 11 , female; 5). All patients suffered from otalgia or head-ache, and 6 patients had cranial nerve palsy including facial, glossopharyngeal, vagus and hypoglossal nerve.

stapedotomy). We excluded revision case and we evalu-ated 96 case of primary surgery. Mean age was 43.2±14.7 at Laser group and 44.8±11.1 at non-Laser group. Pre-operative air-bone gap of each group was 23.3±7.5(Laser group) and 28.2±8.9(non-Laser group) and showed no significant difference statistically(P=0.444). But, post-operative air-bone gap of each group was 8.3±6.9(Laser group) and 12.5±9.5(non-Laser group) and showed sig-nificant difference statistically(P=0.030). Laser group had better results than non- Laser group(best result-41/56 at Laser, 22/40 at non-Laser) and showed significant differ-ence(p=0.027). Conclusion: Laser stapedotomy group showed lower revision surgery rate, lower postoperative air-bone gap and better results. So, Laser stapedotomy is more safe and effective than non-Laser stapedotomy.


Chair : JUNE CHOI, SUNG WOOK JEONG


» OTTPP-41 15:50~15:54

» PREvALENCE OF EAR FULLNESS IN OTO-LOgIC DISORDERS




MEDICINE

JE YEON LEE, MIN YOUNG KWAK, JI WON SEO, HONG JU PARK

Objectives: Ear fullness is a common symptom in oto-logic disorders and can be a sole symptom or associat-ed with other symptoms. The prevalence of ear fullness along to various otologic disease categories has not yet been extensively reported. In this study, we investigated the prevalence of ear fullness in representative otologic disorders and correlated the presence of ear fullness with hearing loss pattern. Methods: We reviewed the clinical data in a cohort of 869 patients with otologic disorders. Among them, 182 were chronic otitis media (COM), 51 were facial nerve palsy (FNP), 153 were sudden sensory

April26(Fri)




patient has the complaints of the pulsating tinnitus, the doctor should be familiar with the related diseases and master the diagnosis process.

» OTTPP-44 16:02~16:06

» COMPARISON OF EFFECT OF THE SOUND THERAPY BY NOTCH-FILTERED NOISE vER-SUS WHITE NOISE


GYEONGSANG NATIONAL UNIVERSITY

CHANGWON HOSPITAL1 DEPARTMENT OF

OTORHINOLARYNGOLOGY, GYEONGSANG

NATIONAL UNIVERSITY, SCHOOL OF MEDICINE2

DONG GU HUR1, HYUN-JIN LEE1, HYUN WOO PARK2, SEONG-KI AHN2

Objectives: Customized notching of music is thought to increase lateral inhibition while providing a pleasant stimulus that helps ease the limbic system reaction to tin-nitus. We have used notch filtered noise instead of music for sound therapy. This study investigates the results of sound therapy by two different noise, notch filtered and white, in treating chronic subjective tinnitus. Methods: Total of 68 patients was enrolled. They complained about chronic tonal tinnitus for more than 3 months. Average of hearing thresholds were within the normal limit in all patients. Tinnitus retraining therapy was conducted with 30 minutes of counseling and sound therapy using a smartphone. All patients carried out sound therapy for more than 3 months. Notch filtered noise was made based on the pitch of the tinnitus. The changes of tin-nitus handicap inventory (THI) and visual analog scale (VAS) for tinnitus were compared. Results: 74% of pa-tients showed improved THI score after sound therapy using both notches filtered noise and white noise. VAS score seemed to show improving tendency but results were varied between the factors in both groups. The cor-relation of THI and VAS which represents loudness and impact to life was higher in notch filtered noise group than white noise group. The correlation of THI and VAS which represents duration was higher in the white noise group than notch filtered noise group. Conclusion: We could identify the effect of tinnitus retraining with sound therapy in subjective tinnitus. Therapy using notch fil-tered noise which is matched with tinnitus pitch showed similar results to therapy using white noise. Considering

Patients were treated with intravenous antibiotics for 7.2 weeks in average and oral antibiotics for 15 weeks. Mean follow-up period was 16.1 months and the mortality rate was almost zero. However, some patients had residual neurologic deficit. Conclusion: SBO was diagnostic and therapeutic challenge to the clinicians. The timely diag-nosis and long-term antibiotics therapy could minimize mortality rate and the permanent neurologic deficit.

» OTTPP-43 15:58~16:02

» CLINICAL ANALYSIS OF 5 CASES OF DURAL ARTERIOvENOUS FISTULAS WITH PULSATILE TINNITUS

DEP.OF OTORHINOLARYNGOLOGY


HENAN PROVINCE PEOPLE'S HOSP

LIU HONGJIAN

Objectives: Tinnitus is a common symptom in otolaryn-gology, which can be divided into subjective tinnitus and objective tinnitus. Among the objective tinnitus, pulsat-ing tinnitus accounts for 4%, while dural arteriovenous fistula accounts for a smaller proportion in vasogenic tinnitus and is rarely concerned by otolaryngologists. In order to deepen the understanding of this disease,this pa-per summarized the clinical characteristics of 5 patients with dural arteriovenous fistula diagnosed with pulsatile tinnitus. Methods: 5 patients with dural arteriovenous fistula were analyzed retrospectively from 2013 to 2018, these patients include 3 males and 2 females aged 27-65 years old. The main clinical symptoms were persistent pulsating tinnitus, with / without headache and memory decline. The course of the disease was from there months to 20 years. Finally, the diagnosis of dural arteriovenous fistula was confirmed by DSA examination. Under gen-eral anesthesia, Dural arteriovenous fistula embolization was performed. The 0.2ml Onyx gel was slowly injected into the fistula. The original dural fistula was completely disappeared by angiography, and dyna-ct showed no ab-normality. Results: 3 cases were cured after embolization and 2 cases of tinnitus improved. Conclusion: Dural ar-teriovenous fistula (DAVF) refers to the abnormal arte-riovenous communication occurring in the dural and its affiliated tentorium, venous sinus, and falx cerebri. It can occur in transverse sinus, sigmoid sinus and cavernous sinus, and involving transverse sinus or sigmoid sinus is the most common cause of pulsating tinnitus. When the

April26(Fri)




» OTTPP-46 16:10~16:14

» NEW INSIgHT OF SUDDEN SENSORINEU-RAL HEARINg LOSS- CEREBRAL BLOOD FLOW

DEP. OF OTOLARYNGOLOGY, KUANG-TIEN

GENERAL HOSP.⒥, TAICHUNG, TAIWAN DEP.

OF OTOLARYNGOLOGY, NATIONAL TAIWAN

UNIVERSITY HOSP.2, TAIPEI, TAIWAN DEP. OF

RADIOLOGY AND NUCLEAR MEDICINE, KUANG-

TIEN GENERAL HOSP.⒧, TAICHUNG, TAIWAN

SHENG-KAI HUANG⒥, JEN-TSUNG LAI⒥, TIEN-CHEN LIU2, KEH-BIN WANG⒧

Objectives: Tinnitus and sudden sensorineural hear-ing loss (SSNHL) are closely related. There were many hypothesis of SSNHL, including vascular compromise, cochlear membrane rupture, viral infection. However, in our experience, the patient who suffered from migraine headache may had fluctuation hearing impairment and even reach definition of SSNHL. The etiology of SSN-HL of these group of patient may possibly due to neu-ro-inflammation initiated in the brain and affected the peripheral auditory system, which may cause increased blood flow rather than decreased. This article was aim to evaluate the cerebral blood flow (CBF) during acute course of sudden hearing loss and examine the relation-ship between migraine and severity of hearing impair-ment. Methods: We collected the patient with acute tinnitus due to sudden sensorineural hearing loss, the onset time limit in 3 months. The patients past history were recorded including migraine, old cerebrovascular accident. Technetium (Tc)-99 m ethyl cysteinate dimer (ECD) single-photon emission computed tomography (SPECT) were used to evaluate the CBF of temporal lobe and the score scale were divided for zero to ten according to an experienced nuclear medicine doctor. Results: We collected 42 patients and 16 patients had migraine head-ache. Among them, 14 patients(87.5%) were detected to have increased temporal lobe CBF in same side of hear-ing impaired ear, compared to normal side. In non-mi-graine group(n=26), 10 patients (38.5%) had increased temporal lobe CBF 14 patients(53.8%) had decreased temporal lobe CBF and 3 of them had old CVA, 2 had ESRD under dialysis, 2 had CKD history. Besides, pure tone audiometry(PTA) were worsen in non- migraine group (P=0.01). Conclusion: In our study, migraineur

the different correlation of VAS and THI between two types of noise, further investigation is needed to settle more customized modality.

» OTTPP-45 16:06~16:10

» DEvELOPINg PREDICTIvE MODELS FOR SUDDEN SENSORINEURAL HEARINg LOSS BASED ON MACHINE LEARNINg METHODS



COLLEGE OF MEDICINE

CHUN HAN, YOUNG JOON SEO, SANG YOO PARK, TAE HOON KONG

Objectives: The aim of our study is to develop predic-tive models based on machine learning methods for sudden sensorineural hearing loss (SSNHL) and to as-sess the optimal model considering the predictive pow-er and stability of each model. Methods: This study is a single-center retrospective study. A total of 357 patients of SSNHL were enrolled. 36 variables including the pa-tients’ demographic characteristics, medical histories, and result of their hearing test and blood tests were analyzed. The bagging (bootstrap aggregating) model, AdaBoost (adaptive boosting) model, random forest model, deep neural network (DNN) model, and simple logistic re-gression (LR) model were developed to predict the di-chotomized hearing outcome of SSNHL. Patients were randomly divided into 7: 3 train data and test data in each model. The k-fold cross validation was used to avoid bias. The receiver operator characteristic curves (ROC) were exploited to compare the prediction performance of different models. Results: The bagging model, AdaBoost model, random forest model, and DNN model showed 36.84%, 34.74%, 34.04% and 20.23% of misclassifica-tion rate sequentially. The DNN model showed the best predictive ability with 36 variables achieving an accura-cy of 79.77%. The LR model was performed by collect-ing common variables listed in order of importance in each model. The misclassification rate of LR model was 22.28%. Conclusion: With the input of 36 of SSNHL features, DNN can be a robust prediction tool for SSN-HL. However, the LR model shows similar prediction power with fewer variables than other models that make simple. Our prediction model should be supplemented by learning other various data and could help explain the prognosis to the patients with SSNHL.

April26(Fri)







COLLEGE OF MEDICINE

DOYEON KIM, JONG WOO CHUNG

Objectives: To analyze the risk factors and epidemiology of otitis media among children in Sindupalchok district, Nepal through questionnaire research. Methods: Med-ical doctors of the Asan medical center otorhinolaryn-gology department went to Sindupalchok district, Nepal for medical service from September 16 to 21, 2016. 79 children under the age of 16 submitted questionnaires regarding otologic, respiratory symptoms and their base-line characteristcs. Results: We defined the symptoms of hearing disturbance, otorrhea, high fever, earfullness and the history of taking medicine for otologic symptoms as symptoms related to otitis media. Age was associated with the number of symptoms related to otitis media (Pear-son's correlation coefficient 0.275) and it was statistically significant (P=0.014). Using Chi-square test, the symp-tom of respiratory discomfort was associated with the presence of symptoms related to otitis media (Odds ratio 4.44) and it was statistically significant (P=0.026). The prevalence of otitis media in children in Sindupalchok district, Nepal was found to be 45.6% which was much higher than South Korea's otitis media prevalence rate in children (1.3%). There was no statistically significant association between symptoms related to otitis media and the number of family members according to Jonck-heere-terpstra test and Kruskal-wallis test. Conclusion: Age and the respiratory discomfort symptom was asso-ciated with the symptoms related to otitis media among children in Sindupalchok district, Nepal. The preva-lence of otitis media in children in Sindupalchok district (45.6%) was much higher compared to the prevalence rate of South Korea (1.3%) and eastern Nepal (13.2%).

» OTTPP-49 16:22~16:26

» WHAT IS THE MOST EFFECTIvE SURgICAL PROCEDURE FOR CONgENITAL CHOLESTEA-TOMA STAgE I



UNIVERSITY MEDICAL SCHOOL AND CHONNAM


who suffered from SSNHL seemed to have higher ratio of increased perfusion in the effected temporal lobe, which may due to neuro-inflammation etiology. This may make a difference though to previously etiology of vascular compromise of SSNHL.

» OTTPP-47 16:14~16:18

» OSSICLE STATUS BASED STAgINg FOR CONgENITAL CHOLESTEATOMA


HEAD NECK SURGERY, CHA UNIVERSITY

CHANG HO LEE, SO YOUNG KIM, HYOUNG-MI KIM, TAE HYUN SHIN

Objectives: Although CC has importance because of its ossicle invasion, ossicle status is not addressed in current staging system. Based on our compilation of our pub-lished reports on large case series of early and advanced congenital cholesteatoma(CC), we propose a staging sys-tem based on ossicle status, and important landmarks for CC surgery. Methods: From our large 1100 cases series of CC from 2008 to 2018. Importanat landmarks were tensor tympanic tendon, cochleariform process, stapes tendon,stapes superstructure. - Early is stage I, II , and adnvaced is stage III,IV Staging system require - Early vs Advanced: ossicle chain destructio nor surgical removal - Early CC subclass: Cochleariform process invasion - Ad-vanced CC subclass: staps superdestruction - Anteriro vs Posterior, pseudoposterior. Results: Early congenital cho-lesteatoma I CC in the ASQ II I + Cochleariform process (CP) invasion Advanced CC III II + ISJ destruction (in-cluding surgical removal) , stapes anterior arch invasion IV III+ stapes suprasuturcure (SS) destruction Posterior type I PSQ ISJ abutment II I+ ISJ invasion III II + ISJ de-struction or stapes tendon invasion IV III + stapes super-structure (SS) destruction. Conclusion: - Ossicle based staging system is directly related to recidivism - Ossicle based staging system is more efficient to predict hearing outcome.

» OTTPP-48 16:18~16:22

» RISK FACTORS AND EPIDEMIOLOgY OF OTITIS MEDIA AMONg CHILDREN IN SIND-UPALCHOK DISTRICT, NEPAL

April26(Fri)




Objectives: The aim of this study was to review the surgi-cal outcomes of revision operation for recurrent non-cho-lesteatomatous chronic otitis media (COM). Methods: From 1989 to 2018, 5248 cases of middle ear surgery were performed at Kangdong and Hallym university sa-cred heart hospital. Among them, a total of 297 subjects were retrospectively collected from computerized data-base of middle ear surgery (KOS 2005), of whom had undergone revision mastoidectomy and/or tympanoplas-ty for recurrences. All cases are performed by one sur-geon at two institutions. Each cases were categorized by surgical approaches to canal wall down mastoidectomy (CWD-M), canal wall up mastoidectomy (CWU-M), or tympanoplasty only. Postoperative perforation was de-fined to be present if confirmed after 3 months. Postoper-ative infection was defined if treated with intravenous an-tibiotics or reoperation done after primary surgery. Suc-cessful hearing was defined based on the previous report, if one of the following three criteria was met. [postoper-ative air-bone gap (ABG) < 20dB, postoperative air-con-duction (AC) hearing gain > 15dB, or postoperative AC hearing < 30dB]. Results: Surgical approaches were tym-panoplasty in 170, CWD–M in 74, and CMU-M in 53 cases. Postoperative perforation occurred in 9.4% and less frequently in CMD-M compared with tympanoplas-ty only (p=0.023), and CMU-M (p=0.049) respectively, where as no differences between tympanoplasty only and CMU-M (p=0.93) were found, while postoperative in-fection rate was 1.0% and did not show any differences among the groups. Postoperative successful hearing was obtained in 66.7% and that of tympanoplasty only was higher than in CMD-M (p = 0.001), and CMU-M (p= 0.011). And, that of CMU-M was higher than CMD-M (p= 0.011). Conclusion: The results showed that postop-erative perforation occurred less frequently, in CMD-M than in tympanoplasty only and CWU-M, and successful hearing was achieved more frequently in tympanoplasty alone than in mastoidectomy in revision operation.

» OTTPP-51 16:30~16:34

» SURgICAL OUTCOMES OF REvISION OPER-ATION FOR RECURRENT CHOLESTEATOMA


HEAD AND NECK SURGERY, HALLYM UNIVERSITY

COLLEGE OF MEDICINE1, LABORATORY OF BRAIN

& COGNITIVE SCIENCES FOR CONVERGENCE

MEDICINE, HALLYM UNIVERSITY

HONG CHAN KIM1, CHUL HO JANG1, HYONG-HO CHO1, YONG BEOM CHO1

Objectives: The aims of this study are to analyze the clin-ical characteristics of congenital cholesteatoma, to evalu-ate the treatment outcomes according to the surgical ap-proach, and to suggest the appropriate surgical method in stage I. Methods: We retrospectively reviewed 74 patients who were diagnosed as congenital cholesteatoma stage I at Chonnam National University Hospital from 2010 to 2017. Stage I indicates a cholesteatoma localized in a single quadrant of tympanic membrane by the staging system proposed by Potsic. Three methods were used for the operation; minimally invasive transcanal myringoto-my (MITM), transcanal endoscopic ear surgery (TEES) and postauricular approach (PA). Results: The operation time and hospitalization period were statistically different between the PA and the other group. There was a statis-tically significant difference in the hospitalization period between the TEES and MITM groups, but no significant difference in operation time. The incidence of recurrence was demonstrated in in 2 of 21 patients (TEES), 1 of 27 patients (MITM) and 0 of 26 patients (PA). However, all patients with recurrence in the TEES group underwent surgery without separating the tympanic membrane from the malleus completely. In the MITM group, one patient had a permanent tympanic membrane perforation and tympanoplasty was performed. Conclusion: The MITM and TEES are an efficacious and feasible method to re-move congenital cholesteatoma in stage I. However, we cautiously suggest to separate tympanic membrane from malleus in order to decrease the recurrence in the TEES.

» OTTPP-50 16:26~16:30

» SURgICAL OUTCOMES OF REvISION OP-ERATION FOR NON-CHOLESTEATOMATOUS CHRONIC OTITIS MEDIA



COLLEGE OF MEDICINE1,LABORATORY OF BRAIN

& COGNITIVE SCIENCES FOR CONVERGENCE

MEDICINE, HALLYM UNIVERSITY


JU-HO HAN1, SUNG-KWANG HONG1,2, HYO-JEONG LEE1,2, HYUNG-JONG KIM1,2

April26(Fri)






KONYANG UNIVERSITY HOSPITAL,

KONYANG UNIVERSITY COLLEGE OF MEDICINE,

DAEJEON, REPUBLIC OF KOREA

JONG BIN LEE, JONG JOONG CHOI, MYEONG HEE KIM, HONG GEUN AHN,

JOONG SU PARK, MYUNG-HYUN CHUNG

Objectives: This study aimed to evaluate the micobiology of acute otitis media (AOM) with spontaneous otorrhea in pediatric patients living in Daejeon. Methods: We ret-rospectively enrolled patients and evaluated otorrhea sep-cimens from children affected by AOM between March 2010 and January 2019 in tertiary hospital. Results: A total of 275 specimens were obtained from 275 chil-dren. The male female ratio was 3:2 and mean age was 7.1 years old. The most common pathogen was Pneumo-coccus (63%), followed by Methicillin resistant Staphy-lococcus aureus (MRSA), Hemophilus influenzae. After adjusting for previous pneumococcal conjugated vaccine schedule, the prevalence of MRSA slightly increased and the prevalence of pneumococcus significantly decreased. Conclusion: Pneumococcus and MRSA are common causes of culture-confirmed AOM in children visiting the tertiary hospital. But the frequency of MRSA among pathogens of AOM slightly increased after pneumococcal vaccination

» OTTPP-53 16:38~16:42

» POSTOPERATIvE TINNITUS CHANgE IN PA-TIENTS WITH CHRONIC OTITIS MEDIA




SCHOOL OF MEDICINE

HOKYUNG JIN, WON-HO CHUNG, YANG-SUN CHO, IL JOON MOON

Objectives: Many patients with chronic otitis media (COM) complain of not only hearing loss but tinnitus. It is important to know the tinnitus change following tympanomastoidectomy in patients with COM however, few studies have examined the subjective changes of tin-nitus after COM surgery. The purpose of this study was


JI-SOO LEE1, SUNG-KWANG HONG1,2, HYO-JEONG LEE1,2, HYUNG-JONG KIM1,2

Objectives: Surgical removal is the main treatment mo-dality in aural cholesteatoma, where recidivism is not unsusual, although postoperative follow up studies were scarce. In this study, we report surgical outcomes of re-vision operation for recurrent cholesteatoma. Methods: From 1989 to 2018, 5248 cases of middle ear surgery were performed at Kangdong and Hallym university sacred heart hospital. A total of 138 subjects were col-lected from computerized database of middle ear surgery (KOS 2005) of whom had undergone revision choleste-atoma surgery, and follow up duration was longer than 3 months. To find out surgical outcomes, postoperative perforation, infection and hearing results were evaluat-ed. Postoperative perforation was defined to be present If confirmed after 3 months. Postoperative infection was defined if treated with intravenous antibiotics or reoper-ation done after primary surgery. Successful hearing was defined based on the previous report, if one of the follow-ing three criteria were met. [postoperative air-bone gap (ABG) < 20dB, postoperative air-conduction (AC) hear-ing gain > 15dB, or postoperative AC hearing < 30dB]. Results: Among 138 cases, surgical approaches were ca-nal wall up mastoidectomy(CWUM) in 38 (28%), canal wall down mastoidectomy(CWDM) in 89(64%), and exploratory tympanotomy 11(8%). Of 138 cases, postop-erative perforations occurred in 6(4.3%), and infections or recurrences were 4(2.9%) during follow up period. Postoperative hearing results showed that postoperative AC hearing level was 48dB, average gain of AC level was 4dB from 52dB to 48dB, and change of mean ABG was 4dB from 28dB to 24dB. With hearing report criteria, 70 cases(50.7%) showed successful hearing. Conclusion: The results showed that CWDM was more frequently done than CWUM, and postoperative perforation and infection occurred less frequently, and hearing results were poorer in revision cholesteatoma cases than those in primary cases. These could be used in preoperative coun-seling when considering revision operation

» OTTPP-52 16:34~16:38

» MICROBIOLOgICAL EvALUATION OF ACUTE OTITIS MEDIA WITH SPONTANEOUS OTOR-RHEA IN CHILDREN

April26(Fri)




and 1.14-mm-sized TTs (silicone) in the other ear. Data were obtained on ventilation tube type, time to extru-sion, comorbidities, tube plugging, incidence of TT otor-rhea during following up, and age of the patient. Postop-eratively, follow-up by an otologist continued every two months to assess the incidence of otorrhea, plugging, and TT extrusion until all tubes were extruded. Results: Out of the 75 children, 7 patients were excluded during sur-gery and 4 were lost during follow-up. The mean extru-sion time of 1.02-mm-sized TTs (thermoplastic elasto-mer) was 10.28 months, whereas that of 1.14-mm-sized TTs (silicone) was 7.36 months, which showed a signif-icant difference. However, thermoplastic elastomer TTs had more plugging events than silicone TTs. Conclusion: There was a significant increase in the time to extrusion in ears with the 1.02-mm-sized thermoplastic elastomer TT, although, generally, the larger inner diameter of the tube last longer in the eardrum. This contrasting result is thought to be due to the different material properties of both TTs. This information may be helpful for TT selection in clinical practice depending on the patient's condition.

» OTTPP-55 16:46~16:50

» ADvANTAgES OF COMBINED TRANS-TEM-PORAL BONE APPROACHES IN SKULL BASE TUMOR SURgERY


GANGNAM SEVERANCE HOSPITAL, YONSEI

UNIVERSITY COLLEGE OF MEDICINE, SEOUL,

KOREA1, DEPARTMENT OF NEUROSURGERY,

BRAIN TUMOR CLINIC, GANGNAM SEVERANCE

HOSPITAL, YONSEI UNIVERSITY COLLEGE OF

MEDICINE, SEOUL, KOREA2

GEUN CHEOL SHIN1, MIN PYO HONG1, JI HYUNG KIM1, INON KIM1,

CHANG KI HONG2, EUN JIN SON1

Objectives: The lateral trans-temporal lateral approach can provide comprehensive access for resection of skull-base tumors. However, intricate anatomical complex of the facial nerve, internal carotid artery, jugular bulb, lab-yrinth, internal auditory canal (IAC), and petrous apex within the temporal bone presents a unique challenge for both neurosurgeons and otologists. In this study, we reviewed the surgical outcomes and advantages of com-

to identify the tinnitus changes after COM surgery and to analyze the correlation between tinnitus and hearing. Methods: 61 patients (male 27, female 34) who had been diagnosed as COM and underwent surgical treatment were enrolled this study. All patients completed Tinnitus Handicap Index (THI) questionnaire preoperatively and one year postoperatively. Also, all patients underwent an audiometry within 6 months before surgery and one year after surgery. Relationship between postoperative surgical outcome, such as graft success and hearing improvement, and change of THI were analyzed. Results: Correlation analysis between hearing change and THI score change after operation was conducted involving 61 patients and no significant correlation was observed. The same cor-relation analysis was applied to patients who had shown hearing improvement after surgery. The criteria for hear-ing improvement were defined as improvement of air bone gap and improvement of air conduction. As a result, no statistical significance was observed as in the previ-ous analysis. Conclusion: Analysis of 61 cases showed no significant association between hearing change and THI score change. This study will provide information to patients when counseling them about tinnitus improve-ment after surgery.

» OTTPP-54 16:42~16:46

» COMPARISON OF ExTRUSION AND PATEN-CY OF SILICON vERSUS THERMOPLASTIC ELASTOMER TYMPANOSTOMY TUBES



UNIVERSITY HOSPITAL1, DEPARTMENT OF


SURGERY, YANGSAN PUSAN NATIONAL


SEOK-HWAN LEE1, DON-WON KIM1, SUNG-WON CHOI1, SOO-KEUN KONG1,

IL-WOO LEE2, HYUN-MIN LEE2, SE-JOON OH1

Objectives: This study aimed to assess the differences in the extrusion rate, patency and incidence of otorrhea according to the material properties of tubes in tympa-nostomy tube (TT) procedures. Methods: A total of 75 children with bilateral chronic otitis media with effu-sion were randomized in this prospective trial to receive 1.02-mm-sized TTs (thermoplastic elastomer) in one ear

April26(Fri)




ANSAN HOSPITAL

YOUNG-SOO CHANG, YONG JUN JEONG, MUN SOO HAN, JUNE CHOI, YOON CHAN RAH

Objectives: To analyze the impact of temporal bone frac-ture on various inner ear and facial nerve functions and their clinical courses according to otic capsule involve-ment. Methods: A retrospective review of medical data was carried out for 86 cases who were radiologically diag-nosed with temporal bone fracture from June 2007. Data from various auditory and vestibular function tests, phys-ical examinations were analyzed by dividing patients into two groups according to having otic capsule violating frac-ture (OcVG) / sparing fracture (OcSG). Clinical courses were also analyzed. Results: Among 86 patients, otic cap-sule involvement was confirmed in 11 patients (12.7%). The bone conduction (BC, 28.0±18.3 dB for OcVG; 24.4±15.8 dB for OcSG, p=0.215) and air conduction (AC, 45.5±27.4 dB; 43.8±21.9 dB, p=0.683) thresholds of involved side were not different between groups. In the last pure tone audiometry (PTA), BC threshold was not significantly changed (25.7±15.9 dB for OcVG versus 23.3±14.3 dB for OcSG) despite of early high dose steroid treatment. In contrast, AC was significantly improved in both groups up to 29.0±13.2 dB (OcVG, p=0.017) and 28.7±18.5 dB (OcSG, p=0.041). Significantly more cases with facial palsy was included in OcVG (7 of 11) than OcSG (12 of 75) with higher House-Brackmann (HB) grade in OcVG (5 of 7 over grade IV) than OcSG group (6 of 12 cases). More successful recovery (≤ HB II) was achieved in OcSG (66.7%) than in OcVG (42.8%). Sig-nificantly more cases of OcVG (8 of 11) suffered from dizziness than OcSG (22 of 75) (p<0.01) and the ratio of abnormal caloric response was also higher in OcVG (71.4%) than in OcSG (45.4%). Conclusion: Otic capsule violating temporal bone fracture was associated with significantly higher change of facial palsy, subjective dizziness with abnormal caloric response and with unfa-vorable recovery. However, initial hearing thresholds (BC and AC) were not significantly different regardless of otic capsule involvement with following favorable closure of air-bone gap.

» OTTPP-57 16:54~16:58

» THE SYMPTOMS AND PROgNOSIS OF TRAUMATIC PNEUMOLABYRINTH BY AIR LO-CATION

bined approach performed by a neurosurgeon and an otologic surgeon for cerebellopontine angle(CPA) and midline-located tumors. Methods: Retrospective review of 33 cases of combined trans-temporal approach were included (M:F=9:24, mean age 44.7± 15.4 yrs). Surgi-cal techniques employed for the trans-temporal approach were surveyed. Operative findings, operation time, tumor characteristics and postoperative complications were re-viewed. Results: Most common pathological diagnoses were 18 cases of meningioma and 6 cases of schwanno-ma. Surgical resection extent in the temporal bone was subtotal petrosectomy in 24 cases, 7 cases of translaby-rinthine approach, and 1 case of subtotal petrosectomy, tympano-ossiculoplasty, and 1 case of mastoidectomy and obliteration of external auditory canal. Mean total operation time was 10h 27min, and mean operation time for trans-temporal approach was 1h 54min. Concurrent chronic otitis media was confirmed in 2 cases. Excluding 8 cases where hearing loss was expected as result of laby-rinthectomy, postoperative hearing status was serviceable in 4 of 25 remaining cases (16%). Conclusion: Famil-iarity with the complex anatomy of the temporal bone and consideration of the relationships of petrous apex and peripetrous neurovascular structures are essential for successful transpetrosal skull base surgeries. Combined trans- temporal approach is a useful surgical option in skull base tumor surgery without the burden of increased operation time.


Chair : SEONG JUN CHOI, YONG HO PARK


» OTTPP-56 16:50~16:54

» THE CHANgE OF INNER EAR AND FACIAL NERvE FUNCTIONS ACCORDINg TO THE IN-vOLvEMENT OF INNER EAR STRUCTURES BY TEMPORAL BONE FRACTURE (AN INvES-TIgATION OF LARgE CASE SERIES)



COLLEGE OF MEDICINE, KOREA UNIVERSITY

April26(Fri)




is one of the most common vestibular disorders. BPPV occurs when otoconia of the utricular macula become dislodged and freely floating otolithic debris moves into the semicircular canals. This release of otoconia from the macula is most often idiopathic, though BPPV has been reported to be associated with decreased serum levels of vitamin D. Recently, several researchers reported the as-sociation between BPPV incidence and climatic factors. These studies may be helpful in treating BPPV and iden-tifying pathophysiology. In the present study, we inves-tigated the association between the climatic factor and the incidence of BPPV. Methods: A total of 346 patients diagnosed with BPPV in the emergency room of Chung-Ang University Hospital were included in the study. The number of patients diagnosed with BPPV every week was calculated. Climatic factors of each day including humid-ity, maximum, minimum and average temperature, atmo-spheric pressure, cloud amount were obtained through Korea meterological administration. The mean value of the climatic factor for one week which was matched with the weekly BPPV incidence was calculated. The correla-tions between the BPPV incidence and the mean values of the climatic factors were analyzed. Then the univariate and multivariate analyses were performed to determine the climate factors associated with the BPPV incidence. Results: In simple correlation analysis, cloud amount, humidity, minimum temperature, average temperature showed significant association (p=0.035, 0.048, 0.037, 0.049 respectively) with the BPPV incidence. Based on multivariate analysis using the stepwise logistic regression method, cloud amount remained as a significantly asso-ciated factor (P=0.035, β=0.507). Conclusion: Cloud amount was significantly associated with the BPPV in-cidence. This association might be because sunlight re-duction due to the increase of cloud affects vitamin D formation.

» OTTPP-59 17:02~17:06

» UPDATE ON ANALYSIS OF AUDIO-vESTIB-ULAR ASSESSMENT IN ACUTE LOW-TONE HEARINg LOSS

DEPARTMENT OF OTOLARYNGOLOGY, KOREA


HYUNJUNG KIM, HYE MIN HAN, HOYOUNG LEE, EUYHYUN PARK,

YOON CHAN RAH, JUNE CHOI, HAK HYUN JUNG, GI JUNG IM

DEPARTMENT OF OTOLARYNGOLOGY HEAD &

NECK SURGERY, INJE UNIVERSITY HAEUNDAE

PAIK HOSPITAL, BUSAN, KOREA1

MYUNG-JUN LEE1, BYUNG-WHOO PARK1, MOO-JIN BAEK1

Objectives: The Pneumolabyrinth is a rare condition in which air is present in the inner ear due to abnormal pathways between the middle ear and inner ear. This con-dition can be caused by congenital reasons, middle ear surgery, and head trauma. The cases of traumatic pneu-molabyrinth are increasing due to the high resolution CT. But Symptoms and prognosis of traumatic pneumo-labyrinth is not clarified yet and needs further investiga-tion. Methods: We reviewed 239 cases of head trauma Patients who underwent temporal bone CT between Jan 1st 2012 to Dec 1st 2018. Review of records was done according to the factors: temporal bone fracture, otic capsule involvement, location of air bubble, symptom improvement. Results: Nine patients showed pneumo-labyrinth with symptoms of dizziness and hearing loss. Dizziness which is related to air bubble in the vestibule showed symptom improvement in all cases. While hear-ing loss followed by air bubble in the cochlea (7 cases) did not show symptom improvement. No correlation was found between Symptom improvement and otic capsule involvement. Conclusion: In cases of traumatic pneu-molabyrinth there are a few factors that can be consid-ered to predict the prognosis. Location of the air bubble appears to be the key factor to predicting the prognosis of traumatic pneumolabyrinth.

» OTTPP-58 16:58~17:02

» THE EFFECTS OF CLIMATE ON THE INCI-DENCE OF BENIgN PAROxYSMAL POSITION-AL vERTIgO


HEAD AND NECK SURGERY, CHUNG-ANG


SEOUL, REPUBLIC OF KOREA

SEUNG RI OH, HYUNKYU CHAE, SEOK CHAN HONG, MUNYOUNG CHANG,

SEOG-KYUN MUN

Objectives: Benign paroxysmal positional vertigo (BPPV)

April26(Fri)




few studies describing the availability in children. And study on artifacts of vHIT has reported up to 57% in adults, but there are few analysis about those of children. The aim of this study is to analyze artifacts of the video head impulse test in children and factors influencing the tests. Methods: Thirty-seven children aged 7-18 years with different types of vestibular disease have been in-cluded in this study. The ICS impulseⓇ(GN Otomet-rics,Taastrup, Denmark) was used to perform vHIT. With video head impulse test, the gain of vestibule-ocular re-flex, refixation saccades, artifacts on all three semicircular canals were analyzed. We categorize artifacts into 8 cate-gories as delay/phase shift, high gain, blink, mini- blink, two peaks, head overshoot, the eye traces goes the wrong direction, trace oscillations. Results: The patients were 23 males and 16 females. The mean age was 13.84±2.60 years (range 7~18).Common causes of dizziness were mi-graine related vertigo(28%), vestibular neuritis(23%) and Meniere’s disease(14%). When analyzed for abnormal findings on video head impulse test patients, common causes were vestibular neuritis(45%), migraine related vertigo(22%), psychosomatic(22%). Calculated sensitiv-ity and sensitivity of video head impulse test were 0.44 and 0.83 respectively. On 39 vHIT results, 13(33%) has artifact free vHIT results with or without catch up sac-cade. 4 patients had inappropriately higher gains (>1.2) on both side systematically. Most common artifacts were mini blink(38%) followed by trace oscillations(35%) and high gain(29%). Conclusion: vHIT data from the chil-dren showed that higher artifacts on vHIT results than those of adults. There results may be related to goggle slippage, lack of concentration or blinking of eyes. More care should be taken to obtain the most accurate results and reduce the technical artifacts when examine the chil-dren. (2018R1A6A1A03025523)

» OTTPP-61 17:10~17:14

» CLINICAL FEATURES OF SECONDARY BE-NIgN PAROxYSMAL POSITIONAL vERTIgO AFTER vESTIBULAR NEURITIS


HEAD & NECK SURGERY, INHA UNIVERSITY

COLLEGE OF MEDICINE, INCHEON, KOREA

CHANG BIN YUN, KI NAM KIM, KYU-SUNG KIM, HYUN JI KIM

Objectives: Although BPPV in most patients is idiopath-

Objectives: Acute low-tone hearing loss (ALHL) or acute low-frequency hearing loss is classified as a subset of id-iopathic sudden sensorineural hearing loss. ALHL is pre-sumed to be an early stage of Meniere’s disease, because symptoms such as ear fullness, low-tone hearing loss, tinnitus, and occasional vertigo are similar between the two diseases. The majority of patients with ALHL tend to complain of ear fullness, tinnitus, and hearing chang-es, rather than hearing loss and vertigo. This study aims to analyze acute low-tone hearing loss (ALHL) without vertigo, this study compared the ALHL group with all patients exhibiting low-tone hearing loss and ear fullness. Hearing changes and vestibular functions were analyzed. Methods: ALHL was defined as a mean hearing loss of ≥ 30 dB at 125, 250, and 500 Hz, and ≤ 20 dB at 2, 4, and 8 kHz. From 255 cases of low-tone hearing loss of more than 10 dB without vertigo, 64 met the ALHL criteria and were subjected to audio-vestibular assess-ments including PTA, electrocochleography (ECoG), vestibular evoked myogenic potential (VEMP) testing, and caloric testing. Results: In ALHL, low-tone hearing loss was 42.0±10.0 dB, and 65.6% of ALHL significant-ly recovered by more than 10 dB. The ECoG in ALHL was 0.306±0.110 (higher than 0.230±0.075 on the nor-mal side) and ECoG abnormality was 29.7% (the greater low-tone hearing loss, the higher ECoG value, p=0.001). Conclusion: This study demonstrated excellent hearing recovery following the combined treatment of diuretic and oral steroid, and electrocochleography (ECoG) was significantly higher than normal side. This study reports characteristics of ALHL that show the greater low-tone hearing loss, the higher ECoG, and excellent recovery, even-though low-tone hearing loss is worse, which can be different compared with sudden deafness.

» OTTPP-60 17:06~17:10

» vIDEO HEAD IMPULSE TEST IN DIzzY CHIL-DREN ARTIFACTS & TECHNICAL ERRORS


HEAD &NECK SURGERY, INHA UNIVERSITY,


INHA INSTITUTE OF AEROSPACE MEDICINE,

INCHEON, KOREA

HYUN JI KIM, HYUNG SUN HONG, HONG JU KIM, KYU-SUNG KIM

Objectives: vHIT has been validated in adults, there are

April26(Fri)




can often be multifactorial, is the most common symp-tom in elderly patients and has been identified as a risk factor for falls. The existence of a lower body muscle im-balance and asymmetric vestibular function may be pre-dictive of fall in elderly patients. Objective: To identify lower body functional asymmetry in elderly patients with chronic dizziness and to determine how these imbalanc-es, if they exist, correlated with vestibular asymmetry and risk of falls. Methods: Design: Case controlled study of self-reported ‘chronic dizziness’ versus ‘no-dizziness’ Subjects: Twenty two women, aged 75 or over, with a history of falls and chronic dizziness and age matched women without dizziness and history of falls Methods: Head shake nystagmus, caloric asymmetry and VEMP was measured. Lower limb explosive power and strength were tested. Physical activity was assessed using self-ques-tionnaire. Results: Results: Both groups had significant asymmetry in the leg muscles for both strength and pow-er. Although both groups were asymmetrical in their lower limb strength, the patients with chronic dizziness demonstrated a significantly greater asymmetry. The pa-tients with lower limb imbalance combined with vestib-ular asymmetry were significantly associated with the risk of falls. Conclusion: Conclusion: Weakness and asym-metry in leg strength was prevalent in women aged 75 and over with or without chronic dizziness. Poor lower limb strength and functional asymmetry combined with vestibular asymmetry may be predictive of the risk of falls in elderly patients.

» OTTPP-63 17:18~17:22

» POTENTIAL ROLE OF DYNAMIC vISUAL ACUITY AND LATENT NYSTAgMUS IN THE DEvELOPMENT OF FAILED CONDITION 4 ON SENSORY ORgANIzATION TEST




KOREA UNIVERSITY ANSAN HOSPITAL

YOUNG-SOO CHANG, JUNE CHOI, YOON CHAN RAH

Objectives: To analyze potential contribution of de-creased dynamic visual acuity (DVA) and latent nystag-mus to the development of failed condition 4 (visual func-tion, VIS) on sensory organization test (SOT). Methods:

ic, it may be also secondary to various other conditions such as head trauma, inner ear disease, or the result of surgery and prolonged bed rest. It has been reported that idiopathic and secondary BPPV differ on several aspects. The aim of this study was to investigate the clinical fea-tures and progress of patients who presented with BPPV secondary to vestibular neuritis(s-BPPV) compared to primary BPPV(p-BPPV). Methods: From 2008 to 2018, among visit INHA university hospital for dizziness and diagnosed as BPPV with interview and physical exam-ination, fifty nine patients aged 30-80 years with BPPV have been included in this study. Twenty nine patients of s-BPPV group and thirty patients of p-BPPV group. We analyze s-BPPV and p-BPPV with age, gender, affected canal, symptom duration. As a subgroup analyze of s-BP-PV, age, gender, symptom duration, affected canal, term to BPPV after vestibular neuritis. Results: The mean age of p-BPPV was 54.8±10.7years and 5 male and 21 were female, whereas mean age of S-BPPV was 55.3±14.6years and 14 male and 15 female. Proportion of patients af-fected lateral canal was 19(66%) in s-BPPV group and 18(60%) in p-BPPV group.For the affected side, 3 of 8 patients(37%) had same side of vestibular neuritis which had been proved peripheral vestibular dysfunction. On symptom duration aspect, 3 out of 8 (37.5%) patients in the group with CP<25 had nystagmus even after 1 week. 8 of the 21 patients (38.1%) in the group with CP>25 had nystagmus even after 1 week. There was no significant difference between the two groups(P=0.97). Conclusion: This study shows there were no statistically significant different in affected canal, symptom duration between p-BPPV and s-BPPV. There is higher proportion of male on s-BPPV compare to p-BPPV(p<0.024). On s-BPPV subgroup analysis, there is no statistically signifi-cant different on affected canal, onset time to BPPV after vestibular neuritis, symptom duration. (2018R1A6A1A03025523&2016R1C1B2014826)

» OTTPP-62 17:14~17:18

» THE IMPACT OF LOWER LIMB MUSCLE IM-BALANCE ON CHRONIC DIzzINESS AND RISK OF FALLS IN ELDERLY PATIENTS

OTORHINOLARYNGOLOGY DEPARTMENT

TAE HYEON SHIN, CHEONG SE WON, SO YOUNG KIM, CHANG HO LEE, HYOUNG-MI KIM

Objectives: Background: Dizziness, of which etiology

April26(Fri)




with video head impulse and vestibular evoked myogenic potential tests. We aimed to investigate the involvement patterns of each canal and otolith dysfunction in vestib-ular neuritis and its symptomatic correlation with DHI scores. Methods: We retrospectively reviewed the medi-cal chart of 28 patients who were diagnosed with vestib-ular neuritis. The subjects underwent caloric test, video head impulse test (vHIT), cervical and ocular vestibular evoked myogenic potential (cVEMP and oVEMP), sen-sory organization test (SOT) and completed the dizziness handicap inventory (DHI). Results: In total, 28 patients were included in the analysis, of which 9 had follow up data. Dysfunction of superior vestibular nerve was ob-served in 10 (36%), inferior nerve only in 1 (4%), and superior and inferior nerve in 15 (54%). Two patients (7%) showed normal vHIT and VEMP responses. The most common involvement pattern was the dysfunction of lateral canal and utricle and was observed in 5 (18%). The second most common involvement pattern was the dysfunction of lateral canal, utricle and saccule, and was observed in 4 (14%). The third most common involve-ment patterns were the dysfunction of lateral and pos-terior canal and utricle in 3 (11%), lateral and posterior canal and utricle and saccule, sparing superior canal in 3 (11%). The extensive involvement pattern tended to show positive correlation with symptomatic severity in subacute stage, but not in acute stage. Conclusion: There were diverse involvement patterns of canal and otolith organs in vestibular neuritis, which could be helpful in the diagnosis, and selecting rehabilitation methods based on the involvement patterns.

» OTTPP-65 17:26~17:30

» AUDIOOgICAL OUTCOME OF STAPEDOTO-MY

DEPARTMENT OF COMBINED MILITARY HOSPITAL,

DHAKA CANTONMENT

LTCOL MOHAMMED IFTEKHARUL ALAM

Objectives: This study was focused on the assessment of patient's improvement in hearing, as measured by pure tone audiometry after stapedotomy for primary oto-sclerosis. Methods: This prospective clinical study was performed in a total of 142 patients diagnosed with Pri-mary Otosclerosis, who underwent Stapedotomy at the Department of ENT & Head-Neck Surgery, Combined Military Hospital, Dhaka between January 2013 to Janu-

Patients with failed condition 5 (vestibular function, VES) and normal condition 2 were included and divided into VIS+VES (failed condition 4 and 5) and VES group (failed only in condition 5). Both groups underwent DVA measurement and quantified examination for latent nystagmus using videonystagmography (VNG) on the same day of undergoing SOT. The correlations were an-alyzed between the result of condition 4 (normal/failed) and the DVA change (two line difference) or the presence of head shaking nystagmus (HSN, ≥4 degree/second). Follow- up assessment for SOT, DVA, and VNG was carried out after 12 weeks for cases with failed condition 4 initially. Results: A total of 38 patients were included (M:F=17:21, mean age: 49.9±16.7). Among them, 21 patients (55.3%) belonged to VIS+VES group. Signifi-cantly more cases with decreased DVA (p=0.031*) and HSN (p=0.047*) were included in VIS+VES group than VES group. Significantly higher directional preponder-ance of bithermal caloric test was confirmed in VIS+VES group (39±14%) than VES group (11±3%) (p=0.043*). Higher canal paresis was also confirmed in VIS+VES group (45±19%) than VES group (27±10%) (p=0.08). A total of 7 patients among VIS+VES group underwent 12 week-follow up exam and the result of condition 4 was normalized in 3 cases with disappeared HSN. DVA was normalized in one patient. Conclusion: The VIS+VES group included significantly more cases with decreased DVA, positive HSN, and higher DP. After 12 week-fol-low up, the result of condition 4 was normalized in 3 of 7 patients with disappeared HSN. Those findings suggest potential contributions of decreased DVA and latent nys-tagmus in the development of failed condition 4 of SOT.

» OTTPP-64 17:22~17:26

» PATTERNS OF CANAL AND OTOLITH DYS-FUNCTION IN vESTIBULAR NEURITIS AND ITS SYMPTOMATIC CORRELATION




MEDICINE, SEOUL, REPUBLIC OF KOREA

YEHREE KIM, EUN HYE CHA, WOO SEOK KANG, JOONG HO AHN,

JONG WOO CHUNG, HONG JU PARK

Objectives: Canal and otolith dysfunction can be assessed

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action during the hypergravity stimulation. Methods: we use our gravity system named Inha G-simulator which is a centrifuge device for animal. With 4G hypergravity stimulation was exposed for 24hrs, 1week, 2weeks and 4weeks with SD male rats( aged 7~8weeks, weighing 250- 300g). We checked the kaolin intake and the ves-tibular function with animal rotator (VOR responses). And we did western blotting and immunohistochemistry analysis to quantify the protein expression of histamine receptors in medial and lateral vestibular nuclei. Results: Kaolin consumption was increased after load of hyper-gravity,in comparison with normal control group.Under 4G stimulation for 4weeks, the gain at 0.04, 0.08,0.16, 0.32 HZ were 0.572±0.113, 0.638±0.095, 0.660±0.093, 0.756±0.198 respectively The expressions of histamine receptors were increased significantly compared to con-trol group in vestibular nuclei after 4G 4weeks stimula-tion of hypergravity.Also 4weeks exposure group showed higher expression than 24hrs and 2weeks exposure group significantly in H1 receptor expression. Conclusion: By observing the data, hypergravity stimulation affect the ka-olin intake and it was correlated with the degree of grav-itational stimuli and exposure time. And also, hypergrav-ity stimulation affect the vestibular function and modu-lation of histamine receptors expression in vestibular nu-clei. (2016R1C1B2014826&2018R1A6A1A03025523)

» OTTPP-67 17:34~17:38

» THE HYPERgRAvITY INDUCED DISRUPTION OF CEREBELLAR MOTOR COORDINATION

1DEPARTMENT OF NANO-BIOENGINEERING,

INCHEON NATIONAL UNIVERSITY,

INCHEON, KOREA 2DEPARTMENT OF

OTORHINOLARYNGOLOGY-HEAD & NECK

SURGERY, INHA UNIVERSITY, COLLEGE OF

MEDICINE, INCHEON, KOREA 2INHA INSTITUTE OF

AEROSPACE MEDICINE, INCHEON, KOREA

MINSEOK LEE1, WONJUN NOH1, HYUN JI KIM2, KYU-SUNG KIM2, SUNGGU YANG1

Objectives: The cerebellum coordinates voluntary move-ments to gain smooth and balanced motor activity. It remains unknown how gravity is associated with cerebel-lum-dependent behaviors and Purkinje cell’s activities.We investigated a causal relationship between the cere-bellar motor coordination and gravity with behavior test

ary 2018. All patients were evaluated as per the candidacy criteria for stapedotomy and selected patients underwent surgery during the study period and were followed up for a period of 12 months in the Otology clinic. Pre-opera-tive and Post-operative audiometric evaluation was done using conventional pure tone audiometry with standard calibrations. Post-operative audiometry was performed at 03 month, 06 months and 12 months. Results: Overall, the frequency specific pre-operative mean averaged Air Conduction thresholds were 63.3dB at 500Hz, 47.5dB at 1 KHz, 55.1dB at 2 KHz and 41.7dB at 4 KHz re-spectively. The frequency specific post-operative mean averaged Air-Bone Gap (ABG) closure was achieved by 24.8dB at 500Hz, 31.2dB at 1KHz, 13.6dB at 2KHz and 12.4dB at 4KHz, respectively by the time of completion of the study at 01 year. A successful closure of AB gap to less than 10dB was achieved in the speech frequencies of 2 KHz and 4 KHz in 65% of cases. All patients includ-ed in our study had significant subjective audiological improvement and responded satisfactorily to the ques-tionnaire formulated to assess their hearing quality after stapedotomy. Conclusion: Our case study confirms that stapedotomy is a safe and successful procedure providing long-term hearing improvement in primary otosclerosis. Meticulous selection of cases for stapedotomy will result in highly successful audiological outcomes.

» OTTPP-66 17:30~17:34

» EFFECTS OF HYPERgRAvITY ON HISTA-MINE RECEPTOR ExPRESSION IN vESTIBU-LAR NUCLEI OF RATS


HEAD & NECK SURGERY, INHA UNIVERSITY,

COLLEGE OF MEDICINE, INCHEON,

KOREA INHA INSTITUTE OF AEROSPACE

MEDICINE, INCHEON, KOREA

HYUN JI KIM, EUN HAE JEON, KYU-SUNG KIM

Objectives: Humans without vestibular function never suffer from motion sickness, indicating that the vestib-ular system is essential for the development of motion sickness. Many different environments can cause motion sickness including travelling on land, sea or space. H1 blockers are clinically effective in preventing motion sick-ness. Histaminergic neuron system is important in the developing of motion sickness.we studied the expression of histamine receptors and vestibule-histaminergic inter-

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and electrophysiological test. Methods: we use our grav-ity system named Inha G-simulator which is a centrifuge device for animal. With 4G hypergravity stimulation was exposed for 24hr, 4weeks with SD male rats( aged 7~8weeks, weighing 250-300g). we measured rat behavior such as foot print and irregular ladder under a hypergrav-ity condition and Purkinje cell’s activities examined with the AMPA-mediated fast currents and mGluR1-mediat-ed slow currents. Results: Compared with control group, abnormal foot prints & irregular ladder patterns were found in hypergravity group. In the electrophysiological study, in response to hypergravity stimulation, AMPA/mGluR1-mediated currents were significantly decreased in Purkinje cells. Conclusion: By observing the data, hy-pergravity stimulation affect the cerebellar motor coor-dination. We found irregular ladder pattern after hyper-gravity stimulation. These were correlated with decreased AMPA/mGluR1-mediated currents in Purkinje cells. These result indicates that hypergravity could severely unbalance the activity of Purkinje cells in Cerebellum. (2016R1C1B2014826 & 2018R1A6A1A03025523)

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RHTPPRoom 2-5 (Crane)

Chair : WIRACH CHITSUTHIPAKORN, CHAN HUM PARK


» RHTPP-01 17:10~17:14

» ANTI-ALLERgIC EFFECTS OF CRUDE Ex-TRACT OF CAENORHABDITIS ELEgANS IN A MURINE ALLERgIC RHINITIS MODEL

CENTER OF MORPHOLOGICAL EXPERIMENT,

YANBIAN UNIV. MEDICAL COLLEGE1, DEP.


NECK SURGERY, CHUNGBUK NATIONAL

UNIV. COLLEGE OF MEDICINE2, DEP. OF



COLLEGE OF MEDICINE3, DEP. OF PARASITOLOGY

AND TROPICAL MEDICINE, SEOUL NATIONAL

UNIV. COLLEGE OF MEDICINE4

YU-LIAN ZHANG1, WOO SUB SHIM2, YOUNG KYUNG KO3, MIN-HO CHOI4,

CHAE-SEO RHEE3

Objectives: To evaluate the anti-allergic effects of a crude extract of <i>Caenorhabditis elegans</i> and elucidate the underlying mechanism, we conducted the study us-ing murine allergic rhinitis model. Methods: BALB/c mice were divided into 4 groups 1) negative control group, 2) positive control group (OVA/alum model), CEC group (50 ug), and CEC/OVA group (50 ug). The positive control group was treated with the convention-al OVA/alum protocol. In CEC and OVA/CEC groups, phosphate-buffered saline or OVA solution plus CEC were administered. We measured multiple parameters of allergic responses to determine the effects of the CEC on allergic rhinitis. CEC was treated with bone marrow dendritic cells (BMDCs) isolated from BALB/c mice. Expression of surface molecules was measured by flow cytometry and cytokine secretion was quantified using ELISA. Results: In CEC/OVA group showed inhibitory effects on both symptoms and eosinophil infiltration in

nasal tissue, respectively. CEC/OVA treatment decreased IgG1 levels in serum compared with positive allergic rhi-nitis group as well as down regulated IL-4 protein levels in splenocyte culture significantly. In addition, CEC/OVA group suppressed IL-5 and IL-10 mRNA expres-sion in local nasal tissue significantly. CEC could induce IFN-g protein and mRNA expression locally and sys-temically. Furthermore, treatment BMDCs with CEC resulted in enhanced expression of the co- stimulatory molecular CD40 and CD80, CD86 and MHC II. CEC also increased the cytokine secretion of IL-12 by BM-DCs relative to PBS-treated control groups. Conclusion: CEC could induce anti-allergic effects by regulating DC maturation and Th1/Th2 balance in an allergic rhinitis mouse models.

» RHTPP-02 17:14~17:18

» ANTI-ALLEgIC AND ANTI-INFLAMMATORY EFFECT OF HIzIKIA FUSIFORMIS

CENTER OF MORPHOLOGICAL EXPERIMENT,

MEDICAL COLLEGE OF YANBIAN UNIVERSITY,

YANJI, JILIN, CHINA1, DEPARTMENT OF

BIOCHEMICAL AND POLYMER ENGINEERING,

CHOSUN UNIVERSITY2, DEPARTMENT OF

OTORHINOLARYNGOLOGY HEAD & NECK

SURGERY, MEDICAL COLLEGE OF CHOSUN

UNIVERSITY, GWANGJU, KOREA³

YU-LIAN ZHANG1, JOONG-HEON LEE2, JIEUN LEE³

Objectives: We aimed to investigate the extract of H. fu-siformis on allergic rhinitis inflammation in vitro and in a mouse model. Methods: RAW 264.7 macrophage cells were incubated in the presence of different concentra-tions of viscozyme component of H. Fusiformis (1, 2, 5, and 10 μg/mL) and changes in expression of pro-inflam-matory cytokines were evaluated. In vivo experiment, the 4-week-old BALB/c mice were randomly assigned into 4 groups: group A, control group (n=9); group B, allergic rhinitis group (n=10); group C (n=10) received 300mg/kg H. Fusiformis during nasal challenging peri-od; group D (n=10) received 600mg/kg H. Fusiformis during general sensitization period and 300mg/kg H. Fu-siformis during nasal challenging period. Allergic inflam-mation was made with ovalbumin (OVA) and alum then challenged intranasally with OVA. H. fusiformis was


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Enhanced expression of pro-inflammatory cytokines such as tumor necrosis factor-α and IL-4 in activated mast cells was significantly inhibited by hispidulin. This inhibitory effect was mediated by the inhibition of JNK phosphorylation. In animal models, hispidulin inhibited compound 48/80-induced serum histamine release and immunoglobulin E-mediated local allergic reaction, pas-sive cutaneous anaphylaxis. Conclusion: Conclusion: Our results indicate that hispidulin might be a possible therapeutic candidate for mast cell-mediated allergic in-flammatory diseases through suppression of histamine release and pro-inflammatory cytokines.

» RHTPP-04 17:22~17:26

» ANALYSIS OF STEROID EFFECT IN PA-TIENTS WITH ANOSMIA


DONG-A UNIVERSITY COLLEGE OF MEDICINE

CHANG BAE LEE, EUN SOO LEE, KYOO SANG JO, WOO YONG BAE

Objectives: anosmia로 이비인후과 외래를 방문한 환자들은 크게 PVOD, CRS, AR ,Trauma 등으로 분류된다. 이중에 구강으로 steroid를 처방하고 효과를 보이는 환자도 종종 있다. 진단별로 각각 군의 steroid 효과를 KVSS ,PNS CT(mackay score,olfactory cleft) 및 환자의 증상을 통해서 분석하고자 한다. Methods: 저자들은 2010부터 2018년 이비인후과 외래에서 무후각증으로 KVSS를 시행한 220명의 환자들을 대상으로 진단명, 수술여부, steroid 처방 유무, steroid 효과, PNS CT(mackay score), olfactory cleft hazziness ,kvss 변화등을 분석하여 각 진단별로 ste-roid 효과를 분석하고자 한다 Results: 코막힘, 악취, 치통, 영상학적 검사 상 이상소견 등의 주요 호소증상으로 anos-mia로 내원한 환자 220명중 PVOD는 48례, CRS c NP 46례, CRS s NP 38례, Allergic rhinitis 18례, trauma 30례로 PVOD, CRS, Trauma 순이었다 이중 steroid effect는 만성 부비동염 환자에서 84례중 58례에서 steroid 치료를 시행하였고 치료 효과 또한 45례에서는 후각의 호전을 보였다. PVOD군에서는 48례중 38례에서 steroid치료를 시행하였고 18례에서 효과가 있었다. PNS CT상 olfactory cleft hazziness가 있는 anosmia환자는 CRS c NP 환자에서 36례중에 25례로 가장 많았으며, CRS s NP 환자에서는 38례중 19례이었다. Conclusion: 외래를 방문한 anosmia 환자는 순서대로 PVOD, CRS ,trauma 가 대다수 였으며 이중에 oral steriod effect는 CRS c NP 군에서 특히 효과를 보였으며 이들 중에서는 olfactory cleft hazziness가 있는 환자들이 많았으며, mackay score가 낮은 군에서는 sur-

intraperitoneally administered 3hr before the OVA ad-ministration. Multiple parameters of allergic inflamma-tion were evaluated. Results: The viscozyme component of H. Fusiformis downregulated the GM-CSF, iNOS, VEGF, COX-2 mRNA expression in a lipopolysaccha-ride (LPS)-induced RAW 264.7 cells. The signal intensi-ty of p-pNF-κB 65, p-pIkBa, p-p38, and p-p44/42 pro-tein activated by LPS was ameliorated by H. Fusiformis. Moreover in animal study, H. fusiformis administrated groups C and D showed significant inhibitory effects on nasal symptoms, IL-13 mRNA expression and eosino-phil infiltration/goblet cell hyperplasia in the nasal tissue; OVA specific IgE production in serum. In group D, H. fusiformis treatment downregulated IL-4, IL-5, IL-13, TNF-α and IL-10 cytokine expression in splenocyte cul-ture as well as significantly decreased IgG2a, IgG1 levels in serum compared with group B. However, the expres-sions of IL-5, IFN-γ and FOXP3 mRNA did not change in groups C and D. Conclusion: H. fusiformis could be considered as a potential therapeutic agent in treating al-lergic rhinitis.

» RHTPP-03 17:18~17:22

» HISPIDULIN INHIBITS MAST CELL-MEDI-ATED ALLERgIC INFLAMMATION THROUgH DOWN-REgULATION OF HISTAMINE RELEASE AND PRO-INFLAMMATORY CYTOKINES


SCHOOL OF MEDICINE, KEIMYUNG UNIVERSITY

JI RYONG KIM, BON MIN KOO, JONG IN JEONG, DONG EUN KIM

Objectives: Objective: The effects of the hispidulin, a polyphenolic flavonoid, were studied on the release of histamine and pro-inflammatory cytokines from the mast cells involved in the pathogenesis of allergic inflamma-tion. Methods: Methods: Hispidulin was treated to the cells for different dosages before stimulation. Histamine release and pro-inflammatory cytokines release from mast cells were assayed. To induce the passive cutaneous ana-phylaxis reaction, the skin on the ears of the mice (n = 5/group) was sensitized with an intradermal injection of anti-DNP IgE (0.5 μg/site) for 48 h. Hispidulin was oral-ly administered at doses of 1–10 mg/kg BW 2 h before intravenous injection of DNP-HSA (1 mg/mouse) and 4% Evans blue (1:1) mixture. Results: Results: Hispi-dulin attenuated histamine release in human mast cells.

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respectively. Further prospective study is needed to clarify causal relationship and physiological mechanism.

» RHTPP-06 17:30~17:34

» CHAMAECYPARIS OBTUSE ESSENTIAL OIL INHIBITS HOUSE DUST MITE ALLERgEN IN-DUCED NASAL EPITHELIAL CELL ACTIvATION AND INNATE TYPE 2 IMMUNE RESPONSE



SCHOOL OF MEDICINE

YOUN-TAE SEO, BU-KWAN GIL, MI-KYUNG YE, SEUNG-HEON SHIN

Objectives: Chamaecyparis obtusa essential oil (COEO) has immunomodulatory properties with antibacterial, antifungal, and antiinflammatory actions. Interleukin-25 (IL-25), IL-33, and thymic stromal lymphopoietin (TSLP) produced from airway epithelial cells has been known to participate in the differentiation and activation of group 2 innate lymphoid cell. The aim of this study was to investigate the effect of COEO on Th2 immune response of nasal mucosa. Methods: Primary nasal epi-thelial cells were isolated from nasal polyps during endo-scopic sinus surgery. Epithelial cells were stimulated with 100 ug/ml and 50 ug/ml cellular extract of Dermato-phagoides pteronyssimus (DP) and Dermatophagoides farinae (DF). Epithelial cells were pretreated with 0.001, 0.005, and 0.01% of COEO then stimulated with stim-ulants for 24 hours. IL-25, IL-33, and TSLP were deter-mined with ELISA and mitogen-activated protein kinas-es, nuclear factor kappa B (NF-κB), and activator protein 1 (AP-1) were determined with western bloat analysis. To determine the effect of COEO on innate type 2 immune response, peripheral blood mononuclear cells (PBMCs) were cultured with nasal epithelial cell conditioned me-dia for 72 hours. Innate lymphoid type 2 cells (ILC2) expression was determined with flow cytometry. Results: DP and DF enhanced the production of IL-33 and TSLP than non-stimulated group. However, IL-25 was not in-creased by DP and DF. When the nasal epithelial cells were pretreated with COEO, IL-33 was significantly in-hibited with 0.001 and 0.005% of COEO, and TSLP was also significantly inhibited with 0.001. 0.005, and 0.01% of COEO. NF-κB expression but not AP-1, and MAPK, was significantly suppressed by COEO. COEO treated nasal epithelial cell conditioned media suppressed

gery와 medication을 병행한 환자군에서 steroid 효과가 더 좋았다. 그러나 steroid를 중단하고 추후에 다시 anosmia가 생기는 경우가 많아서 효과를 지속시킬 추가적인 대안이 필요 할 것으로 사료된다.

» RHTPP-05 17:26~17:30

» CORRELATION BETWEEN SUBJECTIvE OL-FACTORY DYSFUNCTION AND FEMALE-HOR-MONE RELATED FACTORS KNHANES v (2010-2012)



KOREA UNIVERSITY, SEOUL, KOREA

KIJEONG LEE, HOYOUNG LEE, IN HAK CHOI, SANG HAG LEE, TAE HOON KIM

Objectives: Olfaction has been reported to be related with estrogen level changes in particular physiological states in women (pregnancy, postmenopause, menstrual cycle) or exogenous hormone use (oral contraceptives, maternal hormone therpy). However, how various re-productive factors affect olfactory function in general status has not been studied. The aim of this study was to evaluate the association between various reproductive fac-tors and olfaction. Methods: This cross-sectional study included 4,391 women who participated in KNHANES V. Univariable and multivariable logistic regression anal-ysis was conducted to evaluate the association between olfactory dysfunction and various reproductive factors. Hormone-related reproductive factors included age at menarche/menopause, number of pregnancies/deliver-ies, age at the first/last delivery, duration of breastfeed-ing, history of oral contraceptives use/maternal hormone therapy. Results: Of total 2,183 premenopausal partici-pants, 77(3.5%) were reported to have subjective olfacto-ry dysfunction. As for premenopausal participants, only longer duration of breastfeeding was positively associated with olfactory dysfunction with statistical significance (OR=1.026, p=0.016). 105(4.8%) of 2208 postmeno-pausal participant were shown to have olfactory dys-function and younger age at menopause was significantly related with higher prevalence of olfactory dysfunction. (OR=0.939, p=0.028). Conclusion: The longer duration of breastfeeding and younger age at menopause related with increased prevalence of subjective olfactory dysfunc-tion in premenopausal status and postmenopausal status


April26(Fri)



» RHTPP-08 17:38~17:42

» A COMPARISON OF NASAL OBSTRUCTION SYMPTOMS IN PATIENTS WHO UNDERWENT SEPTOPLASTY WITH OR WITHOUT POLY-LAC-TATIDE-CO-gLYCOLIDE (PLgA) PLATE



UNIVERSITY MEDICAL SCHOOL AND

CHONNAM NATIONAL UNIVERSITY HOSPITAL,

GWANGJU, SOUTH KOREA

HYE RIN LIM, HYUNG CHAE YANG, YONG BUM CHO

Objectives: Introduction: The essential and most im-portant aspect of septoplasty is the correction of the in-herent deformity involves the L-strut region of the septal cartilage. Many surgical techniques for L-strut correction including scoring incision and cross-hatching incision have demonstrated limitations in achieving uniformly predictable results. In this study, poly-lactide-co-gly-colide (PLGA) plate over the L-strut was used, and the usefulness of the PLGA plate to correct the L-strut was evaluated. Methods: Seventy-two patients who under-went septoplasty due to deviated L-strut were enrolled in this study. All patients were randomly allocated to the PLGA group and the control group. PLGA group un-derwent septoplasty with PLGA plate, and the control group underwent septoplasty without PLGA plate Nasal Obstruction Symptom Evaluation(NOSE) score, the de-gree of difficulty of surgery, blood loss during operation, revision rate, acoustic rhinometry value, and polysomno-graphic parameters were evaluated. Results: The mean age of the study population was 39.9±16.1, 39.0±14.8 years old. Age, sex, the degree of difficulty of surgery, blood loss during operation, polysomnographic param-eters showed no difference between groups. NOSE score was significantly better in the control group(p=0.022). However, six patients of the control group underwent re-vision operation while none of the patients got revision operation in the PLGA group(p=0.025). Conclusion: The use of PLGA plate to straighten deviated septal car-tilage appears to achieve subjective aggravation in nasal obstruction. However, the use of a PLGA plate reduced the rate of revision. Considering the reduction of revision surgery rate, using the PLGA may be beneficial and can be used with other techniques such as scoring incision

ILC2 levels in PBMCs. Conclusion: COEO effectively inhibited DP and DF induced IL-33 and TSLP produc-tion from nasal epithelial cells and then suppressed ILC2 levels, these results may suggest that COEO can modu-late the Th2 immune response in nasal mucosa.

» RHTPP-07 17:34~17:38

» SPHENOID SINUS FAT PACKINg IN TRANS-SPHENOIDAL SURgERY- LONg TERM OUT-COMES USINg MAgNETIC RESONANCE IM-AgINg



MEDICINE, WONJU, SOUTH KOREA

SUNG MIN HAN, YOUNG SUB LEE, CHI SANG HWANG, DONG-JOON PARK

Objectives: Following the transsphenoidal approach (TSA), reconstruction of the sellar floor with sphenoid si-nus fat packing has been favored in cases with intraopera-tive risk factors for postoperative cerebrospinal fluid leak-age. This study aimed to determine the long-term fate of such fat grafts in the sphenoid sinus, using magnetic reso-nance imaging (MRI) follow-up. Methods: Investigation of 139 postoperative MRI scans from 41 patients who underwent standard TSA with sphenoid sinus fat pack-ing between January 2010 and December 2016. Post-op-erative assessment of MRI time series’ showing vital fat volumes, and the eventual development of inflammatory complications or re-epithelization of the sphenoid sinus. Results: In 82.9% of cases, fat volumes measured in final MRI scans declined to less than 20% of initial volumes; only 4.9% of cases showed corresponding declines to more than 60%. Volumes of fat tissue decreased signifi-cantly with time, with a median half-life of 18.0 months. Typically, the sphenoid sinus was eventually almost filled with air rather than transplanted fat, which had been replaced by re-epithelization. In the subgroup analysis, fat clearance rate was significantly lower in patients with residual tumors than in those without such remnants (P = 0.013). Conclusion: Long-term MRI surveillance of fat grafts in the sphenoid sinus revealed that fat volumes decreased with time. Cases with residual pituitary tumors showed slower declines in fat volume, which therefore shows promise as a predictor of possible tumor burden in patients for whom postoperative MRI scans are available.

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relationship was definitive.

» RHTPP-10 17:46~17:50

» SURgICAL TREATMENT OF NASOLABIAL CYSTS IN A SINgLE INSTITUTE


HEAD AND NECK SURGERY, CHONNAM NATIONAL

UNIVERSITY MEDICAL SCHOOL,

HWASUN HOSPITAL

SUNG MIN JIN, DONG HOON LEE, BONG MIN SHIN, KYUNG SEOK PARK,

JAE GU KIM, SUNG HOON KANG, TAE MI YOON, JOON KYOO LEE,

SANG CHUL LIM

Objectives: To analyze treatment results according to intraoral sublabial approach and endoscopic transnasal approach and determine recent surgical trend in our hos-pital. Methods: Twenty-four patients with histopatho-logically and radiologically confirmed nasolabial cyst be-tween January 2010 and December 2017 were enrolled in this study. Results: Nasolabial cysts were predominant in females (91.7%) and the left side (54.2%). According to surgical approach, 12 (48.0%) cases were performed using intraoral sublabial approach while 13 (52.0%) cas-es were accessed using transnasal endoscopic approach. Thirteen (52.0%) patients underwent surgery under gen-eral anesthesia while 12 (48.0%) underwent operation under local anesthesia. The most common postoperative complications were numbness of upper lip or teeth (n = 9, 36.0%). Only one (4.0%) patient who underwent transnasal endoscopic marsupialization experienced a recurrence. Conclusion: Surgical resection through in-traoral sublabial approach or transnasal endoscopic ap-proach is the best treatment for nasolabial cyst, showing very good results and low recurrence rate. Recently, trans-nasal endoscopic approach under local anesthesia tends to be performed more often in our hospital.

and crosshatching incision.

» RHTPP-09 17:42~17:46

» THE EFFECTS OF AIR POLLUTANTS ON THE PREvALENCE OF COMMON EAR, NOSE, AND THROAT DISEASES IN SOUTH KOREA A NA-TIONAL POPULATION-BASED STUDY


HEAD AND NECK SURGERY, SEOUL

MEDICAL CENTER1, DEPARTMENT OF



COLLEGE OF MEDICINE, SEOUL NATIONAL


MINA PARK1, MOO KYUN PARK2

Objectives: The effects of air pollutants on upper air-way disease development have been seldom studied. In this study, we evaluated the effects of air pollution on the prevalence of ear, nose, and throat (ENT) diseases. Methods: We identified cases of ENT disease occurring in 2009, as recorded by the Korean National Health and Nutrition Examination Survey, and explored their asso-ciations with the levels of five air pollutants: sulfur diox-ide (SO2), nitrogen dioxide (NO2), ozone (O3), carbon monoxide (CO), and particulate matter (PM10 particles; particulates ≤10 μm in aerodynamic diameter). Subjects diagnosed with at least one of the five studied ENT dis-eases were included in analysis, but those aged under 19 years were excluded. Linear associations between ENT disease frequency and pollutant levels were evaluated by calculating Spearman correlations. After adjusting for age, gender, and geographic region, multivariate logis-tic regression was used to obtain odds ratios (ORs) with 95% confidence intervals (CIs). Results: A total of 7,399 subjects with ENT diseases were identified. A linear as-sociation was evident between PM10 concentration and the frequency of septal deviation (Spearman coefficient, 0.50668; P=0.0452). After adjustment, the PM10 level was associated with high ORs for chronic rhinosinusitis (1.22; 95% CI = 1.02–1.46) and septal deviation (1.43; 95% CI = 1.22–1.67). Both of these conditions were more prevalent in males. Conclusion: We found that in-creased ambient concentrations of PM10 particles were clearly associated with increased the risk of chronic rhi-nosinusitis and septal deviation; the exposure-response


April26(Fri)



HNTPP 1Room 2-5 (Crane)

Chair : JUNG HAE CHO, YONG BAE JI


» HNTPP-01 14:30~14:34

» CAROTID PARAgANgLIOMA REMOvAL vIA A RETRO-AURICULAR APPROACH USINg DA vINCI xI AND INDOCYANINE gREEN INJEC-TION


HEAD NECK SURGERY, CHA UNIVERSITY,

BUNDANG MEDICAL CENTER1, YONSEI

UNIVERSITY, COLLEGE OF MEDICINE2

SO-YOON LEE1, YOON WOO KOH2

Objectives: Paragangliomas(PG) are rare tumors of neu-ral crest origin. It is mostly benign disease, however, be-cause of complicated location and high vascularity, much effort is needed to reduce complications such as massive bleeding or cranial nerve damage for the surgeon. Re-cently, we have successfully treated Carotid PGs using da Vinci Xi system and Indocyanine Green (ICG) injection via retroauricular approach(RA). We report our success-ful experiences. Methods: CASE STUDY Three Sham-blin type I carotid PGs were enrolled. Mass excision was done via RA. Da Vinci Xi system and ICG injection was done during operation. Results: All tumors were com-pletely resected. Operation times, perioperative blood loss, progress of the patients on the ward and compli-cations of surgery were acceptable. Patients' satisfaction with invisible scars was high in all patients. Conclusion: The Carotid PG is usually benign but should be treated by an experienced surgeon due to both its complicated location and high vascularity and malignant potential of the tumor. The Carotid PG removal via retroauricular approach using da Vinci Xi and ICG injection is feasible and minimally invasive technique was possible for sham-blin I disease. It has some advantages over conventional trans-cervical approaches in terms of invasiveness and cosmesis. Nevertheless, in advanced Carotid PG, sham-blin II or III disease, the surgical morbidity should be

verified with further studies.

» HNTPP-02 14:34~14:38

» IMPACT OF LOW-LEvEL LASER THERAPY USINg 635NM DIODE LASER ON ORAL ULCER ANIMAL MODEL

1DEPARTMENT OF OTOLARYNGOLOGY-HEAD AND

NECK SURGERY, KOSIN UNIVERSITY COLLEGE OF

MEDICINE, BUSAN, KOREA

HYOUNG SHIN LEE1, CHIWOO HWANG1, YE CHAN LEE2, WOON YOUNG CHUNG2,

SUN JU OH3, HYUN WOOK KANG2

Objectives: Several treatment protocols have been in-troduced to manage oral ulcer which may be caused by trauma, immunological factors, infection, and chemo/ra-diotherapy. Recently, the effect of low level laser therapy (LLLT) on oral ulcer or stomatitis has been introduced. However, previous studies applied small spot size irradia-tion which should be delivered multiple times in multiple spots. In this study we sought to evaluate the impact of LLLT using 635 nm diode laser applied via a cylindrical probe as a wide-field irradiation. Methods: Oral ulcer was developed at the buccal mucosa of Sprague Dawley Rats (200-220 g, male) using a 6 mm skin punch. LLLT was delivered via a cylindrical probe with a diameter of 1.6 cm (Area = 2.01 cm2). Treatment began 3 days after initial tissue injury and was conducted once a day for 5 days. Twenty eight rats were divided into four groups as group A (LLLT, 75 J/ cm2, 500mW, irradiation time : 300 sec), group B (LLLT, 20 J/ cm2, 200mW, irradiation time : 200 sec), group C (LLLT, 4 J/ cm2, 200mW, irra-diation time : 40 sec), and group D (control group with no LLLT). Rats were sacrificed 10 days after initial injury and histologic analysis was conducted. Results: Area of ulcer at 10 days after initial injury was smaller in group B (20 J/ cm2 ) compared to those of other groups and con-trol group. Histologic analysis showed that group B (20 J/ cm2) had better outcomes regarding reepithelization, inflammation and granulation. Conclusion: LLLT using 635 nm diode laser via a cylindrical probe as a wide-field irradiation improved the wound healing process in an an-imal model of oral ulcer. LLLT with 20 J/ cm2 showed more organized and rapid wound healing compared to LLLT with 4 J/ cm2 and 75 J/ cm2

April26(Fri)




1DEPARTMENT OF OTOLARYNGOLOGY AND 2BIOCHEMISTRY AND MOLECULAR BIOLOGY,


COLLEGE OF MEDICINE, SEOUL, 3DEPARTMENT OF OTOLARYNGOLOGY,

INJE UNIVERSITY COLLEGE OF MEDICINE,

HAEUNDAE PAIK HOSPITAL, BUSAN

HYO WON CHANG1, MI RA KIM3, SEONG WHO KIM2, SANG YOON KIM1

Objectives: The loss of p53 is known to contribute to malignant transformation, the acquisition of a glycolytic phenotype in cells during cancer development, and resis-tance to treatments. However, the role of p53 in genotoxic therapy- induced metabolic shift in cancers remains un-clear. Here, we investigated to elucidate how p53 partic-ipates in the glycolytic shift of head and neck cancer cell lines following irradiation. Methods: We established a stable radioresistant head and neck cancer cells (HN30-R; p53 wild type and UMSCC1-R; p53 null type) through cumulative irradiation and then analyzed their glucose metabolic profiles and mitochondria respiration. Results: The metabolic analysis revealed no changes glycolysis of HN30-R cells, but UMSCC1-R cells exhibited increased glycolysis through increased glucose uptake and lactate production and glycolytic intermediates as well as related glycolytic enzymes, compared to UMSCC1 cells. Also, we confirmed that the mitochondrial respiration was re-duced by the maximal respiration parameters of oxygen consumption rate and that abnormal mitochondria were accumulated by electron microscopy in UMSCC1-R cells. Thus, UMSCC1-R cells exhibited an increased sen-sitivity to glycolysis- targeting drugs such a hexokinases inhibitor and a lactate dehydrogenase- A inhibitor, but HN30-R cells did not shown any changes. Moreover, we identified that mitophagy limits glycolytic shift through the p53- dependent clearance of abnormal mitochondria. Conclusion: These results suggest that p53 null type cells increased aerobic glycolysis to overcome the accumula-tion of abnormal mitochondria in radioresistant cells. Conversely, p53 wild type cells inhibited the glycolytic shift by regulating mitochondrial integrity through p53- dependent mitophagy. Thus, glycolysis-targeted drugs could be an alternative strategy for overcoming recurrent cancers after radiotherapy, and p53 status could be a bio-marker for selecting participants for clinical trials.

» HNTPP-03 14:38~14:42

» LAMB3 IS A NOvEL UPSTREAM REgULATOR OF DUAL ONCOgENIC MET AND CAvEOLIN-2 SIgNALINg IN HEAD AND NECK CANCER


AND NECK SURGERY, CHUNGNAM NATIONAL


JAE WON CHANG, LIHUA LIU, MI AE IM, KYUNGMIN LEE, OH CHAN, SEUNG-NAM JUNG,

HO-RYUN WON, BON SEOK KOO

Objectives: Acquired resistances of tyrosine kinase inhib-itors including Met inhibitors by feedback activation are a well known therapeutic hurdle in clinic and interest in concurrent targeting of multiple signaling has increased. Previously we reported that LAMB3 is an oncogenic driver and its suppression increased drug sensitivity in head and neck cancer (HNCA). Here, we showed that LAMB3 is an upstream regulator of not only Met but also, CAV2 which is a feedback up-regulating signaling by c-Met inhibition. Methods: We used The Cancer Ge-nome Atlas (TCGA) data to investigate associated tar-get genes closely associated with LAMB3 up-regulation in HNCA. Functional validations were done by in vitro analyses, cell proliferation, migration, invasion and west-ern blot assays were performed following LAMB3, Met, and CAV2 suppression. Results: TCGA data showed that LAMB3 up-regulation is closely associated with Met, CAV2, Timp3, and PDGFC known oncogene in HNCA and to be associated with acquired resistance. Next, we identified that LAMB3 regulate both Met and CAV2 at the transcription level. Interestingly, we found that CAV2 was activated in response to Met suppression and vice versa suggesting feedback regulation between Met and CAV2 pathways. Conclusion: LAMB3 is not only a novel upstream regulator of Met signaling which plays a critical role in carcinogenesis and progression in HNCA but also simultaneously inhibits its complementary sig-naling, CAV2. Thus, LAMB3, instead of Met, could be a more promising therapeutic target to overcome HNCA.

» HNTPP-04 14:42~14:46

P53-DEPENDENT MITOPHAGY CONTROLS GLYCOLYTIC SHIFT IN RADIORESISTANT

HEAD AND NECK CANCER CELLS


April26(Fri)



and 73%, respectively. 3-year and 5-year disease-specific survival (DSS) of RT group were 85% and 80%, while those of CRT group were both 89%. 3- year and 5-year recurrence free survival (RFS) of RT group were both 55%, while those of CRT group were both 80%. RFS were significantly higher in CRT group than RT group (p=0.022). Recurrence rate of three groups, RT, CRT and SBT, showed 44.44%, 19.56% and 50%, respectively. CRT group showed significantly lowest recurrence rate among groups (p=0.033). According to NCI CTC ver-sion 5.0, CRT group had more patients with symptoms than RT group. However, both group showed low grade of dermatitis and mucositis mostly. Only 1 patient halted CRT due to severe thrombocytopenia. Conclusion: Cur-rent reported treatment guideline for early laryngeal can-cer may not be sufficient for T2N0M0 layrngeal cancer.

» HNTPP-06 14:50~14:54

» vOICE OUTCOMES FOLLOWINg SUPRACRI-COID PARTIAL LARYNgECTOMY

DEP. OF OTOLARYNGOLOGY,

OREGON HEALTH AND SCIENCE UNIV.

WILLIAM E KARLE, JENNIFER P WHERLEY, JOSHUA S SCHINDLER

Objectives: To determine if supracricoid partial laryn-gectomy (SCL) patients have continued vocal improve-ment years after their surgery. One of the benefits of per-forming a SCL, as compared to a total laryngectomy, is the preservation of phonation without the requirement of an electrolarynx or tracheoesophageal prosthesis. For this reason its important to know the quality of voice that should be expected postoperatively. Methods: Included in this study were thirty-five patients who underwent a SCL between July 2006 to April 2017. Acoustic measures and Voice Handicap Index (VHI) were collected during the following three time points immediate post-op (3mo-9mo), short term post-op (12-30mo), and long term post-op (>36mo). Results: The indications for surgery included three spindle cell, one verrucous, and thirty-one squamous cell carcinomas. Of these, seven were located in the supraglottis with the rest in the glottis. Fifty-four percent presented with a recurrence following radiation and only three were found to have nodal involvement. Twenty-nine percent underwent a cricohyoidopexy, while seventy-one percent had a cricohyoidoepiglottopexy. The average VHI for each of the three time points were 43.3,

» HNTPP-05 14:46~14:50

» COMPARISON OF LONg TERM TREATMENT OUTCOME OF T2N0M0 LARYNgEAL SQUA-MOUS CELL CARCINOMA ON ASPECT OF TREATMENT METHOD

DEPARTMENT OF OTOLARYNGOLOGY-

HEAD AND NECK SURGERY, CHONNAM

NATIONAL UNIVERSITY MEDICAL SCHOOL AND

CHONNAM NATIONAL UNIVERSITY HWASUN

HOSPITAL1,DEPARTMENT OF INTERNAL

MEDICINE, DIVISION OF HEMATO-ONCOLOGY,

CHONNAM NATIONAL UNIVERSITY MEDICAL

SCHOOL AND CHONNAM NATIONAL UNIVERSITY

HWASUN HOSPITAL2,DEPARTMENT OF RADIATION

ONCOLOGY, CHONNAM NATIONAL UNIVERSITY

MEDICAL SCHOOL AND CHONNAM NATIONAL

UNIVERSITY HWASUN HOSPITAL3

EUN KYUNG JUNG1, SEONG-MIN JIN1, DONG HOON LEE1, JOON KYOO LEE1,

JAE-UK JUNG2, JUN-EUL HWANG3, HYUN-JEONG SHIM3, WOO-KYUN BAE3,

SANG-HEE CHO3, IK-JOO CHUNG3, SANG CHUL LIM1, TAE MI YOON1

Objectives: Even though treatment outcome of Stage I laryngeal squamous carcinoma is high, the result drops when it comes to stage II (T2N0M0). Therefore, in this study, we investigated the treatment outcome of T2N0M0 patients with different treatment methods. Methods: Patients with previously untreated T2N0M0 laryngeal squamous carcinoma were enrolled. Patients were grouped according to their treatment method: ra-diation therapy (RT), chemoradiotherapy (CRT) with cisplatin base, and surgery based therapy (SBT). Treat-ment response assessment and toxicity according to Na-tional Cancer Institution (NCI) Common Toxicity Cri-teria (CTC) version 5.0 were used. The Kaplan-Meier method with log-rank test, student’s t-test, Fisher’s exact and ANOVA test were used with 95% CI for statistical significance.Results: Patients were grouped into three categories: RT group (n=27), CRT group (n=46), and SBT group (n=10). Overall 3-year and 5-year survival (OS) of all patients under Kaplan-Meier method were 79% and 69%. 3-year and 5- year OS of RT group were 74% and 65%, while those of CRT group were 82%

April26(Fri)




ma. After the VF steroid injection, 226(69.7%) patients showed improvement 159(76.8%) patients, 44(55.6%), 23(60.5%) patients respectively. In MDVP analysis, sig-nificant improvement were noted after the treatment in vocal nodule group for all 3 parameters (Jitter, shim-mer, NHR, P<.05). In vocal polyp and reinke’s edema group, only jitter in vocal polyp group showed signifi-cant improvement (P<.05). For each group, 151(72.9%), 36(45.5%), 21(55.2%) showed subjective voice improve-ment. 24 patients experienced mild vocal fold atrophy and scar, however no critical complications are reported such as internal bleeding, dyspnea, etc. Conclusion: A local steroid injection via the cricothyroid membrane is a useful and safe treatment option for benign vocal fold lesions especially for vocal nodules. However effect of the steroid injection via cricothyroid membrane differs from types of the lesions, appropriate treatment should be ap-plied by disease.

» HNTPP-08 14:58~15:02

» CORRELATION BETWEEN REFLUx FINDINg SCORE AND vOICE HANDICAP INDEx IN LA-RYNgOPHARYNgEAL REFLUx PATIENTS

DEP.OF ORL-HNS, FACULTY OF MEDICINE,

GADJAH MADA UNIVERSITY

RIZKY FIRMANSYAH, DIAN P. WULANDARI, KARTONO SUDARMAN

Objectives: To determine the correlation between Reflux Finding Score (RFS) and Voice Handicap Index (VHI) in Laryngopharyngeal reflux patients. Methods: The study design was cross-sectional. Samples obtain by consecu-tive sampling from LPR patients at ORL-HNS Dept. Outpatient Clinic Sardjito General Hospital, Yogyakar-ta, Indonesia,from July- September 2018. Each patient undergo Flexible Nasopharyngolaryngoscopy to measure RFS and asked to fill out VHI questionnaire. Data ana-lyzed statistically by to determined correlation between the two variable. Results: There were 11 male and 19 female in the sample study, with the ratio of 1 to 1,7. The age range of LPR patients in the study was 19-64 years. Based on the risk of voice user, the patients were catego-rized into vocal elite, vocal professional, non vocal pro-fessionals, and non-vocal non-professional. We compared the the first two group with the last two group based on the vocal used. In this study there were 1 patients in vocal elite's group (3,3%), 6 in vocal professional group (20%),

36.9, and 38.3 (P>0.05) respectively. Maximal phona-tion time (MHT) was 8.82, 11.04, and 11.32 seconds. The difference in MHT between the immediate post-op and the long term post-op time periods was statistically significant (P=0.04). All patients were eventually decan-nulated, tolerated an oral diet, and were able to phonate without the use of augmentative devices. Conclusion: Patients who undergo a SCL have continued vocal im-provement for several years following surgery. Typical acoustic measures such as shimmer and jitter dont accu-rately reflect understandability in these patients as they are forced to use supraglottic speech, and a consensus is needed regarding which vocal measures should be used to evaluate them.

» HNTPP-07 14:54~14:58

» THE EFFECT OF STEROID INJECTION vIA THE CRICOTHYROID MEMBRANE IN PA-TIENTS WITH BENIgN vOCAL FOLD LESIONS


HEAD AND NECK SURGERY, KANGBUK SAMSUNG


SCHOOL OF MEDICINE,


WOOJOO NAM, JIN LEE, SUN WOO KIM, SUNG-MIN JIN, SANG-HYUK LEE

Objectives: Local administration of steroid directly into the vocal fold (VF) has been reported in many larynge-al diseases with different methods. Voice therapy is used as a first choise, although good results cannot always be obtained. The aim of the study is to analyze the useful-ness and safety of a steroid injection into vocal fold be-nign lesions via the cricothyroid membrane. Methods: From Jan, 2008 to July, 2018, 324 Patients with benign VF lesions was performed by VF steroid injection via via the cricothyroid membrane were included in this study. We compared medical record of laryngoscopy, strobos-copy and multi-dimensional voice program (MDVP) analysis at pre and post treatment. Jitter, shimmer and noise to harmony ratio (NTR) were compared in MDVP. Voice handicap index (VHI) was measured for subjec-tive voice improvement. Common complications such as hematoma, scar, atrophy and plaques were monitored. Results: Among 324 patients, 207 patients were diag-nosed as vocal nodule, 79 as polyp and 38 as reinke’s ede-


April26(Fri)



» HNTPP-10 15:06~15:10

» SERUM PROCALCITONIN AS OUTCOME PREDICTORS IN DEEP NECK INFECTIONS

DEP. OF OTOLARYNGOLOGY, FACULTY OF

MEDICINE, CHULALONGKORN UNIVERSITY.

PANOTE KASEMSUWAN, NAPADON TANGJATURONRASME,

WORAWAT RAWANGBAN

Objectives: The Deep Neck Space infections are infec-tions of the anatomically complex spaces of the neck. Despite advancing antibiotics, there is potential mor-bidity and complications. Procalcitonin has emerged an inflammation marker in the 1990s. Multiple aspects of procalcitonin has been described, in diagnosing infec-tions, severity correlations, treatment consideration, and complication associations. There is a potential knowl-edge of procalcitonin in each specific infection. To our knowledge, there is no study on the infections deep neck spaces to the serum Procalcitonin. We study to assess the potential role of procalcitonin in deep neck infections. Methods: A prospective, descriptive study was carried out in a tertiary-care, university-based hospital, in Bang-kok, between August 2560 and December 2561. Patient with deep neck infections diagnosed by history and phys-ical examination were recruited. Baseline data, along with the serum procalcitonin were obtained a baseline. Treatment was decided by case. The patients blood was routinely examined 24-48 hours after either treatment, either antibiotics alone, or surgical drainage, which se-rum procalcitonin was also repeated. Results: 33 patients enrolled in 22 months. The mean Procalcitonin level was 2.34 +/- 4.64 (range 0.04-21.15). A relation is seen with the length of stay (p=0.043), and the body temperature (p<0.001). The second procalcitonin level, which was sampled after the treatment 24-48 hours, was found to increase in 11 (36.7%) patients, and is associate with the status of re-exploration (p=0.016). By an ROC curve, a procalcitonin level of 0.155 and over, can predict a pro-longed stay of 7 days and over, with a 100% sensitivi-ty (CI 96.30-100%), and a 44% specificity (CI 34.67-53.77%). Conclusion: Procalcitonin may have a role in deep neck infections. Further study and specific designs may be conducted to evaluate further.

10 in non-vocal professional group (33,3%), and 13 in non- professional non-vocal group (43,3%). The cor-relation between RFS and VHI was determined by using Spearman's correlation test with the result value of r = 0,356 and p=0,027. This result indicated that the cor-relation between RFS and VHI was significant but has a weak positive correlation. Further correlation analysis was carried out between RFS with physicial VHI(r=0,394 p= 0,016), functional VHI (r=0,394 p=0,068) and emo-tional VHI(r=0,272, p=0,073). Those results showed that there was a weak degree of positive correlation on physical VHI, but there was no correlation between the RFS and the functional and emotional VHI variables. Conclusion: There is a weak positive correlation between RFS and VHI in LPR patients(r=0,356 p=0,027) .

» HNTPP-09 15:02~15:06

» RARE PRESENTATION OF STERNOCLEIDO-MASTOID PYOMYOSITIS IN ACUTE LEUKEMIA

DEP. OF OTOLARYNGOLOGY - HEAD AND NECK

SURGERY, KHOO TECK PUAT HOSP. SINGAPORE

SHIN YIN OOI, DUNCAN KOON KIT WONG

Objectives: Primary pyomyositis is a bacterial infection of skeletal muscle, commonly caused by Staphylococcus aureus. We report a rare case of sternocleidomastoid pyo-myositis in acute leukemia. Sternocleidomastoid pyomy-ositis may cause internal jugular vein thrombosis, sepsis and death if it is not managed immediately. Methods: A 50-year old gentleman presented with painful right neck swelling and fever for 2 weeks. He subsequently devel-oped septic shock with respiratory failure and acute kid-ney injury. His computed tomography scan of the neck showed right sternocleidomastoid muscle hypertrophy with rim enchancing fluid collection spanning the entire muscle. He was diagnosed with right sternocleidomastoid pyomyositis and treated with biapenem antibiotic. How-ever, there was no improvement seen. Ultrasound guid-ed aspiration of the sternocleidomastoid abscess showed no bacterial growth. Results: He was also noted to have pancytopenia, therefore bone marrow aspiration was per-formed. Bone marrow aspiration result showed acute leu-kemia. Conclusion: Patient was then referred to hema-tology department for further management. We would like to create awareness for a routine check for underlying immunocompromised disease that can cause rare neck abscess such as sternocleidomastoid pyomyositis.

April26(Fri)




» HNTPP-12 15:14~15:18

» ANALYSIS OF SURgEON PERFORMED NON-DIAgNOSTIC OR INDETERMINATE CORE NEEDLE BIOPSY BEFORE CERvICAL LYMPH NODE ExCISIONAL BIOPSY


SOONCHUNHYANG UNIVERSITY COLLEGE


OTORHINOLARYNGOLOGY,

CHUNGNAM UNIVERSITY COLLEGE OF MEDICINE2

SANG BIN KIM1, JAE YEUP JUNG1, MYUNG JIN BAN1, JAE WON CHANG2

Objectives: We aimed to analysis non-diagnostic or in-determinate core-needle biopsy (CNB) before excisional biopsy (EB) of enlarging lymph nodes and to determine the diagnostic value of CNB. Methods: Out of the 110 cases that underwent EB from lymph nodes between 2015 and 2018, 37 were included in the study in which pathological lymph nodes were excised after two surgeon performed CNB. Demographic information, pathology and imaging reports, the diameters of the lymph nodes and the length of the CNBs of these cases were obtained from the hospital registry system. Diagnoses of the CNBs and excisional biopsies were then compared Results: According to the excisional biopsy diagnosis, 25 of the 37 cases (67.5%) were benign and 12 of them (32.4%) were malignant. 9 (75%) of the malignant cases were di-agnosed as non-Hodgkin’s lymphoma and 3 (25%) were carcinoma. In the 9 non-diagnostic but adequate CNBs, 6 (66.6%) of them were found to be benign/reactive, while 3 (33.3%) were diagnosed as malignant in EB. In 4 of the 7 (57.1%) indeterminate CNBs, not fully diagnos-tic with adequacy were diagnosed as malignant. Similarly, 2 (13.3%) of the 15 cases diagnosed as benign/reactive in diagnostic CNB, were found to be malignant with excisional biopsy. Inadequate CNBs were found only first 2 years and number of EB per year were decreased suggesting diagnostic CNB confirm disease without EB. Conclusion: CNB is a non-invasive procedure. It is an alternative to excisional biopsy because of its low mor-bidity and low cost. However, the sensitivity of CNB is lower than its specificity, and we recommend the surgical excision of lymph nodes with a clinically strong neoplasm suspicion because of the presence of false negatives in 2 cases in diagnostic results and risk of malignancy were

» HNTPP-11 15:10~15:14

» ExPERIENCE OF ACUPUNCTURE ASSISTED ANAESTHESIA IN NECK SURgERIES AT EN-DOCRINE UNIT, HOSPITAL RAJA PERMAISURI BAINUN

DEP. OF OTORINOLARYNGOLOGY, UNIV. MALAYA 1DEP. OF GENERAL SURGERY, HOSP.

RAJA PERMAISURI BAINUN, IPOH2

HUI MON TEH1, AI CHEN CHAN2

Objectives: To audit all the cases of acupunture assisted anaesthesia (AAA) for neck surgeries in Endocrine Unit in a tertiary hospital in Malaysia. Methods: All cases of neck surgeries under AAA in Hospital Raja Permaisuri Bainun, Ipoh, Malaysia from 1st August 2015 to 28th February 2018 are included in this study. Retrospective data of patients demographic characteristic, comorbidity, type of surgery, diagnosis, postoperative analgesia and complications are all analyzed retrospectively. Results: Our neck surgeries under AAA were in age range of 18-57. There were total of 7 neck surgeries with AAA which included 4 cases of neck exploration and parathyroid-ectomy for tertiary hyperparathyroidism and 3 cases of hemithyroidectomy for suspicious nodules. All tertiary hyperparathyroidism patients had co-morbidities which rendered high GA risks and anticipating difficult intuba-tion. One of our patient with renal osteodystrophy had rugger-jersey spine and multiple bone deformities with difficulty in airway intubation. All 4 cases of the neck exploration and parathyroidectomy were hospitalized for more than 24 hours for calcium monitoring. 3 cases of hemithyroidectomy were discharged after 6 hours of close observation and just required day-care ward admis-sion. The mean operative time was 103 minutes ( range = 69-150 minutes). There was no intra-operative or postoperative complication recorded. All cases achieved satis-factory anaesthesia without conversion to GA. All cases required only simple oral paracetamol, NSAID, oral or intravenous Tramadol. Conclusion: The application of AAA is an alternative to avoid potential GA risks in neck surgeries, speficially in cases with patient with difficult airway and severe co-morbidities of cardiorespiratory sys-tems. It provides an adjunct effect with local anaesthetic agent for analgesia in surgeries.


April26(Fri)



ALOgUE SECRETORY CARCINOMA OF THE PAROTID gLAND



UNIVERSITY MEDICAL SCHOOL,

HWASUN HOSPITAL

JAE GU KIM, DONG HOON LEE, BONG MIN SHIN, KYUNG SEOK PARK,

SUNG MIN JIN, SUNG HOON KANG, TAE MI YOON, JOON KYOO LEE,

SANG CHUL LIM

Objectives: Mammary analogue secretory carcinoma (MASC) of the salivary gland is a newly described rare malignant tumor. There are still few patients with MASC of the parotid gland, so the exact characteristics, treat-ment outcomes, and prognosis of MASC of the parotid gland are unknown. The aim of this study was to analyze the clinical features and treatment outcomes of MASC of the parotid gland in patients undergoing surgery at a single institute. Methods: Retrospectively, five patients with histopathologically confirmed MASC of the parotid gland between January 2015 and August 2018 were en-rolled in this study. Results: In all patients, preoperative fine-needle aspiration cytology failed to provide accurate diagnosis of MASC of the parotid gland. All patients un-derwent a macroscopically complete oncologic resection. Two patients underwent postoperative radiation therapy (RT). In immunohistochemistry, all patients had positive staining for S-100 and mammaglobin and were negative for DOG1. There was no regional recurrence or distant metastasis in any of the patients at the last follow-up. Conclusion: We demonstrated good results for patients with MASC of the parotid gland with surgical treatment and postoperative RT.

» HNTPP-15 15:26~15:30

» CLINICAL OUTCOMES OF BULKY PAROTID gLAND CANCERS - A NEED FOR SELF-Ex-AMINATION, COMMUNITY EDUCATION AND SCREENINg PROgRAM FOR EARLY DIAgNO-SIS OF PAROTID TUMORS


- HEAD AND NECK SURGERY, SAMSUNG

more increased in indeterminate cases than non-diagnos-tic cases.

» HNTPP-13 15:18~15:22

» APPLICATION OF LOCAL FLAP IN REvISION PAROTID SURgERY





EUNKYU LEE1, BO YONG KIM1, SUNGYONG CHOI1, JONGWON PARK1,

HAN-SIN JEONG1

Objectives: For recurrent tumors in the previous parot-idectomy wound, the tumors are commonly scattered in the surgical wound and surrounding subcutaneous tissues. In these cases, excision of overlying skin on the recurrent tumor may be necessary to safely eradicate the recurrent tumors in the parotid area. This study aims to present the application of local flap in revision parotid surgery, even in limited cases. Methods: Retrospective re-view of 45 patients who had revision parotid surgery for recurrent tumors was conducted. Among them, six pa-tients required local flap covering the surgical defect. The types of local flap used were transposition, rotational and advancement flaps. Clinical outcomes and re-recurrence were evaluated in these patients. In addition, distance from the tumor to skin was evaluated radiologically and pathologically. Results: The local flaps were successfully engrafted in all patients. The recurrence rates were not different statistically between the groups with and with-out local flap in revision parotid surgery. However, for benign tumors, none of the patient with local flap had recurrence (n=3) while 4 out of 32 patients without local flap had re-recurrence (12.5%) in their clinical courses. Patients with local flap in revision parotid surgery had wider surgical safety margin (3.4 vs. 1.5 mm, p=0.005) in terms of the distance from tumors to skin. Conclusion: In revision parotid surgery, the application of local flap could be useful to enhance wound healing and ensure the safe tumor resection.

» HNTPP-14 15:22~15:26

» TREATMENT OUTCOMES OF MAMMARY AN-

April26(Fri)




HNTPP 2Room 2-5 (Crane)

Chair : JAE WOOK KIM, SEUNG HOON WOO


» HNTPP-16 15:50~15:54

» 18F-FDg PET-CT vERSUS CT/MRI FOR DE-TECTION OF LYMPH NODE METASTASIS IN CLINICALLY NODE-NEgATIvE ORAL CAvITY CANCER

DEPARTMENTS OF 1OTOLARYNGOLOGY, 2NUCLEAR MEDICINE, 3RADIOLOGY, AND

4PATHOLOGY, ASAN MEDICAL CENTER,

UNIVERSITY OF ULSAN COLLEGE OF MEDICINE,


MI RYE BAE1, JONG-LYEL ROH1*, JAE SEUNG KIM2, JEONG HYUN LEE3,

KYUNG-JA CHO4, SEUNG-HO CHOI1, SOON YUHL NAM1, SANG YOON KIM1

Objectives: Subclinical lymph node (LN) metastasis is associated with poor survival outcome in oral cavity squa-mous cell carcinoma (OCC), which alleges prophylactic LN dissection. Preoperative detection of LN dissection might improve prognostic prediction and proper man-agement of OCC. Therefore, we examined the clinical usefulness of 18F-FDG PET/CT in detection of occult LN metastasis in OCC patients in comparison with conventional CT/MR imaging. Methods: In total, 182 OCC patients with negative neck palpation findings were assessed prospectively with 18F-FDG PET/CT and CT/MR imaging. Histopathologic analyses of neck dis-section samples served as the standard of reference. Di-agnostic values of 18F-FDG PET/CT versus CT/MR imaging were compared by using the McNemar test and logistic regression with generalized estimating equations. Results: Forty-five patients (24.7%) had had metastasis in 49 sides and 683 levels of the neck. The sensitivity and accuracy of 18F-FDG PET/CT for detection of occult metastasis were higher than CT/MR imaging on all of per-patient, per-side, and per-level bases (all P <0.05). However, the specificities of metastatic detection between

MEDICALCENTER,SUNGKYUNKWAN UNIVERSITY

SCHOOL OF MEDICINE, SEOUL,

REPUBLIC OF KOREA

SUNG YONG CHOI, EUNHYE KIM, JONGWON PARK, MAN KI CHUNG,

YOUNG-IK SON, CHUNG-HWAN BAEK, HAN-SIN JEONG

Objectives: It is well known that early detection and diagnosis of parotid gland cancer is essential to improve clinical outcomes, because the TNM stage at diagnosis is very strong indicator to prognosis in parotid gland cancer. However, some patients would take their clinical situation not seriously in spite of big tumor formation around the parotid gland, and miss out an opportunity for cure. Thus, we aimed to present the clinical outcomes of bulky parotid gland cancers, to emphasize the neces-sity of a screening program and community education for parotid gland cancer. Methods: We retrospectively reviewed 60 cases with bulky (d > 4cm) malignant tu-mors arising from the parotid gland (2009-2016). The clinical and pathological factors were analyzed to identify risk factors for poor outcomes. In addition, we designed a self-examination tool for parotid gland tumors, similar to the breast self-examination for breast cancer detection. Results: Patients with bulky parotid cancer had poor clin-ical outcomes (5-year overall survival rate=63.3%, medi-an survival=18 month), and eleven patients (18.3%) were diagnosed as inoperable at presentation. In cases with op-erable parotid gland cancers (N=49), preoperative facial nerve palsy and clinical tumor size were not associated with cancer mortality. Moreover, extent of parotidecto-my, facial nerve sacrifice and neck dissection showed no additional benefits on survival. Instead, lymph node me-tastasis was a sole independent prognostic factor in mul-tivariable analysis (p=0.034; HR=3.721, 95%CI 1.108 -12.498). Conclusion: Even with bulky parotid gland cancers, the patients without lymph node metastasis could have favorable clinical outcomes. Development of a self-examination tool and community education seem to be necessary to detect parotid gland cancers at early stage.


April26(Fri)



Metastatic nodal burden of the number of positive LNs and LN ratio might better predict recurrence and survival for SGC.

» HNTPP-18 15:58~16:02

» ENgINEERINg MICROENvIRONMENT FOR TONSIL-DERIvED MESENCHYMAL STEM CELL-MEDIATED SALIvARY gLAND REgEN-ERATION

1DEPARTMENT OF OTOLARYNGOLOGY-HEAD

AND NECK SURGERY, KONYANG UNIVERSITY

COLLEGE OF MEDICINE, DAEJEON, REPUBLIC OF

KOREA ,2DEPARTMENT OF OTOLARYNGOLOGY-


UNIVERSITY CHEONAN HOSPITAL, REPUBLIC

OF KOREA, 3SOONCHUNHYANG INSTITUTE OF

MEDI-BIO SCIENCE (SIMS), SOONCHUNHYANG

UNIVERSITY, REPUBLIC OF KOREA

JOO HYUN KIM1,2, YUN HYE KIM3, YONG SUNG HWANG3, MYUNG JIN BAN2,

JAE HONG PARK2

Objectives: Human tonsil-derived mesenchymal stem cells (T-MSCs) possess a great potential to differentiate into multiple lineages and self-renewal capacity, allowing them to be utilized as patient-specific cell-based therapeu-tics. Although various stem cells-derived acinar cells or saliva-producing progenitor cells has been proposed as a novel approach for treating radiation-induced xerostomia and Sjogren’s syndrome, an efficient method for estab-lishing functional saliva-producing cells is still a daunting task. Here, we aim to develop a novel cell culture plat-form that could regulate important cell-cell/cell-matrix interactions by introducing three-dimensional (3D) cul-ture methods using 3D bio-printable matrix that can support the adhesion, proliferation, and differentiation of T-MSCs into saliva-producing cells. Methods: First, we have combined salivary gland-like organoid with pre-vas-cularization’s method using human umbilical vein endo-thelial cell. Secondly, functional-multipotent organoids have been developed using human bone marrow derived mesenchymal stem cell. Lastly, we have investigated the long-term growth and maintenance of acinar cell protein expression, cell polarity and secretory function by trans-planting the functional-multipotent organoids (add var-

18F-FDG PET/CT and CT/MR imaging did not sig-nificantly differ (P >0.1). 18F-FDG PET/CT improved detection of occult metastasis up to 28.9% in patients with negative findings on CT/MR imaging. Conclusion: 18F-FDG PET/CT can detect more occult metastasis than CT/MR imaging, which potentially impact on clin-ical management of OCC patients.

» HNTPP-17 15:54~15:58

» PROgNOSTIC NODAL FACTOR FOR SALI-vARY gLAND CANCER




ASAN MEDICAL CENTER1

HOJUN LEE1, JONG-LYEL ROH1, SEUNG-HO CHOI1, SOON YUHL NAM1,

SANG YOON KIM1

Objectives: Extranodal extension (ENE) of a metastatic lymph node (LN) became introduced as a new prognostic factor for nodal staging of head and neck cancer in the re-cent 8th AJCC staging system. However, the prognostic impact of ENE in salivary gland cancer (SGC) has been rarely examined. Therefore, we evaluated the prognos-tic values of ENE and other nodal factors in predicting post-treatment recurrence and survival in patients with SGC. Methods: This retrospective study involved 212 consecutive patients who underwent primary tumor ex-tirpation and neck LN dissection for previously untreated SGC at our tertiary referral center. Histological findings of tumor and LNs were examined and reported. The ex-tent of ENE was defined as the presence and thickness of extracapsular spread of metastatic LNs. Cox propor-tional hazard regression analyses were used to find the factors associated with recurrence-free survival (RFS) and overall survival (OS). Results: Of 212 study patients, 74 (34.9%) had positive LNs and 36 (17.0%) had ENE. The thickness of ENE >2 mm and the number of LNs ≥5 pos-itive LNs were found in 39 (18.4%) and 20 ( 9.43%), re-spectively. All nodal factors of nodal classification, num-ber of positive LNs, LN ratio, and ENE thickness were significantly associated with RFS and OS in univariable analyses (all P <0.05). After controlling the other clinical and pathological factors, no ENE thickness but only the number of positive LNs and LN ratio remained the inde-pendent factors of RFS and OS (P <0.05). Conclusion:

April26(Fri)




respectively (p=0.043), and the mean revision rates of the EG and WEG were 1 and 2 times, respectively (p=1.0). Conclusion: It might be useful to use endoscope when transoral draining of PPSA comparing the conventional drainage technique because using endoscope showed no significant difference of operating time, hospital stays, EBL, and revision rates than conventional technique, but endoscope enable surgeon to drain the PPSA which were located deeper level in the neck.

» HNTPP-20 16:06~16:10

» COMPARISON OF SIMPLE FRENOTOMY vERSUS 4-FLAP z-FRENULOPLASTY FOR CORRECTION OF ANKYLOgLOSSIA A PRO-SPECTIvE RANDOMIzED CONTROLLED STUDY



KYUNG-HEE UNIVERSITY, SEOUL, KOREA

TAE-HOON KIM, YOUNG-GYU EUN, YOUNG CHAN LEE

Objectives: To compare the result of the articulation test values and tongue-tie grade improvement after simple frenotomy or 4-flap Z-frenuloplasty in patients with an-kyloglossia. Methods: From 2015 to 2019, patients who were diagnosed with as ankyloglossia were enrolled. Pa-tients were randomly assigned preoperatively to undergo either (1) simple frenotomy or (2) 4-flap Z-frenuloplas-ty. Patients who had ankyloglossia but did not undergo an articulation test were excluded. Before the surgery and 3 months after the operation, the articulation test and Tongue-tie grade were re-evaluated. The tongue-tie length measurement is from the distance from the tip to the attachment of the frenulum, which was classified as Class I (mild), Class II (moderate), Class III (severe), and Class IV (complete ankyloglossia). U-TAP consists of consonant and short vowel tests at the word and sen-tence level. Results: A total of 74 patients were included in the study. Patients who did not meet the criteria or who had a loss of follow up were excluded. Finally, 12 pa-tients with the simple frenotomy group and 16 patients with the 4-flap Z- frenuloplasty group were enrolled. There was no difference in baseline characteristics be-tween the two groups. Changes in Tongue-tie grade and articulation test (Consonants) in patients undergoing

ious cytokines and growth factors: Hyaluronic acids and Gelatin methacrylate) in salivary-hypofunction animal model induced radiation. Results: Our initial findings demonstrated that cells cultured on 3D bio-printable matrix were able to survive, proliferate, and form acinar cell-like 3D organoids. 3D organoids induced seeded cells to produce significantly more ECM components than 2D cultures. Conclusion: A cell culture platform can offer novel strategies to achieve functional acinar cells from a patient-specific cell source to treat xerostomia.

» HNTPP-19 16:02~16:06

» ENDOSCOPE-ASSISTED PARAPHARYN-gEAL SPACE ABSCESS DRAINAgE


EULJI UNIVERSITY COLLEGE OF MEDICINE

MYOUNG-SU CHOI

Objectives: Parapharyngeal space abscess (PPSA) may cause severe complications such as, airway obstruction, jugular thrombophlebitis, and mediastinitis unless ear-ly diagnosed and properly treated. Transoral drainage is known to reduce morbidity and hospital stays compared to the external drainage. The aim of this study is to assess the effect of endoscope when transoral draining PPSA. Methods: We retrospectively reviewed chart of those who diagnosed with PPSA and treated surgically between February 2013 and September 2018. Thirty-nine pa-tients were enrolled this study who underwent incisional drainage via transoral approach. Patients were excluded who underwent drainage via an external approach or who treated with medication alone. Thirty-nine patients were classified into two groups whether endoscope is used or not when draining of PPSA. We compared the hospital stays, estimated blood loss (EBL), operating time, revi-sion rate, depth of abscess, and postoperative complica-tions between two groups. Results: Of the 39 patients (22 males, 17 females), 13 patients (M:F = 7:6) were in-cluded endoscope group (EG) and 26 (M:F = 15:9) were included without endoscope group (WEG). The mean hospital stays of the EG and WEG were 7.6 ± 4.6 and 9.8 ± 4.8 days, respectively (p=0.188), the mean EBL of the EG and WEG were 222.2 and 254 ml, respective-ly (p=0.595), the mean operating time of the EG and WEG were 40.0 ± 22.5 and 35.4 ± 14.5 minutes, re-spectively (p=0.457), the mean depth of PPSA of the EG and WEG were 4.5 ± 0.9 and 4.0 ± 0.7 c-spine level,


April26(Fri)



» HNTPP-22 16:14~16:18

» FEASIBILITY OF ANTI-FUNgAL AgENT IN BURNINg MOUTH SYNDROME

DEP OF OTOLARYNGOLOGY-HEAD AND NECK

SURGERY, KOREA UNIV COLLEGE OF MEDICINE

JAE HYUNG KIM, HYUNJUNG KIM, HYUNG KWON BYEON, KWANG YOON JUNG,

SEUNG KUK BAEK

Objectives: Treatment of burning mouth syndrome (BMS) is challenging because there is no consensus re-garding pharmalogical or nonpharmalogical therapies. Since the fact is well-known that fungal infection of oral cavity is associated with burning mouth syndrome, we suspected anti-fungal agent can be feasible for treatment of BMS. Methods: Total 243 patient visited with symp-tom of oral cavity pain from 2015 to 2019. And 130 of those were compatible with diagnosis of BMS(Oral cavity pain persistent at least 3 months without abnormal phys-ical examination). All of patients prescribed 2-4 weeks of anti-fungal gargle, oral cavity fungus culture, bacterial culture. And then improvement of symptom were mea-sured subjectively. Results: Patients are divided into 2 groups (Group 1 : fungal infection positive, Group 2 : fungal infection negative). Group 1 was composed of 56 people and showed 76% of symptom improvement. And Group 2 was composed of 74 people and showed 64% of symptom improvement. And through independent samples t-test we found out that there is no statistical-ly significant difference between 2 groups. Conclusion: Through fungus culture and anti-fungal treatment of all burning mouth syndrome patients, we found that an-ti-fungal agent is also feasible in fungal infection nega-tive patients. There was somewhat difference between 2 groups, but statistically there are no significant 2 groups. So we assume that anti-fungal agent can be tried in pa-tients with BMS, but further evaluation with prospective study design because of its ambiguity of assessment of treatment success rate.

» HNTPP-23 16:18~16:22

» vALIDITY OF ENDOSCOPIC RESECTION AND POSTOPERATIvE RADIATION THERAPY FOR TREATMENT OF SINONASAL MALIgNANT MELANOMA

simple frenotomy showed statistically significant results. Similarly, changes in Tongue-tie grade and articulation test (Consonants) in 4-flap Z-frenuloplasty patients were statistically significant. However, the difference in out-come according to the type of surgical procedure was not significant. Conclusion: Both of the surgical methods (simple frenotomy and 4-flap Z-frenuloplasty) for correc-tion of ankyloglossia resulted in significant improvement in tongue length and consonant accuracy 3 months after surgery. However, there was no significant difference in surgical outcome between two groups.

» HNTPP-21 16:10~16:14

» THE EFFECT OF ADENOTONSILLECTOMY ON KOREAN CHILDREN’S vOICE

DEPARTMENT OF OTOLARYNGOLOGY, BUSAN

SAINT MARYS HOSPITAL1, DEPARTMENT OF

LANGUAGE AND INFORMATION, COLLEGE OF

HUMANITIES, PUSAN NATIONAL UNIVERSITY2

SOO-KWEON KOO1, TAE-KYUNG KOH1, SOON-BOK KWON2, GEUN-HYUNG PARK1,

SANG-HOON LEE1, HO-BYUNG LEE1

Objectives: Adenotonsillectomy is commonly performed surgical procedure by otolaryngologist in pediatric age. There is anatomical change of vocal tract after surgery and it may change children’s voice. This study is to eval-uate effect of adenotonsillectomy on Korean children’s voice. Methods: A total of 20 children who underwent adenotonsillectomy were enrolled. We recorded speech of patients before and 1 month after surgery, and ana-lyzed acoustic feature, especially formant frequency. We also conducted perceptual analysis and Pediatric Voice Handicap Index (PVHI) questionnaire to assess subjec-tive change of voice and effect of voice change on social function. Results: On acoustic analysis, vowel /i/ showed significant decrease in the F2, CD(compact-diffuse) and GA(grave-acute) feature of the voice (p=0.026, 0.022 and 0.031 respectively). Vowel /u/ showed significant decrease in the dB of the voice (p=0.025). On perceptual analysis, we found that 86.6% of patients’ voice recordings had postoperative changes. Mean preoperative PVHI score was 2.70±3.37 and this score decreased to 1.65±2.21 (p=0.011) after surgery. Conclusion: The results sug-gest that adenotosillectomy affect Korean children’s voice acoustically and perceptually.

April26(Fri)




TONSIL CANCER




SANG-YEON KIM1, HYE-LIM PARK2, KWANG-JAE CHO1, GEUN-JEON KIM1,

DONG-HYUN LEE1, MIN-SIK KIM1

Objectives: In solid tumor, standardized uptake value(-SUV) and 18F-FDG metabolic tumor volume (MTV), total lesion glycolysis (TLG) have been proposed as po-tential prognostic imaging markers for patient outcome. We hypothesized that patients who have large metabolic tumor volume of lymph node would more likely prog-ress to systemic metastasis. Methods: A retrospective review of the medical record of the patients who were diagnosed with squamous cell carcinoma( SCC) of ton-sil and underwent surgery as primary treatment at our institution from 2006 to 2016. Among those patients, we only included patients who showed lymph node me-tastasis in pre-operative evaluation. Finally 55 patients were included and we analyzed their medical records and SUV, MTV, TLG of primary tumor and lymph node by 18F-FDG PET/CT. Results: Finally 55 patients were in-cluded and 7 patients showed systemic metastasis during follow up period after all the treatment. We divided these patients into two groups by the presence of systemic me-tastasis and compared PET/CT data including SUVmax, SUVpeak, MTV, TLG of primary tumor site and lymph node. In primary site, No significant difference of those parameters was detected between two groups. Mean val-ue of SUVmax(8.18 vs 9.97), SUVpeak(6.45 vs 7.26) of lymph node also showed no significant difference but MTV(18.76 VS 36.07), TLG(89.94 vs 183.46) showed statistical difference between two group(p-value<0.05). ROC curve for systemic metastasis showed AUC as 0.584, 0.590 for MTV, TLG and cutoff value to predict systemic metastasis was calculated as 7.35 for MTV with sensitivity 71.4%, specificity 43.5% and 39.37 for TLG with sensitivity 71.4%, specificity 52.2%. Conclusion: In lymph node metastasis patients, large volume of met-abolic activity has significant correlation with systemic metastasis and in those patients, systemic chemotherapy should be considered to prevent metastatic event. From the result of this study, we could suggest the reference for systemic adjuvant therapy using 18F-FDG PET/CT.

DEP. OF OTOLARYNGOLOGY- HEAD AND NECK

SURGERY, HOKKAIDO UNIV.

GRADUATE SCHOOL OF MEDICINE

NAYUTA TSUSHIMA, SATOSHI KANO, TAKATSUGU MIZUMACHI, TAKAYOSHI SUZUKI,

AKIHIRO HOMMA

Objectives: Sinonasal malignant melanoma (SNMM) is a highly aggressive tumor. While surgical resection and postoperative radiotherapy is the standard treatment pro-tocol, the operative method and indications for postop-erative radiation therapy have not been established. Our standard treatment strategy comprises endoscopic resec-tion and postoperative radiotherapy. We performed com-bined endoscopic and open resection or open resection alone when sufficient resection was difficult to achieve endoscopically. Hence, all patients who underwent sur-gery were subjected to postoperative radiotherapy.The objective of this study was to evaluate the validity of our treatment strategy. Methods: We assessed patients with SNMM, who underwent primary surgery in our insti-tution between 2003 and 2017 and conducted a retro-spective analysis. Twenty patients were enrolled. Three patients whose treatment course was unclear and one patient who underwent palliative therapy were exclud-ed. The validity of our treatment strategy was judged by the local control rate. Local recurrence was considered positive when confirmed by histological analysis. The overall and distant metastasis-free survival rates were also assessed. Results: Median follow-up period was 868 days. Nine patients underwent endoscopic resection, one patient underwent a combination approach of endosco-py and open resection, and six patients underwent open resection alone. All patients underwent postoperative radiotherapy. The two-year local recurrence control rate was 83%. The two-year overall and distant metastasis-free survival rates were 72% and 38%, respectively. Eight pa-tients died during the observation period and 7/8 (88%) patients died due to distant metastasis. Conclusion: We think that our treatment strategy is valid because the local control rate was high at the end of the treatment. The main cause of death in the study patients was distant me-tastasis, and its control was difficult.

» HNTPP-24 16:22~16:26

» PREDICTIvE vALUE OF 18F-FDg META-BOLIC TUMOR vOLUME AND TOTAL LESION gLYCOLYSIS FOR SYSTEMIC METASTASIS IN


April26(Fri)



» HNTPP-26 16:30~16:34

» DIAgNOSTIC vALUE OF SUv IN 18F-FDg PET/CT FOR PAPILLARY THYROID CANCER


NECK SURGERY, DONG-A UNIVERSITY

COLLEGE OF MEDICINE, BUSAN, KOREA

HYUN GI GIM, HEON SOO PARK, DONG KUN LEE

Objectives: F18PET/CT has been used to detect local or distant metastasis and recurrence of PTC. The preop-erative 1F8-FDG PET/CT scan for prognosis was not proven useful. We conducted a study to determine the association between F18-FDG PET/CT scans and fac-tors affecting the prognosis of PTC. Methods: From July 2010 to December 2015, Eighty-eight patients with in-creased local uptake of 18F-FDG in the thyroid gland were included. The degree of 18F-FDG ingestion was evaluated by the SUVmax. Patients were followed up for histopathological examination of the tumor, lymph node metastasis, B-RAF gene mutation, and recurrence. Results: Of the 88 patients with increased local focal 18F-FDG uptake, 68 were women and 20 were men, with an average age of 53.3 years.There was no statistical correlation between recurrence of thyroid cancer and the SUVmax (p = 0.513). There was no statistically signifi-cant difference between the lymph node metastasis and the SUVmax (p = 0.73). The mean SUVmax coefficient of patients with invasion of the thyroid capsule was 7.18, which was higher than the mean SUVmax of patients without invasion (5.34), but not statistically significant (p = 0.100). The mean SUVmax of patients with positive B-RAF was 7.70, which was higher than that of patients with B-RAF negative (wild type) 3.90, and statistical correlation between the two groups was significant (p = 0.024). There was a statistically significant correlation (p = 0.001) between the changes of the SUVmax according to the size of the mass. Conclusion: The size of the mass and the presence of B-RAF mutation in PTC are major factors affecting prognosis. There was a statistically signif-icant correlation between the SUVmax, the size of the tumor, and the B-RAF mutation. There is a possibility that there is a correlation between the SUVmax before surgery and the prognosis of PTC. In the future, further studies using 18F-FDG PET / CT will be needed for a larger number of patients.

» HNTPP-25 16:26~16:30

» DEPRESSIvE DISORDER IN THYROID CAN-CER PATIENTS AFTER THYROIDECTOMY, A LONgITUDINAL FOLLOW-UP STUDY USINg NATIONAL COHORT


AND NECK SURGERY, HALLYM UNIVERSITY



HANYANG UNIVERSITY COLLEGE OF MEDICINE2

HYO GEUN CHOI1, YONG BAE JI2, KYUNG TAE2, CHANG MYEON SONG2

Objectives: The present study compared the frequency of depressive disorder in patients with thyroid cancer who had undergone thyroidectomy with the frequency in con-trol individuals. Methods: We performed a retrospective population-based cohort study using the data from the Korean Health Insurance Review and Assessment Service - National Sample Cohort. A total of 3,609 participants with thyroid cancer who had undergone thyroidectomy between 2003 and 2011 were enrolled in this study and matched 1:4 with 14,436 control participants by age, gender, income, and region of residence. The cumulative incidence of postoperative depressive disorder was evalu-ated over a period of ten years after the thyroidectomies, and compared with the incidence in controls. Depressive disorder was diagnosed by a psychiatrist. Results: The in-cidence of depressive disorder was significantly higher in the thyroid cancer with thyroidectomy group than in the controls up to postoperative year 1. A subgroup analysis showed the same higher incidence of depressive disorder in thyroid cancer group than controls for up to 1 year af-ter operations in young adult (≤44 years old), female, ur-ban, and low-income groups. However, the incidence was elevated only in the year of the thyroidectomies them-selves in middle-aged and older, rural, and high-income groups. Conclusion: Patients with thyroid cancer who undergo thyroidectomy suffer from depressive disorder more frequently than normal controls. However, the fre-quency of depressive disorder after thyroidectomy recov-ers in a shorter period in middle-aged or older, high-in-come, and rural dwelling patients, compared to younger, low-income, and urban dwelling patients.

April26(Fri)




» HNTPP-28 16:38~16:42

» PROPER BENDINg ANgLE AND FLANgE TO ANgLE LENgTH OF THE TRACHEOSTOMY TUBE IN THAI POPULATION

DEP.OF OTOLAYNGOLOGY,FACULTY OF

MEDICINE,CHULALONGKORN UNIV.

KES SRISAWANGWONG, NAPADON TANGJATURONRASME,

WORAWAT RAWANGBAN, NETSIRI DUMRONGPISUTIKUL

Objectives: There are many complications that can be se-vere and life threatening such as bleeding from trachea-in-nominate fistula or accidental tracheostomy tube dislodge.The possible etiology arises from improper tube bending angle or improper flange to angle length of the tube.There is very limited study about the characteristic of Asian air-way anatomy in literatures. This study was measuring the bending angle and the flange to angle length to understand the normal anatomical value,specifically in the Asian pop-ulation. Methods: The study was a descriptive study,assess-ing the bending angle, and the flange to angle length,mea-suring by image from the computer tomography. It was conducted in adults of 18 years of age and over,at the King Chulalongkorn Memorial Hospital in Bangkok, Thailand. Totally 340 cases(208male and 132 female)were included and all those revealed clear views of the larynx and trachea by midline sagittal view,taken between January 2555, and July 2561.The bending angle and the flange to angle length were measured by the CT scans of those who matched the inclusion criteria.Measuring was done with the angle mea-suring tool in the Synapse software(FUJIFILM Medical Systems U.S.A.). Results: Among total of 340 CT scans,-median age was 55 years old (interquartile range 45.5-64 years old).The median bending angle in male was 102 de-grees(interquartile range 96-106 years old) and in female was 102 degrees(interquartile range 94.25-107years old). The median bending angle was 102 degrees(interquartile range 95-107 years old).The median flange to angle length was 21 millimeters (interquartile range 18.45-23.85),and it was statistical significantly related bending angle (p-val-ue <0.001)and gender did not appear to statistically affect the curvature(p value = 0.952). Conclusion: The bending angle was statistical significantly related the flange to angle length.Other factors of gender and age, did not appear to statistically affect the curvature.

» HNTPP-27 16:34~16:38

» vOICE CHANgE AFTER THYROIDECTOMY AN ExPERIENCE WITH 2830 CASES OF THY-ROIDECTOMY




SANG-YEON KIM1*, JA-SUNG BAE2, SO-HEE LEE2, GEUN-JEON KIM1,

DONG-HYUN LEE1, YEON-SHIN HWANG1, MI-RAN SHIM1, DONG-IL SUN1

Objectives: Voice problems after thyroid surgery are well- known complications. However, very few data in the literatures are available which highlights the impact of thyroidectomy and effects of various factors, such as patient age, sex, operation type, operation time, loca-tion of tumor, type of neck dissection on voice of pa-tients undergoing thyroid surgery. We precisely reviewed each factors which could affect post-operative voice after thyroidectomy with large scale of patients by this study. Methods: A retrospective review of the medical record of the patients who were underwent thyroidectomy at our institution from 2014 to 2017. All the surgerys were con-ducted by two experienced surgeons and all the patients had pre- and post-operative voice analysis including stro-boscopic examination. Age, sex, type of surgery, opera-tion time, location of tumor, type of neck dissection and other parameters were investigated pre- and post-opera-tively by chart review. Results: Finally 2830 patients were included. Pitch lowering was investigated by SFF(speak-ing fundamental frequency) and mean value of pre-oper-ative SFF was revealed as 170.85+37.39 and mean value of post-operative 1month SFF was 168.35+40.19. Fol-low up data of SFF at post-operative 2 months showed 170.50+35.26. In total thyroidectomy group, post-op-erative SFF lowering more than 10Hz was more fre-quently observed in lobectomy group at post-operative 1 month(23.61% vs 10.32, p-vaule=0.09) but there was no significant statistical difference between two groups. Type of neck dissection also did not showed statistical impact on post-operative 1mont SFF lowering. Conclusion: In this study we found out the characteristics of post-opera-tive voice after thyroidectomy by large scale patients and we figure out the impact of each parameters on the vocal outcomes after thyroidectomy.




Program at a GlanceApril 27(Sat)



7:00

7:30

8:00

OT-gD 1(Implantable Hearing

Devices)

RHOP 6(Plastic Surgery and

Facial Trauma)HnOP 3(Thyroid)

8:30

Hn-SP 6 (Laryngology update and

Opinion for Future Directions)

9:00

RH-MTP 1(My experiences in

allergen-specific Immunotherapy (aIT))

OT-SP 3(Basic Research in Hearing

loss)

RH-SP 4(extended Surgical

approach for Skullbase Tumors)

9:30Hn-KL4

(evolution of Transoral Robotic Surgery(TORS) to the game-

Changer; Introducing the Single Port Robotic Surgical System)

10:00 Hn-KL5

(Precision Head and neck Surgery: next-generation

Robotic Surgery and Beyond)

10:30 Coffee Break

OT-KL 3(Current hearing health

status of Korea)

RH-KL 3(endoscopic Management of Frontal Sinus Fractures

and CSF Leaks)

Hn-KL 6(Treatment strategy of

papillary thyroid carcinoma)

ORLSP-audiologist

Korean

ORLSP-nurse 1

Korean

ORLSP-SLP(Special Lecture)11:00

OT-SP4(Tinnitus)

RH-MOS 2(How I Do It: Palatal Surgery

for OSa Patients)

Hn-RT 1(Balancing between the

Oncologic and Functional Outcomes in Oropharyngeal

Cancer)

ORLSP-SLP(State of the art

Management for the Dysphonia Patients with normal Laryngoscopy)

Korean

11:30

12:00

12:30

Luncheon Symposium(Oticon Korea)

Luncheon Symposium(BuKWang Pharm.)

Luncheon Symposium(BORyung PHaRM.) general assembly

13:00

13:30

OT-SP 5(genetic Hearing Loss)

RH-SP 5(essentials of asian Facial Plastics: Comparison with

Caucasians)

Hn-gD 1(State of the art

Management for Papillary Thyroid Carcinoma)

OT-MTP 2(Chronic Otitis Media

Surgery)

RH-MTP 2(Tips and Pitfalls for Frontal

Sinus Surgery)

Hn-SP 7(new Horizons in Medicine in the era of 4th Industrial

Revolution)

14:00

14:30

15:00Coffee Break

15:30 OT-KL 4(evidence based treatment of vestibular schwannoma)

RH-KL 4(Holistic approach to the

OSa patients: Precision or Perspectives)

Hn-KL 7(Transnasal endoscopic

Surgery for naso-ethmoidal Cancers: Reflections on a

20-year experience)OTOP 10

(Vestibular Disorder)

HnOP 7(Other Head & neck

Disease)16:00

RHOP 10(allergy (Basic))

16:30

Hn-SP 8(aPTS

Symposium)OTOP 12(Inner ear Disease)

17:00

17:30

18:00Congress Banquet (18:00~)






7:00Poster exhibition

7:30

8:00

OTOP 7(Middle ear(Basic))

RHOP 7(Others)

HnOP 4(Basic)

IC 5(Ossicle Status Based Staging For Congenital

Cholesteatoma)

Poster exhibition

8:30

IC 6(Preoperative CI Diagnostics With

Transtympanic ecog (and eeabr?)

9:00

OTOP 8(Vestibular Disorder)

RHOP 8(Sleep Related Breathing

Disorders II)

HnOP 5(Laryngohypopharyngeal

Cancer)

9:30조교수 이하 젊은 스텝을

위한 학회사업 오리엔테이션

Korean

IC 7(Lateral Temporal

Bone Resection in eac Malignancy Surgical Landmark and Tips)

10:00

10:30

문항개발워크샵

Korean

IC 8(How to use Costal

Cartilage in Rhinoplasty)

Poster exhibition

11:00

OTOP 9(Otitis Media

&Cholesteatoma)

RHOP 9(Rhinosinusitis (Basic))

HnOP 6(Thyroid)

11:30 IC 9(Computerized Database for Chronic Otitis Media

Surgery)12:00

IC 10(Office Laryngology Injections, angiolytic

Lasers and More)12:30

13:00

13:30

ORLOP-audiologist

KoreanORLSP-nurse 2

Korean

ORLOP-SLP

Korean Hn-MTP 2(My Journey in the

Management of Recurrent HnC)

간행워크샵

Korean

IC 11(assessment of Vocal

Fold Vibration)14:00

IC 12(Surgical anatomy of Cavernous Sinus In

endoscopic endonasal Skull Base Surgery)

14:30

15:00Korean-Kresge allumni Coffee Break

15:30

OTOP 11(Others Clinical)

Hn-MTP 3(Transoral endoscopic

Thyroidectomy) 2019 ICORL Head and neck ultrasound

International Joint Symposium

IC 13(Rhinoplasty and Facial

Plastic Surgery in Private Practice)16:00

RHOP 11(Olfaction)

16:30Korean Tinnitus Study

group Meeting

Korean

IC 14(Video Head Impulse

Test Findings from normal Subjects and

Patients with Vestibular Disorders and Clinical

Implications)17:00IC 15

(alternative Palatal Surgeries In Obstructive Sleep apnea: Patients Selection, Therapeutic Options and Surgical

Techniques)

17:30

18:00

April27(Sat)




OT-GD 1Room 4-1 (Convention A)Chair : LEVENT OLGUN,

Moderator : SUNG HWA HONG

Implantable Hearing Devices

» 08:00-08:20

» MANAgEMENT OF FAR ADvANCED OTO-SCLEROSIS : STAPES SURgERY



BUNDANG HOSPITAL

JA-WON KOO

Otosclerosis is a progressive bone remodeling disease that affects the otic capsule resulting in progressive mixed hearing loss. Although the result of stapes surgery to close air-bone gap (ABG) is usually excellent, hearing rehabilitation may not be sufficient only by stapes sur-gery in advanced otosclerosis. Treatment Options in ad-vanced otosclerosis: 1) Hearing aids, 2) Stapes surgery, 3) Implantable hearing devices, 4) Cochlear implantation (CI). The role of stapes surgery and other options were re-viewed for hearing rehabilitation in 15 ears operated due to otosclerosis with advanced hearing loss. The post-op-erative air conduction thresholds improved within 55 dB in 9 ears and 56 dB to 70 dB in 4 patients after stapes surgery in study group. 4 patients further benefited from hearing aids. Hearing aids alone could not result in opti-mal hearing rehabilitation in severe and profound hear-ing loss. Patients who underwent cochlear implantation also demonstrated a good audiological outcome. Effec-tive hearing outcome can be achieved in stapes surgery alone or in combination with appropriately fit hearing aids. Stapes surgery is a suitable treatment option for pa-tients with advanced otosclerosis, and should be consid-ered mandatory, before offering cochlear implantation, for those with a demonstrable conductive component to their hearing loss. A small group of patients get little benefit from surgery and subsequently a cochlear implant should be considered.

» 08:00-08:20

» MANAgEMENT OF FAR ADvANCED OTO-SCLEROSIS: COCHLEAR IMPLANTATION

UNIVERSITY OF CALGARY, CANADA

EUNA HWANG

TBD

» 08:20-08:40

» MIxED HEARINg LOSS : ACTIvE MIDDLE EAR IMPLANT

BAKENT UNIV.ZUBEYDE

HANM RESEARCH CENTET

LEVENT OLGUN

Active middle ear implants can be an excellent choice in selected cases of mixed hearing loss.Enhanced stimula-tion of ossicles or inner ear fluids may overcome hard of hearing and even improve speech discrimination scores.In this presentation indications as well current applica-tion techniques of active middle ear implants with short video clips and results will be discussed.

» 08:20-08:40

» MIxED HEARINg LOSS : BONE CONDUC-TION IMPLANTABLE HEARINg AIDS

UNIV. OF CALGARY, DEP. OF SURGERY,

SECTION OF OTOLARYNGOLOGY

EUNA HWANG

This session will present the indications and roles of bone conduction implants (BCIs) and the Vibrant Sound-bridge (VSB) active middle ear implant in mixed hearing loss (MHL). Both surgical devices have proven successful in the management of MHL. We will discuss the benefits and limitations of each type of device, and their differenc-es in surgical and audiological outcomes in the context of MHL. Specifically for BCIs, obvious advantages are the general ease of surgical techniques of the various BCIs, both passive and active, that are now available, the low

April 27(Sat) Otology

April27(Sat)






JAE-JIN SONG, BYUNG YOON CHOI, JA-WON KOO

Management of progressive hearing loss in subjects with neurofibromatosis type 2 (NF2) is always challenging, because the cochlear nerve is incorporated within vestib-ular schwannoma (VS) in most cases. Therefore, neither auditory brainstem implant nor cochlear implantation (CI) can guarantee successful auditory rehabilitation in patients with NF2. However, in selected subjects with NF2, CI may be of help and even lead to open set speech discrimination in the presence of a stable VS after con-trolling the tumor growth by Gamma knife surgery. In this talk, a thorough review of previous literature on CI in subjects with NF2 as well as the experience of my cen-ter will be adressed.

» 09:00-09:20

» SINgLE SIDED DEAFNESS: COCHLEAR IM-PLANTATION

SINGAPORE GENERAL HOSPITAL., SINGAPORE

BARRIE TAN YAU BOON

TBD

» 09:00-09:20

» SINgLE SIDED DEAFNESS: BONE CONDUC-TION HEARINg AIDS


COLLEGE OF MEDICINE

YOUNG JOON SEO

Cochlear implantation and Bone-anchored hearing aids (BAHAs) have been known to partially restore some of the functions lost in subjects with single-sided deafness (SSD). Our aims in this systemic review were to ana-lyze the present capabilities of BAHAs in the context of SSD, and to evaluate the efficacy of BAHAs in improving speech recognition in noisy conditions, sound localiza-

rate of surgical failure, and the audiological gain. Some limitations of BCIs would be potential wound problems precluding a successful use of the BCI and reduced audi-ological gain vs. the VSB as the BCI bypasses the actual defective middle ear system. Both the BCIs and the VSB can be used to manage MHL more effectively than con-ventional air conduction hearing aids. This debate will help the clinician understand their respective differences in order to choose the proper type of device for a patient and a surgeon's practice.

» 08:40-09:00

» POSTLINgUAL HEARINg LOSS (NF2) : AUDI-TORY BRAINSTEM IMPLANT


IN SEOK MOON

Most patients with neurofibromatosis type II (NF-II) will ev-entually encounter bilateral deafness, creating an ob-stacle to social life. In patients with NF-II, sound ampli-fication with he-aring aids does not provide an effective solution, as speech discrimination scores (SDSs) usually remain low in the presence of retrocochlear lesions. Cer-tain NF-II patients with mild to moderate hearing loss might benefit slightly from the use of hearing aids; how-ever, in most cases, their hearing loss is progressive and often inevitably exceeds a level that can be rehabilitated by hearing aids. In the past, no effective methods for re-habilitating patients with severe to profound hearing loss existed; consequently, lip-reading and sign language have been the only means of communication. In 1979, House and Hitselberger successfully performed a single-channel auditory brainstem implant (ABI) for the hearing reha-bilitation of a patient with NF-II. Subsequently, the prin-ciples and concepts of treatment for patients with severe to profound hearing loss have changed. Advancements in electronic and medical devices have provided satisfacto-ry treatment results in patients with severe to profound hearing loss. Otologists should be fully aware of the di-verse indications and potential benefits of every possible hearing rehabilitation method in order to provide active support for patients with NF-II.

» 08:40-09:00

» POSTLINgUAL HEARINg LOSS (NF2) : CO-CHLEAR IMPLANTATION

April27(Sat)




these Na transporters in the ES with a low sodium diet and high sodium diet animal model, and to investigate estimated sodium intake, plasma aldosterone concen-tration, and other hormone concentration in Meniere’s disease patients. mRNA expressions of Na, K-ATPase and Na transporter were higher in low salt diet animals’ ES. In the clinical study, patients with a mean sodium intake amount lower than 3 g/day comprised complete control (Class A, 100%), significantly better hearing im-provements, and plasma aldosterone concentrations sig-nificantly increased during the 2-year low-salt diet and tended to be higher than other patients. A low-salt diet may induce an increase in the plasma aldosterone con-centration that can activate ion transport and absorbing endolymph in the ES.

» 09:20~09:40

» EFFECT OF SUPRAgRAvITY STIMULATION ON vESTIBULAR END ORgANS


GACHON UNIVERSITY

GYU CHEOL HAN

Introduction: The fact that benign paroxysmal position-al vertigo is caused by otolithic organ and it is an unde-niable fact. Otolithic organ is developed during embry-onic stage and has lifetime maintenance. However, there have been insufficient further studies on how the stable otoconia is liberated and causing BPPV. Therefore, using hypergravity to arouse the modification of otoconia on small experiment animals has been considered. However, due to the technical confines the maximum achievable hypergravity was 2.5G. Thus, we set priority on research-ing the hypergravity (>2.5G) influence on semicircular canal. Method: We observed the ICR mouse (n=10, aged 8-10 weeks, weighing 18-25 g, Narabio tec.) on 4G condition for 2 weeks by remote observation meth-od. The evaluation of vestibular function was measured by OVAR on 0.04, 0.08, 0.16, 0.32Hz cycle on 100% peak velocity. Furthermore, we tilt the axis for 30° and rotated over 10 cycles to cause step velocity stimulation. From the achieved nystagmus data we made 3D analy-sis. Result: The stimulated mice (under 4G for 2 weeks) have gained horizontal nystagmus data was 0.211±0.125, 0.572±0.097, 0.649±0.083, 0.718±0.087 under 0.04 - 0.08 - 0.16 – 0.32Hz conditions respectively. Those of vertical nystagmus was 0.958±0.455, 0.849±0.403,

tion, and subjective outcomes. We performed 'A Prospec-tive cohort study for Surgical, functional, and audiolog-ical Benefits of cochlear BAHA attract implantations'. BAHAs improve the quality of life for patients with SSD. We has presented additional evidence of effective audito-ry rehabilitation for SSD and will be helpful to clinicians counseling patients about treatment options for SSD.

OT-SP 3Room 3-1 (Emerald A)

Chair : KYU-SUNG KIM, GYU-CHEOL HAN

Basic Research in Vestibular Science

» 09:00~09:20

» ION HOMEOSTASIS IN ENDOLYMPHATIC SAC AND MENIERES DISEASE

DEPARTMENT OF OTOLARYNGOLOGY, FACULTY

OF MEDICINE, KAGAWA UNIVERSITY

TAKENORI MIYASHITA

The endolymphatic sac (ES) is a part of the membranous labyrinth, and the obliteration of the ES of experimental animals induces endolymphatic hydrops which is known to be the typical pathological finding of Meniere’s disease. Therefore, the ES is believed to absorb the endolymph and to maintain balance in specific ionic components (high Na and low K) to regulate the volume and hy-drostatic pressure of the endolymph. Recently, the pres-ence of various ion transporters was reported in the ES. Notably, the intermediate portion of the ES has many ion transporters. It is well-known that Na transport and water transport are coupled. Focused on the Na trans-port in the ES, we reported that mitochondria-rich cells in the ES intermediate portion have a higher activity of Na, K-ATPase and a higher Na permeability than oth-er types of cells, and Na, K-ATPase produces enough power of ion transport by simulation. Ion transporters related to Na transport in the ES, such as the epithelial Na channel and thiazide-sensitive Na–Cl cotransporter may be upregulated by aldosterone as other organs. Aldo-sterone concentration increases with a low sodium diet. Therefore, we tried to investigate mRNA expression of


April27(Sat)



» 10:00~10:20

» THE ROLE OF ASTROCYTE - NEURON LAC-TATE SHUTTLE IN vESTIBULAR NUCLEAR AC-TIvITY AND vESTIBULAR FUNCTION

INSTITUTE OF BRAIN SCIENCE & DEPARTMENT OF

PHYSIOLOGY, WONKWANG UNIVERSITY SCHOOL

OF MEDICINE, IKSAN, KOREA

MIN SUN KIM

The maintenance of high energy metabolism in the ves-tibular nuclei (VN) is critical for rapid, precision pro-cessing of peripheral vestibular information. The distur-bance of glucose or lactate metabolism induces severe histopathological changes in the VN and vestibular dys-functions. In astrocyte - neuron lactate shuttle (ANLS) hypothesis, the lactate formed by astrocytes is another major energy source for ATP production in neurons. There is a little information about the role of ANLS in vestibular nuclear activity or in vestibular functions. The purpose of this study is to elucidate effects of the blocking of ANLS by alpha- cyano- 4-hydroxycinnamate (4CIN), a monocarboxylate transporter inhibitor on the vestibular nuclear activity and vestibular functions. In vitro study, the treatment of 4CIN decrease the amplitude of evoked local field potentials with a dose-dependent manner in the medial VN of brain stem slices. In vivo study, a direct injection of 4CIN in the medial VN resulted in the long-term suppression (> 20 min) of spontaneous firing activ-ities of both type I and type II neurons that was identi-fied by horizontal rotation. Type I neurons showed more sensitive changes in their firing activity to the 4CIN than type II neurons. The cFos protein, an excitatory meta-bolic maker was highly expressed in the bilateral medical and inferior VN following the 4th ventricle injection of 4CIN. When the 4CIN was injected into the unilater-al medial VN, the spontaneous nystagmus was appeared with a slow eye movement component toward to ipsilat-eral to the injection site. Collectively, these results sug-gest that energy supply through ANLS contribute to the maintenance of neural activity in the VN as well as of vestibular functions. Key word: aastrocyte - neuron lac-tate shuttle, alpha-cyano-4- hydroxycinnamate (4CIN), vestibular nucleus, neuronal activity, spontaneous nys-tagmus. Acknowledgement: This research was supported by Basic Science Research Program through the Nation-al Research Foundation of Korea (NRF) funded by the Ministry of Education (2017R1D1A1B03032034).

0.800±0.257, 0.831±0.198. The per-rotatory Tc of OVAR data was 5.7±2.238s which is reduced compare with the achievable data from healthy normal mice (p<0.001). Conclusion: By observing above data we can induce the result that the 4G hypergravity stimulation cause the modification not only on the otolithic organ but also on the function of semicircular canals.

» 09:40~10:00

» THE ROLE OF vASOPRESSIN-AQUAPORIN2 SYSTEM IN THE ANIMAL MODEL OF ENDO-LYMPHATIC HYDROPS


CATHOLIC KWANDONG UNIVERSITY


MINBUM KIM

Endolymphatic hydrops(EH) is known to be associat-ed with Meniere’s disease(MD). However, the lack of a widely accepted animal model still results in the uncer-tainty of the patho-mechanism of MD. Specifically, the pathophysiology of its early stage and acute attack is still controversial. Vasopressin(VP) has been known as one of the important stress-hormones related with the water shift in the inner ear. VP increases the amount of mem-branous Aquaporin-2(AQP2) by fast cellular trafficking process, and finally induces the water influx into the en-dolymphatic space. Previous studies showed that both continuous VP infusion and the ablation of endolym-phatic sac(ES) plus VP injection can induce EH in guin-ea pigs. We have investigated the role of VP-AQP system in EH, using dynamic guinea pig models as well as mouse models. The vestibular function transiently changed after systemic VP plus ES ablation in the guinea pigs model, which represented the acute attack of EH. In addition, intratympanic injection of VP(IT-VP) induced the sim-ilar vestibular dysfunction in normal guinea pigs, tem-porarily. Subsequently using normal mouse, we applied IT-VP and investigated the vestibular dysfunction as well as the response of VP-AQP2 system in the basal mem-brane of the inner ear stria vascularis. The results of our studies imply that VP-AQP2 system can affect the inner ear water shift, especially in the early stage and the acute attack of MD. These might be helpful to understand not only the patho-mechanism of the development of EH, but also the relationship between aggravation of MD and the dehydration as well as stress.

April27(Sat)





Chair : TIEN-CHEN LIU, EUI-CHEOL NAM

Tinnitus

» 11:10~11:30

» T O W A R D A T I N N I T U S I M P L A N T v I A LIgHT-DRIvEN PROMONTORY ELECTRICAL STIMULATION A PRELIMINARY REPORT

DEPT. OF OTOLARYNGOLOGY,


TIEN-CHEN LIU

Multiple electrical stimulations to the round window or promontory wall have been used to treatment chronic tinnitus for many years. To develop a possible tinnitus implant through this mechanism, we designed a mini-mally-invasive implant utilizing light-driven electrical stimulation on the promontory wall. Before that, the safety of long-term electrical stimulation to the ear was investigated in an animal model. Guinea pigs were used and a metallic electrode was inserted directly on to the round window. Direct electrical stimulation (1 mA, 1000 pps) was applied daily for 30 minutes a days for a peri-od of 30 days in total. After final stimulation, ABR was performed for threshold comparison and the ears were removed for histological examination. The averaged ABR threshold before, 1 week after and 1 months after elec-trode insertion was not significantly different from each other. No other side effects during stimulation was ob-served. The inner ear structures also looks intact. After confirming the safety of such stimulation, a prototype of the implant was designed and manufactured that can be inserted onto the promontory wall via endoscopic sur-gery and fixed on the ear drum by way of a ventilation tube. The device is currently under approval review by the government.

» 11:30~11:50

» COCHLEAR MIgRAINE AND TINNITUS

ENT DEPARTMENT KUNG-TIEN GENERAL

OT-KL 3Room 4-1 (Convention A)Chair : SEUNG HA OH

Keynote Lecture III

» 10:40~11:10

» CURRENT HEARINg HEALTH STATUS OF KOREA


HEAD & NECK SURGERY, KOREA UNIVERSITY


SUNGWON CHAE

Hearing loss (HL) and deafness are global issues that af-fect at least 278 million people worldwide. Two-thirds of the people who have HL worldwide live in develop-ing countries. Importantly, it is estimated that 50% of this HL can be prevented. Knowing about the hearing health status for prevention, early detection, and rehabil-itative programs are very important for the improvement of hearing health. Delays in diagnosis are common, and social attitudes, local customs, and cultural bias are con-tributing factors. The purpose of this review is to gain an understanding of the prevalence of HL in Korea and to focus attention on the growing need for both preven-tion and effective treatment programs. The results about national wide newborn hearing screening, the prevalence rate of otitis media, hearing loss of adolescence, noise-in-duced hearing loss and age-related hearing loss will be presented. Through these results, the affordable coun-terplan about hearing loss can be drawn out from the knowledge about the current hearing health.


April27(Sat)



perception of tinnitus signal itself, so called 'habituation of perception'. We recently performed a clinical study evaluating the effect of sound generator on tinnitus and hyperacusis among 120 patients with tinnitus and hyper-acusis. The study subjects were divided into two groups by tinnitus category; 78 patients of severe tinnitus (cate-gory 1) and 42 patients of hyperacusis (category 3). And their medical records including questionnaires regarding tinnitus severity were retrospectively reviewed to evaluate the therapeutic effect of SGs on tinnitus and hyperacu-sis. Category 3 patients included more female patients, were younger than category 1 patients (p=.001), and were prescribed SG earlier due to their severe symptom of hyperacusis. (p=.004) All patients showed significant improvements on all categories of tinnitus visual ana-logue scale (VAS)scores and tinnitus handicap inventory (THI) scores after six months use of SG (p<.05). Loud-ness discomfort levels measured by pure tone audiome-try were significantly improved in category 3 group after six months use of SGs. We could conclude that SG with directive counseling seemed to be an effective treatment modality for all tinnitus patients, especially those with comorbid hyperacusis. Not only with the study results above but also with our 20-year clinical experiences at a specialized tinnitus clinic, we would propose that sound therapy with SGs need to be strongly recommended to the patients with severe tinnitus and hyperacusis. Indica-tions and successful results of SGs will be introduced and the interesting cases of tinnitus and hyperacusis managed by SGs or hearing aids with SGs will be presented during the talk.

» 12:10~12:30

» EPIDEMIOLOgY, ETIOLOgIES, AND TREAT-MENT OPTIONS FOR PEDIATRIC TINNITUS

UNIVERSITY OF TEXAS SOUTHWESTERN

MEDICAL CENTER AT DALLAS

KENNETH H LEE

Tinnitus in the pediatric population has historically been considered an uncommon condition and more of a clinical problem for the adult population. Recently, it has been identified that tinnitus in children and adoles-cents is largely unreported and most published studies include small numbers of patients. Due to the lack of large studies and thus knowledge in this area, tinnitus in the pediatric population is not a focus of practice of

HOSPITAL ,TAIWAN

JEN TSUNG LAI

Migraine plays an important role in clinical tinnitus management. ' Inner ear migraine' a migraine variant , is often encounter in our neurological practice. Inner mi-graine presented as well known vestibular migraine (VM) and new proposed diagnosis cochlear migraine (CM). CM often confused in the clinical practice as acute low tone hearing loss (ALHL), sudden hearing loss and co-chlear Meniere’s disease(MD). Migraine might damage the hearing and balance . The neuroflammation resulted from migraine is a possible cause of hearing loss and tin-nitus. In large-scale cohort study, we found that patients with a history of migraine had a tendency to develop co-chlear disorder and tinnitus. People with migraine had al-most three times increased risk of cochlear disorder espe-cially tinnitus , compared with people without migraine. In our clinical observation, there is a group of patients had symptoms overlapping between VM and CM. We call them vestibular- cochlear migraine( VCM) or co-chlear-vestibular migraine (CVM), depend on vestibular or cochlear symptoms develop first. In fact, VCM and CVM often misdiagnosed as MD before. Estimation of CVM and VCM are 5~10 times more than MD patients in epidemiology

» 11:50~12:10

» EFFECT OF SOUND gENERATOR ON TINNI-TUS & HYPERACUSIS




SHI NAE PARK

Sound generator (SG) plays an important role as effective sound therapy during tinnitus retaining therapy(TRT) for the patients with severe tinnitus or hyperacusis. Since hyperactivity of the auditory central nervous system caused by the decreased auditory input in some frequen-cies of hearing has been a well-known mechanism of tin-nitus or hyperacusis, sound therapy with SG as a com-ponent of TRT has been known to decrease the contrast between tinnitus and background signals, which strives to eliminate transference of stimulus to a reaction, also known as the ‘habituation of reactions’and finally control

April27(Sat)




hearing loss. Virus-mediated transfer of genes encoding the Msrb3 and Slc26a4 into the inner ear restored hear-ing in animal models of human genetic hearing loss We used adeno-associated virus serotype 1 (AAV1) to express therapeutic gene in mice and. To evaluate the safety and efficiency of virus, we transferred an AAV1-GFP into the otocyst at embryonic day 12.5. After the gene transfer, a strong expression of transgene was observed without ototoxicity within cochlea and the hearing ability was unaffected by AAV. These results were identified by sev-eral histological interpretations and auditory brainstem responses, respectively. We also examined a successful expression of an exogenous gene within hair cells in the same way. Together, these results indicate that gene thera-py by in utero is potential strategy to treat genetic hearing loss by monogenic mutations. It may apply to treat the human genetic hearing which results in autosomal reces-sive non-syndromic hearing loss.

» 13:50~14:10

» gENETIC ETIOLOgY OF MILD TO MODER-ATE SENSORINEURAL HEARINg LOSS: IS IT gENETIC?


CHUNGNAM NATIONAL UNIVERSITY

COLLEGE OF MEDICINE

BONG JIK KIM

Mild-to-moderate sensorineural hearing loss (SNHL) has been sometimes overlooked and its etiology was not thoroughly investigated. Recently, with the advance of sequencing techniques and biomedical informatics, as-sociation of genetic etiology and such hearing loss has been revealed. For example, STRC gene was recently highlighted as an important causative gene for hered-itary mild-to-moderate SNHL. But, the presence of pseudogene and the CNVs still hinders the easy identi-fication of genetic etiology in this disease entity. In our study, patients with mild-to-moderate hearing loss in a sporadic or autosomal recessive inheritance pattern were recruited and specifically tailored strategy to make a mo-lecular genetic diagnosis in mild-to- moderate SNHL was designed using MLPA, Sanger sequencing, long-range PCR and whole-exome sequencing (WES) etc. Our work could provide the description of the spectrum of genet-ic etiology in mild-to-moderate SNHL and propose the strategic pipeline to identify the etiology of such SNHL.

many otolaryngologists nor has it been a topic of much interest and research. The latest epidemiological studies however reveal that tinnitus in children and adolescents is much more common than previously appreciated and may even be as prevalent as what is found in adults. This presentation will review the epidemiology and prevalence of tinnitus and discuss common etiologies in the pediat-ric population. In addition, it will evaluate risk factors and co-morbidities as well as identify associated imaging anomalies in children. Treatment options and prognosis for resolution of symptoms will also be reviewed. As with many diseases and conditions, there are differences in tin-nitus in pediatric compared to adult patient populations. These differences will be highlighted to assist in under-standing pediatric tinnitus to better counsel patients and their families.


Chair : KENNETH H. LEE, KYU-YUP LEE

Genetic Hearing Loss

» 13:30-13:50

» COCHLEAR gENE THERAPY FOR SENSORI-NEURAL HEARINg LOSS


KYUNGPOOK NATIONAL UNIVERSITY,

DAEGU, KOREA

KYU-YUP LEE

Genetic hearing loss is a heterogeneous disorder that re-sults in a common sensorineural disorder. To date, more than 150 loci and 100 genes have been reported for non-syndromic hearing loss. Gene therapy for treating genetic hearing loss has made astonishing progress with biotechnical advance, but it still remains the difficulty to treat the disorder ultimately. A diversity of viral vec-tors was used in gene therapy as vehicle for delivery of therapeutic gene. Moreover, the successful outcome of the gene therapy depends on timing and delivery route as well as titer of virus. Here, we demonstrate that gene therapy by in utero is a promising tool for treating genetic


April27(Sat)



filtrating bacteria in the scala tympani and subsequently recruits resident immune cells to eliminate the bacteria. Importantly, hearing loss in a cochlin knock-out mouse model is remedied by treatment with a cochlin LCCL peptide. These findings suggest cleaved cochlin LCCL constitutes a critical factor in innate immunity and audi-tory function and may be a potential therapeutic target to treat chronic otitis media-induced hearing loss.

OT-MTP 2Room 3-1 (Emerald A)Chair : SEE OK SHIN,

Moderator : HYEONG JONG KIM

Chronic Otitis Media Surgery

» 13:30-13:50

» TYMPANOPLASTY


SEOUL NATIONAL UNI. HOSP.

JUN HO LEE

The underlay and overlay tympanoplasty will be reviewed and demonstrated using various techniques under certain situations.

» 13:50:14:10

» MANAgEMENT OF MASTOID CAvITY IN CHRONIC OTITIS MEDIA





WON-HO CHUNG

The mastoid cavity was developed for the purpose of air reservoir in the middle ear cavity. However, it can pro-duce the problems in the pathogenesis of chronic oti-tis media, such as infection source and involvement of cholesteatoma. The purposes of mastoidectomy are 1. To eradicate the source of infection. 2. To remove the choles-

» 14:10~14:30

» gERMLINE MUTATIONS CAUSINg AUTOIN-FLAMMATORY INNER EAR DISEASE:CLINICAL IMPLICATIONS



BUNDNAG HOSPITAL

BYUNG YOON CHOI

Recently, the concept of autoinflammatory inner ear dis-ease has been introduced. The disease entity CAPS com-prising CINCA, MWS and FCAS manifests systemic inflammation with variable degree of severity. The former two disese entities show progressive, fluctuating hearing loss. They have been reported to be caused by the vari-ants in NLRP3. Very recently, nonsyndromic DFNA34 turned out to be also caused by variants in NLRP3, in this talk, we present a series of CAPS patients carrying germline mutant alleles NLRP3. These patients respond-ed to Anakinra which is a IL1b competitive inhibitor. We present genotypes and phenotypes of these patients and hearing results.

» 14:30~14:50

» THE PATHOMECHANISM OF DFNA9 AND THE PHYSIOLOgICAL ROLE OF COCHLIN



JINSEI JUNG

Deafness, autosomal-dominant 9 (DFNA9) is an au-tosomal dominant disorder characterized by late-onset, non-syndromic hearing loss and vestibular dysfunction. Mutations in the COCH gene encoding cochlin, the most abundant protein in cochlea, are etiologically linked to DFNA9. However, the physiological role of cochlin in the inner ear is not completely understood. Here, we re-port that DFNA9-linked mutations in COCH produce cochlin proteins that are resistant to cleavage of LCCL domain. As for the physiolocial role of LCCL domain, it has the local immune-surveillance role during Pseudomo-nas aeruginosa infection in the cochlea. Upon infection, the LCCL domain is cleaved from cochlin and secreted into the perilymph. This cleaved fragment sequesters in-

April27(Sat)




supporting examination be completely such as decom-pression, exploration – eradication granulation tissue on facial nerve. Greater auricular and suralis nerve can be use as nerve grafting for reanimation surgery. Keyword: facial nerve, iatrogenic, decompression, grafting, greater auricular nerve, sural nerve.

» 14:30-14:50

» OSSICULAR CHAIN RECONSTRUCTION UN-DER OTOSCOPE

DEP. OF OTO-RHINO-LARYNGOLOGY,

WEST CHINA HOSP., SICHUAN UNIV.

YU ZHAO

The clinical data of 45 included patients who had under-gone ossiculoplasty surgery between October 2015 and December 2017 from five hospitals in China were col-lected. The tympanic membranes of those patients were intact before surgery. The lesion only occurred in the ossicular chain from CT and intraoperative exploration. The cases of otosclerosis, tympanosclerosis, cholesteato-ma of middle ear, chronic suppurative otitis media, and tumor of middle ear were excluded. The characteristics of postoperative complications, hearing improvements and operation time were analyzed. There were no sensorineu-ral hearing loss and facial paralysis after surgery. Seven patients had transient mild tinnitus, nine patients devel-oped dysgeusia and two patients developed mild dizziness after surgery. The ABG range of pre-operation was 22.5 - 45.7 dB, with average ABG of 25.3±8.6 dB. The ABG range in the third month after surgery was 5.7 - 26.8 dB, with average ABG of 9.3±8.6 dB, which was significant-ly lower when compared with pre-operation (t=2.31, P<0.05). The average of operation time was 43.56±18.25 min. The oto- endoscope can be deserved for the clinical application in the ossiculoplasty surgery, since it has the advantages of better vision, less trauma, minimal invasive and quick recovery.

teatoma extended to mastoid cavity 3.To identify the dis-ease extent (Sinus tympani, ant epitympanic recess) The problems of mastoidectomy are 1. it can produce post-operative retraction pocket and cholesteatoma. Therefore we need to select the mastoidectomy candidate. In this symposium, the indication of mastoidectomy, the types of mastoidectomy, and the problems and management of mastoidectomy will be presented.

» 14:10-14:30

» MANAgEMENT OF FACIAL NERvE INJURIES IN THE EAR SURgERY

PROKLAMSI ENT HNS INSTITUTE, INDONESIA

SOEKIRMAN SOEKIN

Objective: To introduce the cause and site of facial nerve injuries during ear micro surgery. To purpose the technic and method of its management. Method and time: thir-teen cases facial nerve injuries during micro ear surgery at 2015-2017 , who underwent exploration and surgery animation were be analyzed. On exploration some sur-gery have been performed such as facial nerve decompres-sion (5 cases), repair from granulation tissue (3 cases), cable grafting by using greater auricular or sural nerve for substitution(5 cases)on restoration facial nerve func-tion. The most cases came from outside of the our cen-tre after several time or several months from the injury. House Brackmann (HB) grading has been use a grade of facial nerve function. Result: the most common site the facial nerve injury at mastoid segment as complicat-ing iatrogenic mastoidectomy, tympanic segment could be happened during tympano mastoidectomy or endo-scopic ear surgery. The condition of facial nerve during exploration after iatrogenic complication be founded edema, perineuron erosion, neuron erotion and total nerve fibers transection. Reanimation surgery was facial nerve decompression, anastomosis partial, and facial nerve grafting by using greater auricular or sural nerve . Time on re animation surgery be done from directly during surgery until 6 months after surgery Reanimation surgery process could be from grade III-VI become grade 0- II HB, depand on severity pathologic condition of the facial nerve before surgery. Conclusion: site lesion of the nerve facial trauma during mastoidectomy most was mastoid segment. Tympanic segment could be hap-pened on tympanomastoidectomy and ear endoscopic surgery. Reanimation Surgery be done after clinical and


April27(Sat)



OT-KL 4Room 4-1 (Convention A)Chair : YANG-SUN CHO

Keynote Lecture IV

» 15:20~15:50

» EvIDENCE BASED TREATMENT OF vESTIB-ULAR SCHWANNOMAS

DEP. ORL-HNS, COPENHAGEN UNIV. HOSP.,

COPENHAGEN, DENMARK

PER CAYE-THOMASEN

Surgical treatment of large vestibular schwannomas re-main undisputed. However, data on the natural history of small and medium-sized vestibular schwannomas have shown that only one third of tumors grow after diagnosis, within 5 years of observation. Around 50% of the pa-tients have good hearing at diagnosis and 60% will keep this. Hearing preservation is even better in patients with normal discrimination at diagnosis, as 85% will keep their good hearing within 5 years and 70% within 10 years. Results on tumor growth control by radiotherapy vary from 80 to 95%. However, a number of studies in-clude patients without documented pre-therapy tumor growth. The quality of data for reported hearing preser-vation is poor and results vary considerably, from 7 to 94%, on average being around 50-55%. Hearing pres-ervation following surgery range from 20 to 85%, on average being around 55%. Thus, the overall conclusion is that active treatment, i.e. radiotherapy or surgery, of small and medium-sized vestibular schwannomas should await documented tumor growth. However, new equip-ment and methods of continuous, near real-time cochle-ar nerve monitoring during hearing preservation surgery have improved results significantly and implementation of this novel system is likely to be the golden standard of future treatment.

April27(Sat)




RH-MTP 1Room 4-1 (Convention A)Chair : SEON TAE KIM,

Moderator : DO-YEON CHO

My Experiences in Allergen-specific Immunotherapy (AIT)

» 08:50-09:20

» TABLET SUBLINgUAL IMMUNOTHERA-PY FOR JAPANESE CEDAR POLLINOSIS - EFFECTS AND ITS MECHANISM

NIPPON MEDICAL SCHOOL

KIMIHIRO OKUBO

The prevalence of pollinosis caused by cedar pollen has increased by 10% these ten years of 26.5% in the investi-gation of 2008 in Japan. The pharmacotherapy is a main treatment tool for pollinosis, and the surgical treatment is not acknowledged to the treatment of pollinosis in-ternationally. Moreover, allergen immunotherapy enters a special treatment method, and is an important thera-peutic procedure. The allergen immunotherapy is unique for having possibility of curing allergen specific allergic diseases. However the side effect of allergen subcutaneous immunotherapy (SCIT), such as anaphylaxis is kept at a distance in a medical situation in Japan. Then, a sub-lingual immunotherapy (SLIT) that was safer than it, developed in Europe for pollinosis induced by grass or ragweed. In Japan, we developed tablet SLIT for Japanese cedar pollinosis. As a result, the effect of SLIT was prov-en the symptoms of the cedar pollinosis continuing for some years in Japan as high level evidence with increased induced regulatory T cells and Ag specific IgG4. A whole body immunity induction is thought in the appearance of the effect, and, in addition, it is necessary to be going to be cleared the accurate mechanism of the effect in the future.

» 09:20-09:50

» EFFICACY OF AIT FOR MONO- AND PO-LY-ALLERgEN SENSITIzATION




DONG-YOUNG KIM

We aimed to compare immunologic modification and treatment outcomes after two years of sublingual immu-notherapy (SLIT) with house dust mite extracts (HDM) between mono-sensitized and poly-sensitized patients with allergic rhinitis. Among the patients who were pro-spectively enrolled in the SLIT cohort study, patients with allergic rhinitis who were sensitized to HDM and treated with SLIT for at least two years were studied. All partici-pants underwent serologic tests at baseline and after SLIT to evaluate changes in immunologic parameters. The to-tal nasal symptom score (TNSS) was measured before and after SLIT, and effective and less effective responder groups were categorized depending on whether patients had a TNSS reduction of 50%, as compared with base-line. The increase in Dermatophagoides pteronyssinus and Dermatophagoides farinae specific immunoglobulin G4 levels was significantly higher in mono-sensitized pa-tients than those of poly-sensitized patients (p=0.020 and p=0.005, respectively). The TNSS significantly improved after SLIT in both the mono- and poly-sensitized groups (p<0.001 in both groups). However, the difference in the changes in TNSS from baseline was not significant be-tween two groups (p=0.374). This study demonstrated different immunologic modifications after SLIT between mono- and poly-sensitized patients. However, patients in the poly-sensitized group who were treated with single-al-lergen SLIT experienced comparable clinical improve-ment in TNSS to those in the mono-sensitized group despite demonstrating different immunologic changes.

» 09:50-10:20

» ALLERgEN-SPECIFIC IMMUNOTHERAPY (AIT) IN UNITED STATES

UNIVERSITY OF ALABAMA AT BIRMINGHAM

DO-YEON CHO

The International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR), which came out in 2018 from American Rhinologic Society, is a crit-ical examination and review of the scientific evidence relating to allergic rhinitis and more than 100 different individual topics, including its epidemiology, risk fac-

April27(Sat)


April 27(Sat) Rhinology


ented methodology by using a symptom and etiology based clinical approach to these potentially vital condi-tions. In focus, the importance of reliable diagnosis will be strictly emphasized for the optimum management of each patient. In that sense, the most modern CSF diag-nostic tests including the immunological markers Be-ta-trace- protein and beta-2-transferrin as well as tracing methods with endoscopic/laboratory sodium- fluoresce-in in combination with imaging methods (high-resolu-tion-CT and MR-cisternography) will be discussed with their advantages and limitations. The utility of the new, fast and cost- effective Beta-trace-protein test will espe-cially be pointed out. Pitfalls of the former nonspecific diagnostic tools will be mentioned. The synergistic effect reached by the optimal combination of modern CSF tests and radiological imaging, according to the symptom and etiology based clinical criteria, will be demonstrated with illustrative cases in a problem-solving manner. At the end participants should be able to indicate and localize CSF fistulas or possible dura lesions precisely by using a com-prehensive algorithm, which combines the most modern diagnostic tools in easily applicable patterns.

» 08:55-09:10

» COMPREHENSIvE MANAgEMENT OF SIN-ONASAL MALIgNANCY

DEPARTMENT OF OTORHINOLARYNGOLOGY-HNS,


BUNDANG HOSPITAL

TAE-BIN WON

Malignant sinonasal tumors are difficult to treat due to their rarity, late presentation, histologic diversity, and proximity to important structures such as the orbit and skull base. Moreover there is a paucity of robust data with which to guide management decisions. Generally, the first opportunity to treat patients with sinonasal cancers is the most effective. Although treatment of malignant sinonasal tumors should be planned on an individual ba-sis, radical treatment is required which usually involves a multidisciplinary treatment protocol including surgery, radiotherapy and chemotherapy. Treatment is usually based on extent, histologic behavior, and general condi-tion of the patient. The common surgical goal is wide re-section with negative margins. A range of surgical options are available with established traditional open approach-es. A significantly increasing number of cases are now be-

tors, diagnosis, management, and associated conditions/comorbidities, compiled by more than 100 international authors from various specialties using a structured, iter-ative review process. The consensus statement regarding allergen specific immunotherapy will be reviewed in this presentation. In addition, an otorhinolaryngic allergy practice in the United States will be discussed: eg. Clinic setup, Role of allergy nurse or advanced practice provid-er (midlevel provider), billing (payment system) in the US. The presentation also considers the following real world questions: 1. Evidence for mono vs poly-sensitiza-tion (US patients tend to have a higher rate of polysen-sitization) 2. clinical allergy symptoms vs. sensitivity on testing (approximately 50% of US people are sensitized to allergens, approximately 20% have clinical allergic rhi-nitis - it is important to correlate allergy symptoms with test results) 3. Evidence for treatment of polysensitized patients with a single allergen IT prescription 4. Evidence for treating allergic patients with multiple allergen IT prescriptions (relatively poor evidence overall) 5. A few studies that supported the approval of SLIT tablets in the US 6. Practical considerations for testing/treating with few vs multiple allergens.


Chair : HWAN JUNG ROH, CEM MECO

Extended Surgical Approach for Skullbase Tumors

» 08:40-08:55

» USE OF MODERN IMMUNOLOgICAL MARK-ERS IN CSF LEAK DETECTION AND IMPLE-MENTATION IN A COMPREHENSIvE DIAg-NOSTIC ALgORITHM

ANKARA UNIVERSITY, TURKEY AND SALZBURG

PARACELSUS UNIVERSITY, AUSTRIA

CEM MECO

This presentation targets to achieve a logical understand-ing of modern diagnosis of CSF fistulas and dura lesions, which could be very challenging in various cases. It will help participants to acquire a practical and problem-ori-

April27(Sat)




» 09:25-09:40

» ENDOSCOPIC ENDONASAL TRANSPTERY-gOID APPROACH


NECK SURGERY, SEOUL ST MARYS HOSPITAL

SUNG WON KIM

The pterygopalatine fossa (PPF) is a small anatomic space located between the posterior wall of the antrum and the pterygoid plates. Surgical access to the PPF is difficult because of its protected position and its complex neurovascular anatomy. Traditionally, pathologic lesions were treated via transcranial approaches. However, with advancements in endoscopic skull base surgery, includ-ing improved surgical exposures, angled endoscopes and instruments, and novel repair techniques; these can be successfully treated with purely endoscopic endonasal transpterygoid approach. Endonasal approaches provide better visualization of this area and are associated with less morbidity than external approaches. In this sym-posium, the author review the endoscopic endonasal transpterygoid approach to the lateral side of skull base, including an overview of the surgical anatomy from an endoscopic perspective and the operation techniques. The authors also present several cases of endoscopic en-donasal transpterygoid approach that were successfully treated using this approach.

» 09:40-09:55

» ENDOSCOPIC APPROACH TO THE NASO-PHARYNx





SANG DUK HONG

Although nasopharynx is familiar to ENT surgeon, the surgery for nasopharygeal tumors are uncommon. However, endoscopic nasopharyngeal approach have been popularized along with the advancement of the endoscopioc skullbase surgery. Radiotherapy (RT) is the mainstream treatment for nasopharyngeal cancer. RT had showed good locoregional control, but there had

ing dealt with endoscopically which with careful patient selection can achieve comparable surgical clearance with reduced morbidity. In this presentation, comprehensive management of sinonasal malignancy will be discussed with emphasis in endoscopic approaches and coordinated multidisciplinary care.

» 09:10-09:25

» ENDOSCOPIC RESECTION AND RECON-STRUCTION OF ANTERIOR SKULL BASE

DEP. OF OTORHINOLARYNGOLOGY,

UNIV. OF TSUKUBA

SHUHO TANAKA

Endoscopic endonasal approaches (EEA) have been widely accepted to treat not only sinus disease, but also pituitary and several skull base lesions. We otorhinolar-yngologist and neurosurgeon have made a collaboration team of endoscopic endonasal skull base surgery in our hospital since 2010. The indication of EEA is extending year by year. We have adopted EEA for malignant skull base tumor since 2011. We have 21 cases of sinonasal ma-lignant tumor invaded into skull base which exclude the cases of maxillary malignant tumor such as maxillary car-cinoma, lymphoma and sarcoma. 10 cases of them were operated by only EEA, the other cases were operated by EEA combined with transcranial approach or craniofa-cial approach. All five cases with craniofacial approach needed orbital exenteration because of invasion of orbit. The pathological detail was, 9 olfactory neuroblastoma, 5 squamous cell carcinoma, 2 adenocarcinoma, 2 neu-roendocrine tumor, and 1 basal cell adenocarcinoma, 1 basaloid scc, 1 small cell carcinoma. 16 cases were patho-logically negative of resection marginal study. There were 2 cases of postoperative CSF leakage and one of them had meningitis. The wider the indication of skullbase surgery expands, the wider the area of skullbase resection is. The wide resection area used to be covered by free skin flap. We tried to utilize the pedicled nasoseptal flap and nasal turbinate flap if it is possible these days. The mucosal cov-er is better postoperative intranasal condition than skin cover. But there is the limitation of area to cover with mucosal flap. We have two cases of anterior skullbase reconstruction with mucosal cover after wide anterior skullbase resection with orbital exenteration. There was no postoperative complication and no need to daily care for crust of nasal cavity.

April27(Sat)




(18 cases)were the commonest sie of fistula. Aetiological factors were idiopathic (53 cases), accidental trauma (34 cases), meningocele (19 cases), surgery (12 cases) and Pi-tuitary tumour (2 cases). Postoperative follow-up ranged from 5 month to 129 months. Postoperative transient cerebral irritation and meninsitis were noted in 1 and 2 cases respectively. The success rate at first attempt was 86.89 % (106/122). The overall success rate was 97.54% (119/122). Conclusion: Endoscopic endonasal repair of CSF rhinorrhea appears to be a safe and effective proce-dure. Success rate does not vary without using tissue glue.


Chair : HUN-JONG DHONG

Keynote Lecture III

» 10:40-11:10

» ENDOSCOPIC MANAgEMENT OF FRONTAL SINUS FRACTURES AND CSF LEAKS

UNIVERSITY OF ALABAMA AT BIRMINGHAM (UAB)

SCHOOL OF MEDICINE, USA

BRADFORD A. WOODWORTH

Management of frontal sinus trauma and CSF leaks of the posterior table have traditionally included coronal or direct open approaches through skin incisions to ablate or obliterate the frontal sinus and openly reduce/inter-nally fixate fractured anterior tables. The incorporation of transnasal endoscopic management into the treatment algorithm challenges this surgical dogma. Participants in this lecture will learn unique issues related to CSF leak etiology, novel technical aspects of repair, and methods for ensuring frontal sinus patency as a consequence of these approaches.

been some serious complications such as osteoradione-crosis. Repeated endoscopic debridement and conser-vative management have been used for this devastating complication, but endoscopic sequestrectomy followed by reconstruction with nasoseptal flap have shown prom-ising results. Although RT showed good tumor control, recurrent tumors still exists despite of salvage re-RT. In this situation, endoscopic nasopharyngectomy could be an option. For endoscopic debridement or nasopharyn-gectomy, parapharyngeal and petrous internal carotid ar-tery (ICA) is on danger. Therefore, anatomical knowledge and management plan of ICA is essential for endoscopic approach to nasopharynx. In this lecture, I will show you some instances of endoscopic approach to nasopharyn-geal tumor and necrosis as well as to benign lesions.

» 09:55-10:10

» ENDOSCOPIC ENDONASAL MANAgEMENT OF CSF RHINORRHEA


BANGABANDHU SHEIKH MUJIB MEDICAL

UNIVERSITY

SHEIKH HASANUR RAHMAN

Objective: To asses the outcome of endonasal endoscop-ic management of cerebrospinal fluid rhinorrhoea. Study Design: Prospective study carried out in the Department of Otolaryngology, Bangabandhu Sheikh Mujib Medical University Hospital, Dhaka. Consecutive 122 cases of CSF rhinorrhoea who underwent endonasal endoscop-ic surgery from Feb, 2008 to Oct, 2018 were included in the study. Preoperative investigation included high resolution CT scan/CT-cysternography, nasoendosco-py, measurement of glucose concentration in the nasal discharge and MRI in some cases. Using preoperative and peroperative nasoendoscopy leakage sites were con-firmed. A combination of graft materials (autologus fat, fascia lata, rotated middle turbinate flaps, septal cartilage) were used for repair of CSF fistula. In selective cases hy-droxyl apatite was used as sealing material. Surgicel, gel foam and BIPP pack were used as packing materials. No tissue glue or postoperative lumber drain was used. Cases were followed up regularly by direct visit/ telephone. Re-sults: Sample size was 122. Age ranged from 8 months to 62 years (Mean = 36.88 years). M:F = 1:2.05. Mean dura-tion of CSF leakage was16.14 months. Cribriform plate (73 cases), sphenoid sinus (19 cases), fovea ethmoidalis

April27(Sat)




A new surgical procedure for preventing LPW collapse, lateral pharyngoplasty (LP), was first introduced by Ca-hali . By involving the myotomy of the superior pha-ryngeal constrictor (SPC) muscle and suturing this with palatoglossus, this technique presented a better surgical outcome (approximately a 60% success rate) compared with conventional UPPP. In our clinical practice, we adopted this technique. However, we have encountered several problems with this technique. Therefore, we mod-ified the original technique to improve LP. The surgical technique is as follows. The anterior pillar is partially re-sected in a wedge shape to expose the upper pole of the tonsillar fossa and the superior pharyngeal constrictor muscle is dissected and divided into medial- and later-al-based flaps. The divided muscle flaps overlap and are closed with a modified vertical mattress suture from the upper to lower pole. The palatopharyngeus is retracted supero- laterally and anteriorly with a suspension tech-nique using Vicryl 3-0 suture. The redundant mucosa of the uvula is trimmed. The upper portion of the posterior pillar is partially incised and the released posterior pillar is sutured to the anterior face of the soft palate to cover the denuded soft palate. We modified the original LP tech-nique by superimposing the anterior and posterior mus-cle flaps and anchoring sutures to the region of the upper second molar gingiva. Our overlapping LP technique ap-pears to be safe and effective among OSA patients. The multi-level surgery of OLP combined with CobTBR can be a good surgical strategy for OSA patients with retro-glossal obstruction.

» 11:40-11:55

» HOW I DO THE PALATAL SURgERY: UvU-LOPALATOPHARYNgOPLASTY WITH UvULA SAvINg


KOREA UNIVERSITY ANSAN HOSPITAL,


SEUNG HOON LEE

Obstructive sleep apnea (OSA) in adult is a respiratory disorder caused by the anatomical abnormality of the soft tissues and bone structures that constitute the upper respiratory tract during sleep. Accurate diagnosis of the cause and appropriate treatment for the patient are very important to obtain the best treatment results. The main treatment methods for OSA include the upper airway

RH-MOS 2Room 4-2 (Convention B)

Chair : Chair : METIN ONERCI, Moderator : SUNG WAN KIM

How I Do It: Palatal Surgery for OSA Patients

» 11:10-11:25

» HOW I DO IT: CONCEPT OF PALATAL SUR-gERY



KYUNG HEE UNIVERSITY SCHOOL OF MEDICINE,

SEOUL, KOREA

SUNG WAN KIM

Palatal surgery is the most commonly and widely per-formed surgical procedure among various sleep surgery for obstructive sleep apnea (OSA) patients. It has longest history and abundant experiences during last 50 years, and a lot of modification of palatal surgery has been re-ported because of limited success rate and considerable complications in classical uvulopalatopharyngoplasty (UPPP). Even some patients showed aggravation of dis-ease after surgery. However, objective outcome by AHI criteria of various modification of palatal surgery is still variable. Variability of patients’condition may be the first reason of these results. But the technical and indicational factors for surgery per se is also considerable reason to be. Definitely, the surgeon needs to dwell on this surgical technique on right case. For enhancing the possibility to correct the factors of surgery itself, I would like to expose my opinion and concept for choosing surgical technique in palatal surgery for OSA patients.

» 11:25-11:40

» SLEEP SURgERY: HOW I DO IT

DEPARTMENT OF YONSEI

UNIVERSITY, SEVERANCE HOSPITAL,

OTORHINOLARYNGOLOGY

HYUNG JU CHO

April27(Sat)




patients Conclusion The procedures to address pharyn-geal wall collapse in OSA patients : Surgical options for treating OSA - changing of the pharyngeal muscular wall properties - to splint entire collapsible pharynx - reposi-tioning pharyngeal muscles

» 12:10-12:25

» MY PALATAL SURgERY - LIMITED PALATAL MUSCLE RESECTION


PUSAN NATIONAL UNIVERSITY HOSPITAL,

BUSAN, REPUBLIC OF KOREA

KYU SUP CHO

The success of surgery in the treatment of obstructive sleep apnea (OSA) depends on the accurate diagnosis of the sites of obstruction and the appropriate selection of procedures to address these sites. The palatal level is one of the major areas of obstruction in the upper air-way contributing to OSA and uvulopalatopharyngoplas-ty (UPPP) remains the most commonly utilized surgical procedure for treating OSA. However, the long- term success rate of UPPP was no greater than 50% in unse-lected patients with OSA. Furthermore, UPPP has been associated with complications such as velopharyngeal in-sufficiency and nasopharyngeal stenosis. Therefore, many modifications of UPPP have been proposed to contend with anatomical variations of the pharynx and minimize morbidities. In a recent study, limited palatal muscle re-section (LPMR), a modified technique of UPPP, showed significant improvement regardless of tonsil size in sub-jective and objective outcomes of OSA patients with nor-mal postoperative pharyngeal function. In this lecture we present the surgical techniques of LPMR in the different cases and preoperative and postoperative DISE findings. References 1. Kim JW, Kim DS, Kim SD, Mun SJ, Koo SK, Cho KS. Does drug- induced sleep endoscopy pre-dict surgical success of limited palatal muscle resection in patients with obstructive sleep apnea? Auris Nasus Larynx 2018;45:1027-32. 2. Limited palatal muscle re-section with tonsillectomy: a novel palatopharyngoplasty technique for obstructive sleep apnea. Auris Nasus Lar-ynx 2014;41:558-62. 3. Lee HM, Choi SW, Kang DW, Lee JH, Roh HJ, Cho KS. Comparative analysis for the surgical outcomes of uvulopalatal flap and palatal muscle resection in patients with obstructive sleep apnea. Korean

surgery, the positive airway pressure (PAP) therapy, and oral appliance. Surgical treatment of the upper airway is effective in patients with certain anatomical abnormali-ties narrowing the upper airway. Among the various sur-gical technique, the uvulopalatopharyngoplasty (UPPP) is one of the most effective surgical procedures in adult OSA. Especially, it is very important to preserve the uvu-la during UPPP, because the resection of uvula is relat-ed to the regurgitation during oral feeding and mouth leak during CPAP treatment. The purpose of this video lecture is to show how I perform the UPPP with uvula saving technique and try to help you understand this sur-gical procedure.

» 11:55-12:10

» ALTERNATIvE PALATAL SURgERIES IN OB-STRUCTIvE SLEEP APNEA BEYOND UPPP

SEOUL NATIONAL UNIVERSITY HOSPITAL, SEOUL

NATIONAL UNIVERSITY COLLEGE OF MEDICINE

HYUN JIK KIM

The surgical treatment to reduce pharyngeal collapsibility in OSA patients : Reduce the upper airway collapsibility and narrowing / Enlarge the airway : Removing soft tis-sue from pharyngeal lumen or mobilizing the surround-ing tissue : Should address the whole collapsible pharynx : Tensioning the pharyngeal wall through repositioning the surround tissues : Approaching pharyngeal lateral muscular walls * Lateral Pharyngoplasty : Initiate with a bilateral tonsillectomy : Identify the palatoglossus and palatopharyngeus muscles : Undermine and elevate the superior pharyngeal constrictor muscle : Anterior suture of the superior pharyngeal constrictor muscle to palato-glossus muscle : Section of the palatopharyngeus muscles : Covering the superior part of the tonsillar fossa - Pala-tine flap and upper part of the palatopharyngeus muscle * Expansion sphincter pharyngoplasty 1) Isolate the pala-topharyngeus muscle 2) Rotate this muscle superoantero-laterally : to create the lateral wall tension : to remove the bulk of the lateral pharyngeal walls -> Useful and effective in patients with small tonsils, Friedman stage II or III and lateral pharyngeal wall collapse : Perform simply / Promising results / anatomically sound / Minimal com-plications * Soft palate webbing flap : Aimed at address-ing obstruction at the retropalatal level : Combined pha-ryngeal surgeries to minimize surgical failure at palatal level : Surgical options for primary snoring or mild OSA

April27(Sat)




of Brent, Nagata and subsequently Firmin. The nature of the skin definitely plays a key role in determining the outcome of these reconstructions and as such, results may be subject to racial variations. Because the description of techniques has been mainly in Caucasian, there have been few studies comparing the results between different races. In anthropometric studies of the human auricle in vari-ous populations, the length of the auricle in Korean pop-ulation is slightly shorter than Caucasians and Indians, and longer than Africans and Han population. Regarding lobule configuration, pendular type is the most prevalent in males and tapering type in females. Differences in an-thropometric data and surgical techniques regarding lob-ule transfer, harvesting the costal cartilage, fabrication of framework and enhancing the definition of framework in patients with thicker skin, should be considered to ac-quire best surgical results in Asian population.

» 14:10-14:30

» NASAL vALvE SURgERY REvISITED IN ASIANS

DEPT OTOLARYNGOLOGY,

TAICHUNG VETERANS GENERAL HOSPITAL

CHIH-WEN TWU

The fact that functional and aesthetic disorders of the nose almost always coincide makes functional-esthetic rhinoplasty become the most demanding procedures in facial plastic surgery. Incomplete preoperative analyses, improper planning and undue surgical procedures will cause airway problems after septorhinoplasty. Altered airway resistance, residual septal deformities, synechiae and webs, collapsing valve, intrusion by the lateral crura of the lower lateral cartilage, or excessive alar base nar-rowing. In order to success in functional-aesthetic rhino-plasty, a facial plastic surgeon should start with a detailed analysis of the presenting anatomical and physiological problems, taking into account fundamental factors like the age, gender, skin and connective tissue status of the patient. Furthermore, the surgical approaches should be as minimal invasive as possible and any unnecessary tis-sue trauma should be prevented. Surgeons ought to ad-dress themselves to the effects of the septal cartilage on the shape of the external nose. Deformed septal. carti-lage causes crooked nose, tension nose, saddle nose, tip and columellar deformities. Several physiological con-siderations in funtional-aesthetic rhinoplasty are worthy

J Otorhinolaryngol-Head Neck Surg 2011;54:467-72.

RH-SP 5Room 4-2 (Convention B)

Chair : JUNG SOO KIM, CHIH-WEN TWU

Essentials of Asian Facial Plastics: Comparison with Caucasians

» 13:30-13:50

» DOS AND DONTS IN ASIAN EYELID SUR-gERY

CHASE LAY MD CENTER FOR ASIAN FACIAL

PLASTICS BAY AREA CALIFORNIA

CHASE LAY

This talk will describe the various techniques used in Asian Eyelid Surgery. The lecture will go into details re-garding proper techniques and surgical planning for a variety of different orbital and peri-orbital anatomy. It will describe specific pitfalls to avoid in the shallow orbit. The lecture will also describe how to effectively treat the aging Asian eyelid, one of the most challenging case in Asian eyelid surgery. This talk will include some cases of ptosis as well but will not go into great detail about ptosis surgery itself.

» 13:50-14:10

» ASIAN AURICULAR RECONSTRUCTION: DIF-FERENCES FROM CAUCASIANS




JEONG-HOON OH

Auricular reconstruction is a reconstructive challenge as it is difficult to replicate the complex three-dimensional anatomy of the ear and produce lasting results. The tech-nique of microtia correction has evolved over the years with Tanzer introducing the reconstruction with autol-ogous costal cartilage, followed by the pioneering efforts

April27(Sat)




UNIVERSITY OF CALIFORNIA, LOS ANGELES

JEFFREY DONGSUNG SUH

OBJECTIVES/HYPOTHESIS: The Outside-In Draf 3 is a new method of performing an endoscopic modified Lothrop. This technique differs from the standard Draf 3, but can challenging to adopt. The outside-in Draf 3, where the limits of the sinusotomy are first defined and the FR is addressed last, is described. The objective of this session is to describe the indications, techniques, and results of the Outside-In Draf 3. Also the surgery specific risks are discussed. A review of the current literature on this technique will be highlighted. Conclusion: The out-side-in Draf 3 is technically feasible and safe. Its advan-tage is a wide approach to the frontal sinus with shorter operative times compared to a standard Draf 3.

» 13:50-14:10

» FRONTAL SINUS INvOLvEMENT IN PRIMER AND REvISION FESS

UNIVERSITY OF HEALTH SCIENCES SISLI

HAMIDIYE ETFAL TRAINING AND RESEARCH

HOSPTAL, CHEF OF ENT DEPARTMENT

SUAT - TURGUT

Frontal sinusitis is a challenging entity both in terms of diagnosis and treatment. The cases resistant to medical treatment are candidates for surgery especially the ones with frontal sinus involvement. Nowadays other than the resistance to medical treatment, most of the frontal si-nusitis cases are candidates for surgery due to iatrogenic causes such as frontal sinus surgery itself or etmoid sur-gery. The data of 288 patients who had been operated on due to chronic sinusitis and nasal polyposis at our tertiary care hospital at Otolaryngology Head and Neck Surgery Clinic between February 2014- December 2018 was an-alysed in terms of frontal sinus involvement and surgical outcome. 217 patients were diagnosed as chronic rhi-nosinisutis with nasal polyposis (CRSwNP), 71 patients were diagnosed as chronic rhinosinisutis without NP (CRSsNP). While 242 patients had primer endoscopic sinus surgery, 46 patients had revision surgery. Among the patients who had their primer surgery, 141 of them had frontal sinus involvement while the frontal sinus in-volvement was observed in all revision sinus surgery pa-tients. As revision surgery, we had applied Draf 1 to 40

of remark: Preservation and reconstruction of a nasola-bial angle between 90o to 100o can guide the inspired air equally into the functional area in the nasal cavity. Over-expansion of the ostium internum will reduce the nozzle effect of nasal vestibule and cause turbulent flow. Thus proper expansion in surgery of the ostium internum should be planned. Since the caudal margin lower lateral cartilage construct the upper area of the inner nostril, the concave shape of the ostium internum should be main-tained while making caudal resections at the lower lateral cartilage.

» 14:30-14:50

» THE NEW METHOD OF CAP gRAFT IN RHI-NOPLASTY

PRIVATE PRACTICE

H.BAKI YILMAZ

Nasal tip management is the most challenging part of rhinoplasty surgery. For nasal tip management, optimal nasal tip projection and rotation must be maintained. Multiple techniques for nasal tip rotation and projection have been proposed. Velasco et al introduced a pivotal interpolated flap for achieving tip refinement and projec-tion. Using this technique in our cases resulted in obvious alar retraction. In the technique that will be described in this lecture, we have managed to solve this problem by using a cap graft; obtained from the cephalic trim. We have used this technique for 48 patients in our practice. A natural and symmetric appearance without alar retrac-tions was achieved in all patients by using this simple and applicable method.

RH-MTP 2Room 3-2 (Emerald B)

Chair : JANNIS CONSTANTINIDIS, Moderator : JOSEPH K. HAN

Tips and Pitfalls for Frontal Sinus Surgery

» 13:30-13:50

» OUTSIDE - IN DRAF 3

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improved by creating the largest possible neostium and speeding re-mucosalization to prevent ostial stenosis. We would provide our modification technique and results at the end of this talk.

» 14:30-14:50

» ENDOSCOPIC FRONTAL SINUSOTOMY US-INg THE SUPRAINFUNDIBULAR PLATE AS A KEY LANDMARK



CHANG-HOON KIM

Since the introduction of an endoscopic intervention in the management of frontal sinusitis, endoscopy has become the first choice of treatment for patients who have a frontal sinus disease. Reports of endoscopic inter-vention for frontal sinus surgery have been on the rise, and a wide range of technically advanced operative in-struments have become available. As a result, endoscopic frontal sinus surgery has evolved considerably. However, because the anatomical structure of the frontal sinus is extremely intricate and there are many critical structures such as the lamina papyracea and the cribriform plate in the area, endoscopic frontal sinus surgery remains tech-nically difficult. Various endoscopic techniques of frontal sinus surgery have been suggested. In 1995, a study of the anatomical terminology and nomenclature of paranasal sinus structures was reported. Despite this information, during the approach to the frontal sinus the bony septa between the lamina papyracea and the middle turbinate have not yet been determined. Furthermore, a consensus on the surgical landmarks and terminology that should be adopted has not been reached and the operative tech-niques remain difficult to understand. As an example of indefinite terminology, “frontal recess” is a term current-ly being used for the structure that is seen after removal of the natural tract of the frontal sinus outflow. When the frontal sinus drains anterosuperiorly to the ethmoid infundibulum, which is the most common type of fron-tal sinus drainage, the superior end of the infundibulum has a dome-shaped appearance, which is called the ter-minal recess. The upper portion of the uncinate process and the anterior wall of bulla ethmoidalis always meet to form the superior end of the ethmoid infundibulum, and both are attached superiorly to the skull base as a plate. They are some portions of the ethmoid bone, and there

(87% ) patients, Draf 2 to 4 (8.7%) patients and Draf 3 to 2 (4.3%) patients. It has been reported that patients af-ter FESS have frontal sinusitis symptoms with short-term follow-up of 2-11% and long-term follow-up with 15-20% failure rates and up to 11% of these patients should undergo revision surgery. Frontal recess is the most com-mon site of disease recurrence. Inadequate surgery in the frontal recess and iatrogenic injury can cause frontal sinus obstruction via residual mucosal inflammation, synechia, mucosal hypertrophy, neo-osteogenesis and osteitis. In the literature, incomplete dissection of ethmoid cells, including frontal recess cells during primary surgery, is seen as one of the causes that require frontal sinus revi-sion surgery.

» 14:10-14:30

» APPLICATIONS, OUTCOMES AND MODIFI-CATIONS OF EMLP

1DEPARTMENT OF OTOLARYNGOLOGY, HEAD AND

NECK SURGERY, MACKAY MEMORIAL HOSPITAL 2MACKAY MEDICAL COLLEGE

YING PIAO WANG

Also known as the Draf III or Frontal Drillout, the En-doscopic Modified Lothrop Procedure (EMLP) is a crit-ical procedure for surgeons who practice rhinology. The purpose of EMLP is to create the largest anterio-posterior and lateral to lateral spaces between bilateral frontal si-nuses and nasal cavities. Since the introduction of EMLP, several studies have reported the successful experiences of this technique to treat the patients with recurrent frontal sinusitis. In the past few years, several authors have pro-posed many other implications for the treatment of sev-eral diseases in addition to chronic frontal sinusitis. This talk will summarize the applications of this operation with the following: (1) failed prior endoscopic sinus sur-gery, (2) neo- osteogenesis in the FR and frontal ostium, (3) frontal mucocele, (4) failed osteoplastic flap frontal sinus obliteration, (5) resection of sinonasal tumors, (6) repair CSF leakage and (6) frontal osteoma. Outcomes of EMLP where the neo-ostium has been maximized are excellent and provide effective endoscopic rehabilitation for recalcitrant sinus disease despite maximal medical and surgical intervention. The outcomes in terms of neoos-tium opening, SNOT-22, VAS, TWSIT (Taiwan Smell Identification Test) and nasality of EMLP are presented as well. Theoretically, outcomes of this procedure are

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searches that will be tried to find the way to go. In this lecture, I will try to talk about uncertainties in the process of OSA management and to expose my opinion for the possibility to solve these uncertainties in terms of per-spective of sleep doctor and surgeon.

is no definite landmark to distinguish one from the oth-er. Therefore, we needed a new term, “suprainfundibular plate (SIP),” which indicates both the superior portion of the uncinate process and the superior portion of the bulla ethmoidalis. To perform endoscopic frontal sinuso-tomy, a complete knowledge of the structures that must be removed before the frontal ostium is in the endoscopic field of vision view is essential. To this end, we suggest a simplified surgical approach, which uses the SIP as a key landmark in identifying the frontal ostium.


Chair : JIN HEE CHO

Keynote Lecture IV

» 15:20-15:50

» HOLISTIC APPROACH TO THE OSA PA-TIENTS: PRECISION OR PERSPECTIvES


HEAD AND NECK SURGERY, KYUNG HEE


SEOUL,KOREA

SUNG WAN KIM

Obstructive sleep apnea (OSA) showed variable causes and phenotypes. It is very difficult for sleep doctors to choose therapeutic modality to recommend for a partic-ular individual because they are either poorly tolerated or only resolve OSA in a proportion of patients. It is true that one treatment modality cannot achieve desirable success rate to treat OSA patients. Therefore, to manage the OSA patients, sleep doctors need to take care of the patients with holistic approaches. However, it seems that we don’t have enough evidences and cumulated research-es for the holistic and precision approach to OSA patients until now. There are lots of uncertainties in diagnostic and therapeutic modalities which make difficulties for the sleep doctors to find the right direction and provide the guideline to the patients. To overcome these obstacles for management of OSA, we, at least, need to recognized what kind of uncertainties we have and what kind of re-

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Chair : BYUNG-JOO LEE, SUSAN THIBEAULT

Laryngology Update and Opinion for Future Directions

» 08:30-08:45

» TOWARDS CLINICAL REgENERATIvE MEDI-CINE OF THE LARYNx

UNIVERSITY OF WISCONSIN MADISON

SUSAN L THIBEAULT

This session will discuss progress in the area of tissue re-generative of the larynx, specifically for the vocal folds. Using systems biology and in utero developmental data, we are trying to provide cellular therapy options for tissue engineering. Work that has been completed to date will be discussed in the context of the field in genera.

» 08:45-09:00

» INNOvATION OF INJECTION MATERIALS FOR vOCAL FOLD REgENERATION


SEONG KEUN KWON

Glottic insufficiency is one of the most common con-tributing factors in patients who present with dysphonia. Glottic insufficiency results from the vocal fold immobil-ity, vocal fold atrophy or soft tissue deficiency. Patients with these laryngeal disorders have symptoms of voice change, dysphagia, and aspiration pneumonia, which not only decrease the patient’s quality of life, but also affects their lives. To compensate this glottis insufficiency, sev-eral materials have been devised and applied to clinical trials for several decades, including Teflon, calcium hy-droxyapatite (CaHA), silicone, Gelfoam®, collagen, au-tologous fat, and others. But, these materials have lim-itations, such as unpredictable resorption, inflammation, granuloma formation, migration, allergic reactions, and issue of expense. In addition, regeneration of laryngeal tissues or restoration of laryngeal intrinsic functions is an

intractable problem. An ideal injection substance should be easily injectable, volume-stable, nonantigenic, and nonmigratory. In an effort to improve the convention-al injection material, my lab developed several different injection materials that have the properties of enhanced biocompability, reduced migration, growth factor deliv-ery system by slow release technique or gene transfection. In this session, I would like to cover the intrinsic char-acteristics that is required for the injection laryngoplasty materials, and also results on the vocal fold augmentation (decellularized ECM, surface modified silicone particle, crosslinked hydrogel by gamma irradiation) and regen-eration using mesenchymal stem cell, and growth factor loaded injectable agents. Lastly, I would like to present the hydrogel with self- healing ability and strong tissue adhesion that can be applied as an artificial vocal fold implant.

» 09:00-09:15

» UPDATE IN PEDIATRIC AIRWAY SURgERY

DEPARTMENT OF OTOLARYNGOLOGY MEDICAL

COLLEGE OF WISCONSIN, USA

ROBERT CHUN

The invited pediatric otolaryngology presentation on “Updates on Pediatric Airway Surgery” will provide an overview of the best evidence in the management of mul-tilevel pediatric airway obstruction. The lecture will also review the literature on the state of the art airway treat-ment for laryngotracheal disease as well as airway vascular anomalies. Lecture objectives: 1.Provide the learner with overview of the best evidence for pediatric airway surgery for laryngeal cleft, subglottic stenosis, tracheal stenosis, tracheomalacia and vascular malformations. 2.Provide the learner an understanding that the patient and their comorbities as a whole need to be evaluated prior to air-way surgery 3. Provide the learner the knowledge of new innovations in pediatric airway surgery

» 09:15-09:30

» LARYNgEAL REINNERvATION FOR UNILAT-ERAL vOCAL FOLD PARALYSIS



COLLEGE OF MEDICINE, BUCHEON, KOREA

April 27(Sat) Head & Neck Surgery

April27(Sat)



ryngeal high-speed videoendoscopy (HSV) can be sup-planted to solve the limitations of videostroboscopy. HSV provides more accurate information on vocal fold vibra-tion. However, HSV has not been widely used in clinical practice because of practical limitations, such as the con-siderable time necessary for encoding and recording, the extremely large storage necessary for archiving, and the intense concentration required to analyze HSV images. To solve these problems, functional imaging modalities using high-speed videoendoscopic images such as digital kymography (DKG), strobovideokymography, and two- dimensional scanning digital kymography (2D DKG), as well as assessment of glottal area wave form, glottal width pattern, and laryngeal topography have been introduced. These methods could provide information on the char-acteristics of vocal fold vibrations. However, these meth-ods, with the exception of digital kymography, might need complicated software applications, and the results are sometimes difficult to interpret. The DKG images are extracted from the HSV images and show the real vibra-tory image of the vocal folds. However, there are some disadvantages, such as a considerable waiting time before kymographic visualization and a recording duration lim-ited to a few seconds. With advanced computer perfor-mance and software technology, Wang et al developed a real-time multislice DKG system to overcome the limita-tions of the conventional DKG system. In this session, multifunctional laryngeal examination system including a real-time multislice DKG system will be introduced and its clinical usefulness regarding evaluation of vocal cord paralysis and atrophic vocal cord also will be introduced.

» 09:45-10:00

» vOCAL FOLD SCAR

TURKEY

FERHAN OZ

TBD

» 10:00-10:15

» PEDIATRIC LARYNgOTRACHEAL STENOSIS SURgERY, STEPS TO PREvENT COMPLICA-TIONS

PROFESSOR, HACETTEPE UNIVERSITY

MEDICAL SCHOOL, DEPARTMENT OF

SEUNGWON LEE

Currently, medialization thyroplasty with or without ary-tenoid adduction is the standard treatment for unilateral permanent vocal fold paralysis (VFP). However, medial-ization thyroplasty is an open surgery that requires an ex-ternal skin incision and may require future revisions. Re-cently, injection laryngoplasty techniques have regained popularity since they are easier and less invasive than con-ventional medialization thyroplasty and may be equally effective. However, injection laryngoplasty is less suitable for patients with large posterior glottic gaps, and long-term results have not been verified. In comparison, RLN reinnervation is theoretically an ideal approach, because it may prevent the progressive loss of thyroarytenoid (TA) muscle tension and bulk and does not require implan-tation of a foreign-body. Intraoperative RLN reinnerva-tion has the potential to restore a normal or near-normal voice, while preserving the laryngeal anatomy. In this symposium, the author will present advantages and dis-advantages of RLN reinnervation. And also demonstrate it's prospective long term results and comparative data between IL and RLN reinnervation.

» 9:30-09:45

» INTRODUCTION OF SIMULTANEOUS MUL-TIFUNCTIONAL LARYNgEAL ExAMINATION SYSTEM AND IT'S CLINICAL USEFULNESS


HEAD & NECK SURGERY, PUSAN NATIONAL

UNIVERSITY YANGSAN HOSPITAL, PUSAN

NATIONAL UNIVERSITY SCHOOL OF MEDICINE

JIN-CHOON LEE

Observation of vocal fold vibration in patients with dys-phonia is essential for accurate diagnosis and evaluation before and after treatment. Laryngeal videostroboscopy has been used primarily in clinical practice. However, the images from videostroboscopy are illusory, as they are col-lected from different cycles. In addition, it is impossible to examine vocal cord vibration in cases of very irregular vocal fold vibration or short sustained vowel phonation. Videokymography addresses some of the main shortcom-ings of videostroboscopy, and is displayed in real time, but an important limitation remains that only a single line of the laryngeal image is scanned and displayed. La-

April27(Sat)




gERY(TORS) TO THE gAME-CHANgER;IN-TRODUCINg THE SINgLE PORT ROBOTIC SURgICAL SYSTEM

PROFESSOR, CHAIRMAN & DIRECTOR OF


YONSEI UNIVERSITY

SE-HEON KIM

Over the past decade, TORS has been recognized as a useful procedure for minimally invasive and functional preservation surgery in the treatment of head and neck cancer. The reason is that the endoscope is put into the lesion site through the oral cavity and the surgical field is obtained to the difficult part if we are using the micro-scope. And the lesion is enlarged about 10 times by the endoscopic camera supporting full HD and 3D function. Moreover, the two robotic arms can move freely accord-ing to the intention of the surgeon even in the narrow space of pharynx and larynx. Ten years ago, TORS was limited to early stages of tonsil cancer and base of tongue cancer, but the author extended their coverage to larynx and hypopharynx. in the early stage of introduction, only T1 and T2 lesions were adaptive to TORS. But our team used the neoadjuvant chemotherapy to minimize lesion size and then remove the original lesion site using TORS. After that, radiation Tx was delivered by individually tai-lored format to preserve function in head and neck can-cer patients. By introducing our treatment protocol, the survival rate was improved by more than 20% compared to conventional therapy. However, the conventional ro-botic surgical system was difficult to perform TORS be-cause of its size and volume. This new robotic surgical system (da Vinci SP) is a revolutionary evolution. This system is consisting of a single port (2.5 cm) which has a camera and three working arms (6 mm). Furthermore, endoscopic cameras can be freely angled with a flexible arm. In addition, three multi-jointed wristed 6mm in-struments enable free movement within narrow lesion. This system dramatically improved the disadvantages of conventional robotic surgical systems. We will report the results of the world's first single-port robotic system for head and neck cancer patients.

OTORHNOLARYNGOLOGY, TURKEY

MEHMET UMUT AKYOL

Laryngotracheal stenosis surgery in pediatric patients, es-pecially babies, is a hard and challenging subject. Due to many reasons like, technique challenges, existing un-derlying disease of the patients and need of multidisci-plinary care, complication rates are high. It is not always possible to maintain functional upper respiratory and aero digestive tract continuity, and there is always a pos-sibility of significant mortality and morbidity due to the surgical treatment. Little children with laryngotracheal stenosis most of the time have multisystem diseases that must be taken care by a multidisciplinary team. Therefore working in close contact, and with continuous commu-nication with our colleagues from different medical dis-ciplines as pediatric cardiology, pediatric pulmonary dis-ease, pediatric neurology, pediatric infectious disease, etc. is very important. Decision of surgical treatment should be given only after consulting these colleagues to prevent unexpected complication during or after the surgery. As in the medical disciplines, very close collaboration with our surgical colleagues in pediatric surgery and cardio-thoracic surgery is of utmost importance, as we most of the time, share the same surgical area with them, and their expertise in their own fields always help to prevent complications. The most important cooperation should be built and kept between pediatric anesthesiologists and intensive care specialists and staff, as most of our compli-cations in our clinical setting happens during the early post-operative period in ICU. As Hacettepe University pediatric airway surgery team, we will be presenting our experience with pediatric laryngotracheal stenosis surgery and try to delineate the factors that increase the compli-cation rate in our hands and clinical setting. We will be sharing “what we have learned” from our clinical failures.


Chair : KWANG YOON JUNG

Keynote Lecture IV

» 09:20-09:50

» EvOLUTION OF TRANSORAL ROBOTIC SUR-


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may improve quality of surgery. From robotics to com-puter vision, the tools to perform more precise head and neck surgery is a are emerging. Looking ahead, most lim-itations of what can be done are, in fact, those restrictions we choose to place on our imagination.


Chair : KYUNG TAE

Keynote Lecture VI

» 10:40~11:10

» TREATMENT STRATEgY FOR PAPILLARY THYROID CARCINOMA

KUMA HOSPITAL

YASUHIRO ITO

In this lecture, risk factors of papillary thyroid carcinoma (PTC) will be discussed. To date, several prognostic fac-tors based on pre- or intraoperative have been identified such as old age, large tumor size (T), extrathyroid exten-sion (Ex), extranodal tumor extension (LN-Ex), distant metastasis (M1) at presentation, and clinical node metas-tasis (N1). In guidelines conducted by Japan Association of Endocrine Surgeons and Japanese Society of Thyroid Surgery (now unified as Japan Association of Endocrine Surgery), risk classification was divided into four cate-gories: very low-risk, T1aN0M0: low-risk, T1bN0M0: high-risk, cases fulfilling at least one of these five charac-ters, 1) M1, 2) T > 4 cm, 3) Ex(+), 4) LN-Ex(+), and 5) N > 3 cm: intermediate risk, cases that do not belong to very low, low, and high-risks. Very low-risk PTC can be, although not always, a candidate of active surveillance. Disease-free survival and cause specific survival became significantly poorer from very low to high-risk patients. Therefore, total thyroidectomy is not recommended for very low and low-risk patients, but mandatory for high-risk patients. For intermediate risk patients, our institution performs total thyroidectomy, but guidelines describe that extent of thyroidectomy should be decid-ed in a case-by-case fashion. Furthermore, age is a very important prognostic marker, but interestingly, progno-sis of very low or low-risk patients is excellent regardless


Chair : MIN SIK KIM

Keynote Lecture V

» 09:50-10:20

» PRECISION HEAD AND NECK SURgERY NExT-gENERATION ROBOTIC SURgERY AND BEYOND

STANFORD UNIVERSITY

CHRIS HOLSINGER

Transoral endoscopic head and neck surgery (eHNS) now plays a pivotal role within the multidisciplinary manage-ment of patients with head and neck cancer. Whether performed with transoral robotic surgery (TORS) and/or transoral laser microsurgery (TLM), transoral eHNS appears to provide oncologic and functional outcomes comparable to traditional approaches. Approved in 2009 by the US FDA, TORS plays an important role in the treatment of T1-2 tumors of the oropharynx. Since then, TORS has been performed widely, with low sur-gical morbidity and mortality across community-based and academic medical centers. Recently, a next-genera-tion single-port robotic system was studied in prospec-tive multi-center clinical studies in the United States and Hong Kong. Based on these studies, the use of the device appears feasible, safe and effective for transoral eHNS of oropharyngeal tumors Technical refinements in this next-generation, single-arm flexible robotic system seem capable of ushering in several conceptual advances for the field of robotic head and neck surgery. However, future innovations in hardware and software are sure to push the envelope even further. Materials and mechani-cal engineering advances will bring stronger, more agile instrumentation. Fluorescence imaging technologies, and machine-learning image processing will change the way that we see tissue interfaces and detect oncologic mar-gins. Autonomous robotic behaviors may even become interwoven with our maneuvers to streamline tasks and increase the efficiency and precision of our surgeries. This departure from the conventional master-slave configura-tion, is sure to raise ethical and medicolegal issues, but

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controlled form, there is an abundance of retrospective and prospective reports of TORS and TLM. Both early and advanced stage OPSCC can be operated successfully with operation, with or without adjuvant therapy. Even if there is no solid experimental discrepancy in oncolog-ic results between chemoradiation protocols and surgery with TOS-based approaches, retrospective evaluation supports the advantage of surgery. Furthermore, func-tional results may be superior following TOS treatment. Management of OPSCC will most likely continue to be multidisciplinary with a continuing attempt to de-esca-late treatment to reduce morbidity.

» 11:25-11:40

» BALANCINg BETWEEN THE ONCOLOgIC AND FUNCTIONAL OUTCOMES IN OROPHA-RYNgEAL CANCER: RADIATION ONCOLOgY PERSPECTIvE

PROTON THERAPY CENTER, RESEARCH

INSTITUTE AND HOSPITAL,

NATIONAL CANCER CENTER

SUNG HO MOON

The treatment strategy of 70 Gy of definitive radiother-apy (RT) with concurrent cisplatin in locally advanced oropharyngeal squamous cell carcinoma (OPSCC) has been demonstrated to attain clear survival benefit over that without chemotherapy in several randomized trials [1-3]. However, the acute and delayed toxicities associ-ated with chemo-radiation (CRT) are substantial. Acute toxicities of CRT include mucositis, dysphagia, and der-matitis, which frequently reduce treatment compliance of patients, with gastrostomy tube replacement ranging from 5% to as high as 85% [2- 3, 4]. Furthermore, many patients are observed to be suffering from delayed tox-icities including dysphagia, xerostomia and osteroradio-necrosis. The incidence and severity of toxicities depend upon RT-related factors such as total radiation dose, types of fractionation, and which parts of the head and neck treated. Technical advancement of RT, especially the ad-vent of intensity- modulated as well as multi-disciplinary supportive management including dental care, speech and swallowing therapy reduced the incidence and sever-ity of acute and delayed complications related with RT. Methods to minimize acute and chronic RT-toxicities are summarized as those of organ at risk (OAR) sparing, e.g. salivary sparing, omitting IB or contralateral level II/

of patient age. However, in high-risk PTC, old patients show much poorer prognosis than young patients. In this lecture, extent of lymph node dissection will also be dis-cussed.

HN-RT 1Room 4-3 (Convention C)

Chair : YOUNG HAK PARK, Moderator : YOUNG-IK SON

Balancing between the Oncologic and Functional Outcomes in Oropharyngeal Cancer

» 11:10-11:25

» ONCOLOgIC OUTCOMES: SURgERY vS RA-DIATION



JUNG JE PARK

Oropharyngeal squamous cell carcinoma (OPSCC) originate in the epithelium of the palatine tonsils, base of tongue, and pharyngeal wall. As times has gone on, the clinical epidemiology of OPSCC occurred a critical movement. In the past, exposure of tobacco and alcohol was the main risk factors. The profit of prevention ed-ucation has more and more brought about a decline in the incidence of OPSCC. At same time, there has been a significant increase in the incidence of human papillo-mavirus (HPV)-associated OPSCC. Although HPV-as-sociated tumors show a long-term good prognosis to any therapy for a given stage, as compared with carcinogenic OPSCC, there is not yet enough confirmation collect-ed allowing for a de-escalation of management in these tumors. This point shows a major inquiry in the treat-ment of OPSCC. Both the OPSCC and the definitive management make significant morbidity. H&N surgeon, oncologists and radiation oncologists are recognizing a changing pattern in the cause of OPSCC, namely the in-creasing incidence of HPV(+)OPSS. An attempt is ongo-ing to reduce the morbidity of definitive treatment. Tran-soral surgery including laser microsurgery (TLM) and robotic surgery (TORS) have changed the surgical ap-proach to OPSCC. Although there are no investigations analyzing nonsurgical therapy to TOS in a randomized


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retrospective study on the clinical outcomes in patients with recurrent or metastatic HPV-positive head and neck cancer, the patients with HPV-positivity showed more favorable prognosis and aggressive systemic treatment could lead to a prolonged disease-free period or possibly cure, even after metastasis. Previous studies have demon-strated that levels of pretreatment serum antibodies against the HPV-related E6 and E7 oncoproteins predict disease-free survival in HPV+ OPSCC, suggesting that a highly immunogenic response to these proteins before treatment can be readily detected and may provide in-sight to a patient’s immune status. Moreover, other study suggested that higher E6 and E7 serum antibody levels after chemoradiation therapy are significantly associated with recurrent oropharyngeal cancer and these oncopro-teins can be potential biomarkers of recurrence. However, considering that a lack of standardization in HPV testing and reliance on only p16 in retrospective analysis has also led to a significant overestimation of HPV-positive cas-es as well as poor quality data, a prospective randomized study should be necessary to prove the role of HPV in recurrent oropharyngeal cancer.

» 11:55-12:10

» SALvAgE STRATEgIES FOR RADIATION FAILURE

DEPARTMENT OF HEAD AND NECK SURGERY,

THE NATIONAL CANCER CENTER HOSPITAL,

JAPAN

SEIICHI YOSHIMOTO

Surgery is the mainstay for salvage after radiation failure in the treatment of oropharyngeal cancer. The 2-year and 5- year overall survival rates, after salvage surgery, have been reported to be 50–62% and 23–30%, respective-ly, with a high risk of postoperative local complications. Most patients need a tracheostomy and/or feeding tube, either temporarily or permanently. For advanced tumor, reconstruction with a free flap is recommended to prevent wound complications including carotid artery rupture. Occasionally, total laryngectomy may be suitable for pa-tients who prefer oral consumption of food, without any aspiration. However, surgical salvage can offer extended survival compared to non-surgical approach. Therefore, the curability and quality of life have to be balanced for each patient. Factors reported to have an association with salvage surgery include initial stage of cancer, stage at

retropharyngeal lymph nodes, unilateral neck treatment, limitation of mandibular, constrictor and larynx doses. Recently, the epidemiological changes in OPSCC have led to paradigm shift in the clinical as well as biological researches [5]. The incidence of p16 positive OPSCC is rapidly increasing and now recognized as a distinct entity, compared to p16 negative OPSCC. In general, patients with p16 positive OPSCC have been known to have bet-ter prognosis than those with p16 negative OPSCC in prospective studies [4, 6-13]. In a retrospective analysis of RTOG 0129 study cohort, OS at 3 years was 82.4% in patients with p 16 positive OPSCC and 57.1% in pa-tients with p16 negative OPSCC (p < 0.001) [4]. Taken together, concern for treatment-induced morbidity has prompted the initiation of multiple trials aiming to re-duce treatment-related toxicity. Any of the following 3 definitive treatment paradigms for OPSCC - (1) transoral surgery followed by pathological risk- adapted RT and chemotherapy, (2) concurrent RT and chemotherapy and (3) neoadjuvant chemotherapy followed by CRT has its own de-intensification strategies. Appropriate selection of patients for de-intensified RT is critical and presently not recommended outside of a clinical trial.

» 11:40-11:55

» BALANCINg BETWEEN THE ONCOLOgIC AND FUNCTIONAL OUTCOMES IN OROPHA-RYNgEAL CANCER: PATTERNS OF FAILURE




SEUNG-KUK BAEK

The risk factors most associated with Head and neck can-cer (HNC) are tobacco and alcohol. Recently, human papilloma virus (HPV) has been established as a major cause of Head and Neck cancer, primarily as oropha-ryngeal cancer involving tonsils and base of tongue. The prognostic value and biological implications of HPV sta-tus in locally advanced settings are now well established. However, there are considerably fewer data regarding the role of HPV in recurrent oropharyngeal cancer. The rel-atively low rate of recurrence in patients with locally ad-vanced HPV- positive disease has led to a small number of HPV-positive patients with recurrent oropharyngeal can-cer. It may be difficult to identify the role of HPV in the recurrent oropharyngeal cancer. Undoubtedly, In recent

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With the widespread use of ultrasound-guided fine nee-dle biopsies, there has been an increase in the incidence of small tumors of the thyroid. These microcarcinomas have been diagnosed much more frequently in recent years. There is some debate that these small well differentiated thyroid cancers have been “overtreated” without much benefit in the overall survival. The role of lymphatic in-volvement on long term survival is subject to intensive debate and research and the best indications of lymph node dissection are still controversial. The role of lateral and central neck dissections for well differentiated thy-roid cancers is still being studied and its role should be “tailored” to each individual patient.

» 14:00-14:15

» TUMOR TO TUMOR METASTASIS OF THY-ROID gLAND

CHULALONGKORN UNIV., DEPARTMENT OF

OTOLARYNGOLOGY, THAILAND

NAPADON TANGJATURONRASME

Tumor-to-tumor metastasis is exceeding rare condition. It means identify one malignant tumor cell metastasis to another unrelated tumor, which can be benign or malig-nant. Dobbing and Campbell described the strict criteria include; proven (at least) two primary tumors; the recip-ient tumor must be a true tumor (any benign or malig-nant); donor tumor must be true metastasis. Collision tumor,contiguous tumor and tumor embolism without any invasion to surrounding tumor are exclude from tumor-to-tumor metastasis. Thyroid tumor incidence is increasing worldwide. Despite high frequency of benign follicular nodule and well-differentiated thyroid carci-noma are, tumor-to-tumor metastasis condition involve thyroid tumor as donor or recipient still very uncommon.

» 14:15-14:30

» THE DIFFERENCE BETWEEN PRIMARY vS SECONDARY METASTASIS OF WDTC- PAT-TERN AND OUTCOME

DEP. OTORHINOLARYNGOLOGY,



HONG KONG

recurrence, tumor size, time to recurrence, locoregional recurrence, and HPV status. Therefore, it is important to discuss the indications for salvage surgery with each patient. The surgical free margin is the most import-ant aspect of salvage surgery. Recently the effectiveness of transoral robotic surgery has been reported for select cases of recurrent oropharyngeal cancer without bone in-volvement. However, more clinical evidence is needed to confirm its efficacy.

HN-GD 1Room 4-3 (Convention C)Chair : YASUHIRO ITO,

Moderator : JEONG SOO WOO

State of the Art Management for Papillary Thyroid Carcinoma

» 13:30-13:45

» ExTENT OF THYROIDECTOMY



JEONG-SOO WOO

Extent of thyroidectomy has been a concern always even though endocrinologist’s request of total thyroidectomy for the papillary thyroid cancer. As the surgeons have ac-cumulated their experience in the treatment the patients with the cancer and have watched them after treatment, they have noticed the differences from other cancers and have curiosities of this cancer. Thyroid surgeons have be-gun to modify the extent of thyroidectomy for the pap-illary thyroid cancer carefully according to revision of famous guidelines of treatment for thyroid cancers. Still we are on the way of changing the resolutions for the question about optimal extent of thyroidectomy for the papillary thyroid cancer

» 13:45-14:00

» CENTRAL AND LATERAL NECK MANAgE-MENT

RUTGERS NEW JERSEY MEDICAL SCHOOL, USA

RICHARD CHAN WOO PARK


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to primary thyroid surgery.


Chair : Yoon Woo Koh

New Horizons in Medicine in the Era of 4th Industrial Revolution

» 13:30-13:50

» DIgITAL TRANSFORMATION IN HEALTH-CARE: 3D REvOLUTION

BIOMEDICAL INSTITUTE,


SANG-JOON PARK

The rapid development and proliferation of medical 3D imaging technologies are revolutionizing medicine. The role of medical imaging has expanded beyond the sim-ple visualization and inspection of anatomic structures. A thorough understanding of human anatomy through 3D technologies empowers medical doctors to plan a suitable approach, predict possible complications, prepare neces-sary equipment, and properly counsel the patient. It has become a tool for surgical planning and simulation, in-tra-operative navigation, radiotherapy planning, and for tracking the progress of disease. These 3D technologies have dramatically changed how we think about making things, thus it has been used for scientific discoveries to develop practical applications based on patient-specific information in real clinical medicine. In this lecture, we’ll talk about AI-empowered 3D applications of VR/AR and 3D printing for operating efficient medical workflow including fundamental knowledge with various applica-tions in clinical fields.

» 13:50-14:10

» EvOLUTION OF ROBOTIC SURgERY: FU-TURE PROSPECTS 2019

YONSEI UNIVERSITY

KOON HO RHA

JASON CHAN

Primary papillary thyroid carcinoma commonly metasta-sizes in the primary setting to the regional lymph nodes in the central neck followed by the lateral neck. In rarer circumstances unusual distant metastases may occur in the primary setting. In the secondary setting, the recur-rence patterns do not follow the usual metastatic patterns of primary disease despite most of these still occurring in the lymph nodes. Here we will explore these differences and what factors affect the outcomes in secondary metas-tasis of papillary thyroid carcinoma.

» 14:30-14:45

» SURgICAL TECHNIQUE AND OUTCOMES OF REvISION THYROID SURgERY UNDER RE-CURRENT LARYNgEAL NERvE MONITORIzA-TION

ANKARA UNIV. IBNI SINA HOSP.

ORL&HNS DEP., TURKEY

KURSAT GOKCAN

Revision thyroid surgery may pose additional risks, when compared to primary surgery. We had 133 patients (25.5% male, 74.5% female) with recurrent thyroid pa-thology that needed redo thyroidectomy and/or central neck dissection or redo central neck dissection. There were 97 patients with papillary thyroid cancer (PTC), 3 patients with follicular thyroid cancer (FTC), 11 cases with benign pathology. All patients were operated under recurrent laryngeal nerve monitorization. Mean unstim-ulated Tg level dropped from 7.29ng/ml to 3.31ng/ml in the patients with DTC. With a cut off value of <2ng/ml for biochemical remission, 66.7% of patients with DTC had remission with no evidence of clinical disease, and 27.4% of patients had undetectable levels of Tg with no evidence of clinical disease. In the MTC group, mean un-stimulated calcitonin level dropped from 205.1 pg/ml to 40.7 pg/ml. We encountered 1.96% temporary, 0.98% permanent vocal fold paralysis; 4.8% temporary, 3.2% permanent hypocalcemia among whole group. One pa-tient needed re-intubation due to hematoma and dyspnea at postoperative 6th hour. We conclude that, with the utilization of careful anatomical dissection and utilization of recurrent laryngeal nerve monitoring, revision thyroid surgery can be performed with similar complication rates

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Revo-i is a robot for laparoscopic surgeries that will be used to treat cancer.

» 14:10-14:30

» FLExIBLE ENDOSCOPIC ROBOT FOR HN SURgERY

KOREA ADVANCED INSTITUTE

OF SCIENCE AND TECHNOLOGY

DONG-SOO KWON

This talk will present research on flexible surgical robotics of KAIST center for future Medical robotics. We believe that surgical robot for HN surgery should be developed to satisfy both flexibility for high lesion accessibility and high payload for stable tissue manipulation. It also needs to be able to perform a complex surgical task in confined space. In order to meet these requirements, a flexible en-doscopic surgery robot, K-FLEX, has been developed that can perform dexterous robotic surgery through a flexible pathway by adding small robot arms to the flex-ible endoscope. Due to its flexibility, K-FLEX can be usefully used to access to the lesion located at the deep area in HN surgery. The robot arm provides dexterous motion for performing a surgical task in confined space. An attractive feature of the robot arm is that its arm can exert a great deal of force to manipulate organs and tis-sues with specially designed joint. Several bench-top and in-vivo animal experiments had shown the effectiveness and feasibility of K- FLEX. Next generation of K-FLEX is under development with improved design optimized for head and neck surgery. With these robot technologies, we believe that surgeons can conduct a challenging HN surgery that has not been tried before. Based on our re-search experience over the last 20 years, we are planning to commercialize our research outputs with our company, EasyEndo Surgical Inc. Our flexible robot technologies will extend endoscope application to robotic surgery.

» 14:30-14:50

» TRON - THE TELEROBOTIC OPERATINg NETWORK

CHIEF OF SURGERY, FORT BELVOIR COMMUNITY

HOSPITAL, ASSISTANT PROF., UNIFORMED

SERVICES UNIVERSITY, USA

Intuitive Surgical Inc.’s da Vinci Surgical System is a leading robotic technology in the global market today. Approved by the FDA in 2000, it can be used in cardiac, thoracic, colorectal, general, head and neck, gynecology and urology surgeries. It took several years for Tianjin University, based in China, to develop a minimally inva-sive surgical robot system called the Micro Hand S. From 2014 to 2015, the system went through human clinical trials, operating on patients in need of laparoscopic sur-gery. With positive results and no technical problems or complications encountered, the Micro Hand S has the potential to be a safe and effective system for surgeries in the future. Surgeons in China are required to go through extensive training before they are able to use the surgical robot in operations. Hong Kong is a leading location in Asia where many robotic surgeries have been performed. In 2012, Hong Kong acquired the first Robotic Inter-active Orthopedic (RIO) system in Asia from MAKO Surgical Corporation (acquired by Stryker Corp.). The RIO system is mainly used for partial knee replacement surgeries, but can potentially be used for hip, ligament, and spinal surgeries as well. The RIO system enables the surgeon to hold and guide the robotic arm during the surgery, rather than operate it remotely on a console. Not only can surgeons perform more difficult surgeries with the RIO system, but they can also sometimes do it with less experience. Taiwan has the most surgical robots in Asia relative to its population. While there are benefits to robotic surgery as discussed earlier, many hospitals in Taiwan are being criticized for recommending expensive robot-assisted surgeries when traditional surgeries would have sufficed. In Japan, the government is currently col-laborating with five universities and 14 companies to develop a robotic surgery system that allows doctors to operate with more precision and accuracy, as well as si-multaneously monitor MRI readings and data from other devices. In 2015, Japanese researchers revealed EMARO, an air-powered endoscopic robot that gives surgeons hands-free control and enhances visualization inside a pa-tient’s body with three movable cameras. It is expected to be marketed to hospitals and universities in Japan in the fall of 2016 and be available overseas within the next few years. Like many other Asian countries, Korea is adapting surgical robots for healthcare, too. Robotic surgery train-ing is not required in Korea and has sometimes led to adverse events that possibly could have been avoided. A training center was therefore opened in 2008 at a Korean hospital for surgeons to gain experience and practice the skills necessary to operate surgical robots. Inspired by the renowned da Vinci system, the Meere Company in Korea has been developing the new Revo-i system since 2007.


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these nontechnical hurdles could cripple future research efforts. Using a semi-autonomous model would allow the surgeon to have adequate oversight of the surgical proce-dure and enables a gradual progression towards greater robotic autonomy. Future deployment of surgical robots will enable the Army to deliver immediate damage con-trol surgery/interventions closer to the point of injury, reducing mortality and morbidity rates in future battle-fields. Telesurgery can directly address delayed evacuation and prolonged field care problems that will adversely af-fect military medicine in future MDB environments by acting as a medical force multiplier; it can substantially enhance the capabilities of forward deployed mobile mil-itary treatment facilities, improve military medical read-iness and training, and redefine operational medicine by moving stabilization surgery and surgical expertise farther forward in the MDB battle space. Similarly, telesurgical robots could be deployed during peacetime humanitarian missions or used in rural/remote civilian medical facilities to provide the expertise of multiple surgical specialties in one machine.

HN-MTP 2Room 2-5 (Crane)

Chair : YOUNG SOO RHO, Moderator : DONG IL SUN

My Journey in the Management of Recurrent HNC

» 13:30-13:50

» SALvAgINg ORAL CAvITY CANCER

YONSEI UNIV.

EUN CHANG CHOI

The management of advanced oral cavity cancer has evolved over the last decades. Treatment plans should be individualized based upon patient and tumor factors. In-creased awareness of risk of occult metastasis has prompt-ed acceptance of elective neck dissection. Comprehensive neck dissection is still a dissection of choice for clinically positive neck. Surgery is the mainstay of treatment of ad-vanced lesion with or without postoperative radiotherapy. Postoperative chemotherapy is expanding and evolving.For the salvage cases, treatment with surgery is still main-stay of successful outcome. Recent advancement of sur-

DANIEL J. GALLAGHER

Multi-Domain Battle (MDB) environments, an opera-tional environment involving greater dispersion and near isolation of maneuver units, is likely to cause severe re-strictions on mobility for medical missions and shortfalls in both human and materiel resources due to area denial challenges. Combat units will need to be more self- suf-ficient as delayed medical evacuation becomes increas-ingly likely due to the freedom of movement challenges imposed by the MDB environment. These scenarios will require patients to be held for longer durations near the point of injury with limited medical resources. The im-plementation of tele-robotic surgery has the potential to bring advanced procedures further forward in the battle-field by allowing surgeons to remotely perform the types of interventions necessary for preserving life, preventing morbidity, and improving outcomes. However, employ-ment of tele-robotic surgery in the battlefield is currently infeasible due to the operational communications chal-lenges of limited bandwidth, latency, and loss of signal in the deployed combat environment. Identification and evaluation of the methods to mitigate these communi-cations challenges which hamper tele-robotic surgery are required to enable safe and effective tele-robotic technol-ogies for future forward surgery applications in MDB en-vironments. This research will address current and future gaps in combat casualty care, prolonged field care, and extended enroute care capabilities that can potentially be mitigated by leveraging autonomy in telesurgical robot-ic applications. Our objective is to identify trauma re-lated surgical procedures that could be partly automated with the latest sensor technologies and machine learning to effectively mitigate these problems to enable safe and effective robotic telesurgery. Our semi-autonomous ro-botic framework enables safe and effective telesurgery by accommodating for signal latency with countermeasures such as dynamic motion scaling (slowing down erratic or unintended movements). Additionally, when signal delay becomes too excessive or there is a loss of signal during a procedure, autonomous actions by the robot maybe en-gaged. This would work via the robot utilizing machine learning to have ‘learned’ the surgeons moves from hav-ing observed multiple previous trials or attempts to finish that portion of the task. An inherent risk in introducing disruptive technology such as autonomous robotic tele-surgery is a level of discomfort with the magnitude of change especially in regard to enabling greater autonomy to robots. Without adequate time and effort to establish societal buy-in and ethical norms for telerobotic surgery,

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tients. Further research is required to investigate the asso-ciation between HPV status, patterns of recurrence and survival outcomes following salvage surgery. Post-opera-tive complications following salvage surgery cause signifi-cant morbidity and mortality, affecting 17–78 per cent of patients. These range from mild wound infections to cat-astrophic carotid artery ruptures. High-dose RT (over 60 Gy) is an important factor in locoregional flap or free-flap failure in head and neck reconstructive surgery, likely due to poor wound healing. Local and general complications were also closely correlated in patients with high levels of co-morbidities, including pulmonary disease, diabetes mellitus, myocardial infarction and peripheral vascular disease. We conducted a retrospective chart review from 1994 to 2018 of patients who underwent salvage opera-tions for recurrent oropharyngeal squamous cell carcino-ma in Hallym University Medical Center. Of 91 patients who underwent surgery for recurrent oropharyngeal car-cinoma, 72 patients were included. Mean age were 57.6 years old. The recurrence developed in 30 (41.7%) pa-tients. 3-year and 5-year overall survival rate was 56.5%, 20.8% respectively. 3-year and 5-year disease free survival rate was 55.0%, 21.2% respectively. Univariate analysis showed that patients who had T4a stage or IV stage had significantly lower overall survival rate. Major complica-tions developed in 30(41.7%) patients, and of them, 3 patients had postoperative mortality due to sepsis.

» 14:10-14:35

» MY JOURNEY IN THE MANAgEMENT OF RE-CURRENT NPC


AND NECK SURGERY,SHIN KONG WU HO-SU

MEMORIAL HOSPITAL, TAIWAN

SHENG-PO HAO

NPC is traditionally treated with radiation therapy or combined chemoradiation therapy. However, once it recurs locally, salvage nasopharyngectomy becomes the treatment of choice. Surgical approach to rNPC could be either open or endoscopic approach. To select a good approach for various anatomical site involvement is the cornerstone of successful salvage treatment. There is a paradigm shift of nasopharyngectomy, that is from open to endoscopic. My journey for salvage nasopharyngecto-my starts from open transfacial approach, possibly with elective facial osteotomy, the so called facial translocation

gical techniques made possible for more functionally safe surgical salvaging trial. Young patients had same survival rates comparing old age group through same application of surgical principle and surgical margins.

» 13:50-14:10

» SURgERY FOR RECURRENT OROPHARYN-gEAL CANCER

DAIN ENT SPECIAL HOSPITAL

YOUNG-SOO RHO

Although standard treatments for oropharyngeal squa-mous cell carcinoma vary by surgeon preference and by the stages of the disease, there has been a paradigm shift in the primary treatment of oropharyngeal SCC toward non-surgical treatment modalities. Despite evolution in the treatment modalities available, locoregional recur-rences are a large source of morbidity and mortality. De-spite advances in treatment modalities, surgery remains the main form of salvage treatment to improve patient survival. Salvage surgery appears to be the best chance of survival for patients with recurrent disease. The survival rates of salvage surgery patients were significantly high-er than those for patients treated with palliative chemo-therapy, re-irradiation or supportive care. Salvage surgery is a technically complex procedure necessitating skilled teams, and mortality can still reach. The appropriate se-lection of patients for salvage surgery is crucial given the morbidity and mortality involved. It is thus important to identify factors that can predict outcomes after salvage surgery. Best candidates for salvage surgery are young-er patients with disease-free intervals following primary definitive treatment, and small recurrences for which it is possible to obtain negative margins. The stage of oro-pharyngeal SCC at the time of recurrence has been asso-ciated with survival outcomes following salvage surgery, with overall stage III–IV, T3–4 or N2–3 disease associ-ated with poorer survival outcomes. Positive margins at salvage surgery have been correlated with poorer survival outcomes. Aggressive disease characterized by lympho-vascular invasion, concurrent regional recurrences, and high histological grading with tongue base involvement have all been associated with poorer survival outcomes. Although HPV is associated with improved survival out-comes in primary treatment, several studies have reported no significant difference in survival outcome of salvage surgery between HPV-positive and HPV-negative pa-


April27(Sat)




Chair : SE-HEON KIM

Keynote Lecture VII

» 15:20-15:50

» TRANSNASAL ENDOSCOPIC SURgERY FOR NASO-ETHMOIDAL CANCERS REFLECTIONS ON A 20-YEAR ExPERIENCE


NECK SURGERY, UNIV. OF BRESCIA

PIERO NICOLAI

Sinonasal malignant tumors are rare diseases character-ized by a large histological variability and biological be-havior. Meticulous diagnostic workup is crucial to plan an appropriate histology-driven, patient-tailored man-agement, which is usually based on multimodal strate-gies. In the present lecture, concepts from the contem-porary literature together with data from our 20-year lasting experience will be presented. The first section will focus on epidemiology of anterior skull base malignanc-es. Furthermore, some of the innovative features of the latest WHO pathological classification will be described. Diagnostic and treatment strategies for different tumors will be discussed and surgical nuances of endoscopic approaches will be highlighted based on demonstrative clinical cases. Biology and extension of the tumor are key factors in the treatment decision-making process. The role of non-surgical strategies is currently expanding, es-pecially with regards to neoadjuvant chemotherapy and chemoradiation. However, upfront surgery followed by adjuvant radiation therapy still plays a pivotal role in the management of several histologies. In the last 20 years, transnasal endoscopic resection of sinonasal malignancies has emerged as the surgical treatment of choice for the large majority of cancers involving the anterior skull base. The unparalleled visualization provided by endoscopy al-lows a precise mapping of tumor borders even in critical areas that cannot be safely managed with traditional ex-ternal approaches. In this scenario, intraoperative assess-ment of margin status with frozen sections is of utmost importance to ensure radical resection. Large retrospec-

or modified facial translocation 20 years ago, and now shifting to endoscopic miniinvasive approach in recent 10 years. The indications and contraindications for vari-ous approaches will also be discussed.

» 14:35-15:00

» EvOLUTION OF SALvAgE SURgERY IN LA-RYNgEAL CANCER


NECK SURGERY, UNIV. OF BRESCIA, ITALY

PIERO NICOLAI

A remarkable number of patients with laryngeal cancer are currently treated by (chemo)- radiotherapy as a first-line approach. However, approximately 20-40% will sub-sequently present persistence or recurrence of disease re-quiring salvage surgery. As of today, there is no clear con-sensus on the optimal choice of treatment in the salvage setting, especially for early-intermediate laryngeal can-cers. Patient and tumor characteristics should be carefully assessed before opting for conservative approaches. Pri-mary and recurrent tumor staging both play a significant role in determining the extent of surgery. Similarly, pa-tient comorbidities and pulmonary function may contra-indicate conservative surgical treatments due to the high risk of chronic aspiration. Transoral laser microsurgery has proven to be a viable treatment in selected early-stage recurrent tumors (T1-2 N0), with optimal oncologic and functional outcomes. External partial surgery, with special reference to supracricoid laryngectomies, shows satisfying results in early- intermediate tumors (T1-3 N0), although an increase in complications and adverse events should be expected. Finally, total laryngectomy still represents the most frequent indication for salvage surgery after (chemo)-radiotherapy. However, the rates of pharyngo-cutaneous fistula and pharyngo-esophageal stricture are significantly higher than in treatment-na-ive patients. In this view, pharyngeal reconstruction by means of a pedicled or free flap seems to significantly re-duce these complications.

April27(Sat)




DaVinci SP (Flexible Single Port Robotic System) has led to the implementation of the ultimate “minimally inva-sive HN surgery”. Since it was introduced at the end of October last year, we have successfully performed about 100 DaVinci SP surgeries. There are many advantages in performing various HN surgeries as well as TORS with DaVinci SP and, more importantly, we think we have made a breakthrough in TORT (transoral robotic thy-roidectomy). Transoral robotic thyroidectomy (TORT) is being considered as an ideal method for minimally inva-sive thyroidectomy, as there is less flap dissection during the procedure and no postoperative scars. However, this method also has the limitation of present DaVinci system and some technical problems related to CO2 gas insuffla-tion that must be resolved. We investigated the feasibility and safety of gasless TORT using the latest version of the DaVinci system (SP). Gasless TORT using the DaVinci SP system is feasible and safe for selected patients and is a potential alternative approach for scarless thyroid surgery. In this session, I would like to introduce my experience mainly in the field of Transoral thyroid surgery using Novel Flexible Single Port Robotic System.

2019 ICORL Head and Neck Ultrasound International

Joint Symposium

Room 2-5 (Crane)Chair : JEONG KYU KIM, WOOJIN CHO

2019 ICORL Head and Neck Ultrasound International Joint Symposium

» 15:20-15:30

» APPLICATION OF ULTRASOUND-gUIDED CORE BIOPSY FOR AN ELDERLY INFIRM PA-TIENT WITH HUgE NECK MASSES


HEAD AND NECK SURGERY, NATIONAL TAIWAN

UNIVERSITY HOSPITAL, TAIWAN

CHUN-NAN CHEN

Head and neck masses are common medical problems encountered in ENT- HN surgeons’ daily practice. A

tive series from different institutions have demonstrated the oncological adequacy of this approach together with a number of advantages in terms of quality of life, hos-pitalization time, morbidity, and mortality compared to traditional external techniques.

HN-MTP 3Room 2-3 (White Heron)

Chair : GUK HAENG LEE, Moderator : YOON WOO KOH

Transoral Endoscopic Thyroidectomy

» 15:20~15:50

» PRINCIPLE AND UPDATED EvIDENCE OF TRANSORAL THYROIDECTOMY


HONG KONG

HOK NAM LI

Transoral Thyroidectomy is a natural orifice transluminal endoscopic surgery, and it has been adopted for thyroid surgery because of its potential for scar-free operation. Most of thyroid patients are female and relatively young. Therefore, there is increasing demands for removal of thyroid pathology with additional aesthetic benefit now-adays. Currently many hospitals in Asia, US, Europe have already started with this approach successfully. The lecture is going to review the principle of transoral thy-roidectomy, and discuss the most up-to-date evidence on the benefit and complication rate of this novel approach.

» 15:50~16:20

» gASLESS TRANSORAL ROBOTIC THYROID-ECTOMY USINg DAvINCI SP SYSTEM

YONSEI UNIVERSITY

YOON WOO KOH

Thanks to the remarkable development of robotic (Da-Vinci) system, we were able to expand the scope of the robotic HN surgery. Very recently, the introduction of


April27(Sat)



the examination.

» 15:40-15:50

» A CASE OF PRIMARY THYROID LYMPHO-MA DIAgNOSED BY SURgEON-PERFORMED CORE NEEDLE BIOPSY

DEPARTMENT OF OTORHINOLARYNGOLOGY &


KOREA CANCER CENTER HOSPITAL

IK JOON CHOI

Background: Primary lymphoma of the thyroid is a rela-tively rare malignant thyroid neoplasm. It is known to be frequently associated with Hashimoto’s thyroiditis. The clinical presentation includes an enlarging neck mass, ac-companied by dysphagia, dyspnea or hoarseness, with its most common histologic type being the diffuse large B cell non-Hodgkin’s lymphoma. Given the rarity of this disease, making a prompt diagnosis can be challenging. For instance, fine-needle aspiration (FNA) cytology, which is the first-line diagnostic test that is performed in patients with thyroid nodules, is often not diagnos-tic in cases of thyroid lymphomas, with subsequent de-lay of the start of therapy. Case Presentation: Here we report the case of a 81-year-old man presenting with a rapidly enlarging thyroid mass. Thyroid ultrasonography demonstrated a solid hypoechoic nodule. FNA cytology was only suggestive of a Hashimoto’s thyroiditis and did not provide a definitive diagnosis. It is core needle biop-sy (CNB) that helped us to overcome the limitations of routine FNA cytology, showing the presence of thyroid lymphoma (DLBL; diffuse large B cell lymphoma). Sub-sequent incisional biopys demonstrated DLBL subtype (GCB Type). The early start of an intensive multi- agent chemotherapy resulted in complete disease remission. At 9 months after the diagnosis, the patient is alive and has not had any recurrence. Conclusion: In case of rap-id growing, large thyroid mass accompanied by dyspha-gia, dyspnea or hoarseness, thyroid lymphoma should be suspected by clinicians. The ultrasonoic procedures in-cluding FNA, CNB or incisional biopsy performed by a surgeon offers several advantages over the same proce-dures performed by a radiologist. One of the strongest advantages is that it is possible to make decision making about treatment through quick and accurate diagnosis by surgeon in office.

lengthy list of differential diagnoses may lead to many possible treatment plans before definite histopathological evidences, especially for malignancies. Open biopsy is the gold standard procedure for decision making, but it may be a big challenge for an elderly patient with multiple comorbidities. Ultrasound-guided tissue sampling ap-proach provides an alternative way to help these patients. A 72-year-old man with a huge parotid and neck mass-es was referred to the National Taiwan University Hos-pital for tissue proof. He had type II DM retinopathy and coronary artery disease status post coronary artery bypass surgery. Lab data showed only eosinophilia but it was not controlled by steroid. Ultrasound showed mul-tiple lymph nodes scattered at intra-parotid region and all levels of right neck. Considering the patient’s multi-ple comorbidities and risk of general anesthesia, ultra-sound-guided core biopsy (USCB) under local anesthe-sia was performed instead of open biopsy under general anesthesia. Final pathology and flow cytometry revealed diffuse large B cell lymphoma and these huge masses re-solved dramatically after standard chemotherapy. A ma-jor operation was avoided for this elderly infirm patient with huge neck masses by correct USCB diagnosis. Our experience confirmed that application of USCB provides a minimally- invasive manner to guide the most precise and individualized treatment plan for this patient.

» 15:30-15:40

» ULTRASONOgRAPHIC EvALUATION OF UP-PER AIRWAY STRUCTURES IN CHILDREN

DEP. OF OTOLARYNGOLOGY, NATIONAL TAIWAN

UNIV. HOSP. AND CHILDREN HOSP., TAIWAN

CHE YI LIN

The anatomic structures factors and abnormal neuromus-cular functions of upper airway compose the pathophys-iology of obstructive sleep apnea (OSA) in children. The direct oropharyngeal examinations for tonsil grading and the position of the tongue and palate are the primary as-sessment in children’s upper airway. Other image modal-ities, including the cephalometry, computed tomography and magnetic resonance image also used to give quan-titative evaluation of upper airway structures, but these are irradiation or cost much. Here we will demonstrate how we use the head and neck ultrasound in evaluation of upper airway structures in children. We will also dis-cuss the pit and fall of this non-invasive imaging during

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sy or endoscopic procedures. In this session, I introduce several applications that shows expanded use of neck US for evaluation of upper aerodigestive tract which may en-hance ENT physician’s diagnostic performance.

» 16:10-16:20

» OBJECTIvE ASSESSMENT OF POSTOPER-ATIvE SWALLOWINg DIFFICULTY THROUgH ULTRASOUND IN PATIENTS UNDERgOINg THYROIDECTOMY



COLLEGE OF MEDICINE

JAE-GU CHO

Background: Swallowing discomfort is a common post-operative complaint in patients undergoing thyroidecto-my. Contraction of the strap muscles might cause resis-tance to elevation of the laryngotracheal unit, and down-ward movement of the laryngotracheal unit may lead to swallowing discomfort. However, few studies have eval-uated the mechanism related to limited laryngotracheal elevation after thyroidectomy. We aimed to objectively verify the presence of postoperative impaired laryngotra-cheal elevation through ultrasound evaluation in patients undergoing thyroidectomy and evaluate its relationship with limitation of laryngotracheal elevation. Methods: This is a prospective clinical study. Among patients un-dergoing hemithyroidectomy and total thyroidectomy, the patients who were followed up for ≥ 6 months were selected (N=40). Ultrasound evaluation was done pre-operatively and at 1, 3, and 6 months postoperatively. Laryngotracheal movement was recorded and the length of elevation was measured. Symptom after thyroidec-tomy was evaluated through swallowing-related items of thyroidectomy-related voice questionnaire. Results: Ultrasound evaluation verified the presence of limited laryngotracheal elevation postoperatively in patients un-dergoing thyroidectomy. After thyroidectomy, the swal-lowing-related score was significantly increased, and was recovered time-dependently at 1 month. Laryngotracheal elevation showed significant decrease after thyroidecto-my. The symptom score of swallowing was significantly correlated with the length of laryngotracheal elevation. Conclusion: Post-thyroidectomy ultrasound evaluation verified that laryngotracheal elevation was significantly impaired. Presence of adhesion between the laryngotra-

» 15:50-16:00

» CLINICAL APPLICATION OF LARYNgEAL UL-TRASONOgRAPHY FOR THE TREATMENT OF PATIENTS WITH vOICE DISORDER


COLLEGE OF MEDICINE, YEUNGNAM UNIVERSITY

YOON SEOK CHOI

Scanning the neck for lymph nodes and the thyroid gland is an integral part of head and neck US in the clinical set-ting but laryngeal US is not used that often. Just recently it was suggested that it could be used for the examina-tion of the laryngeal regions. But there had been studies in the past as well and already at this time it was found that the visualization of the larynx had its limitations due to thyroid cartilage especially in older men. Some stud-ies suggested lateral approach of larynx which improved the visualization of laryngeal internal structure such as thyroid cartilage, cricoid cartilage, arytenoid cartilage, trachea, the cricothyroid muscle and thyroid arytenoid muscle. Clinical application of laryngeal US to assess the vocal lesion was reported in children, which was also used to assess the vocal cord paralysis or crico-arytenoid joint dislocation. But previous use of laryngeal US were diagnostic method. In this presentation, I explain the US images of Internal structure of larynx and report the cases of using laryngeal US for treatment of patient with voice disorder.

» 16:00-16:10

» ExPANDED USE OF HEAD AND NECK UL-TRASOUND - A SINgLE SURgEON'S ExPERI-ENCE

KYUNGPOOK NATIONAL UNIVERSITY

DONG BIN AHN

Ultrasonography (US) has been used as a first-line imag-ing modality for evaluation of neck lump involving the thyroid gland, lymph nodes, salivary gland, and other neck structures. However, I often use neck US to evaluate some of upper aerodigestive tract disease, combining with US-guided FNAC and CNB, to facilitate immediate and accurate diagnosis without additional operating-room based procedures such as suspension laryngoscopic biop-


April27(Sat)



ty to the primary tumor. We applied high-resolution US to identify metastatic lingual lymph node in oral cavity cancer. In comparison with other imaging modalities, the ultrasonographic appearance of metastatic lingual lymph nodes was more definite. The metastatic lingual lymph node with irregular margin and the hypoechoic feature can be identified in the sublingual space by ultrasonog-raphy. Therefore, we recommend that detection for lin-gual lymph node in oral cavity cancer should be routinely done by ultrasonography before surgery.


Moderator : HIROYA KITANO, KWANG YOON JUNG

APTS Symposium

» 16:20-16:35

» ACTIvE SURvEILLANCE OF PTMC

KUMA HOSPITAL, JAPAN

YASUHIRO ITO

Most low-risk papillary thyroid microcarcinomas (PT-MCs) generally have an indolent character, while its small portion constantly grows and becomes clinical. Active surveillance was initiated from 1993 in Kuma Hospital and from 1995 in Cancer Institute Hospital. At 10-year active surveillance in Kuma Hospital, only 8.0% and 3.8% of patients showed size enlargement by ≥ 3 mm and novel appearance of node metastasis, respectively. Importantly, none of the patients showed life-threaten-ing recurrence or died of thyroid carcinoma during active surveillance. Active surveillance is therefore recognized as the first-line of management of low-risk PTMC. In this lecture, several clinical questions will be discussed such as 1) how to evaluate tracheal and/or recurrent laryngeal nerve invasion, 2) how to manage young and old patients with PTMC, 3) how to manage PTMC patients with family history, 4) how to manage PTMC patients who have a chance of pregnancy, and 5) the appropriateness of “prophylactic hemithyroidctomy” for solitary PTMC.

cheal unit and the superficial soft tissue was the probable cause of the limitation at 6 months after thyroidectomy. The length of laryngotracheal elevation was related to the symptom score of swallowing after thyroid surgery.

» 16:20-16:30

» CURRENT TRENDS OF HEAD AND NECK UL-TRASOUND IN HONg KONg


HONG KONG

HOK NAM LI

Ultrasound is an important skill for thyroid surgeons. It help us to interpret the thyroid lesion in clinic, improve the quality of consultation to patient, help us to have an idea of the lesion before surgery, and monitor for any re-currence of thyroid malignancy. We can have ultrasound fine needle aspiration to help the diagnosis for our thy-roid patients. And we can also have ultrasound guided intervention including ethanol injection and radiofre-quency ablation as the treatment for some of the thyroid patients. So nowadays in Hong Kong and over the world, more and more thyroid surgeons learn the ultrasound skills and use it as their routine in the management of thyroid patients.

» 16:30-16:40

» THE IMPORTANCE OF ULTRASONOgRAPHIC DETECTION OF METASTATIC LINgUAL LYMPH NODE IN ORAL CAvITY CANCER



JUNG-HAE CHO

It is known that the lymphatic drainage of the oral cav-ity does pass through the intervening tissues of the floor of the mouth before entering the upper cervical lymph nodes. There are some lymphatic tissues in the floor of mouth that will not be dissected using discontinuous neck dissection. The lymphatic tissue between the oral cavity and neck can harbor tumor cells in transit. Metastatic lin-gual lymph nodes cannot be easily detected by contrast neck CT scan or PET-CT scan because of their proximi-

April27(Sat)




and time-consuming for anesthesiologists, 3) Rotation, upward displacement or downward displacement of the EMG tube during surgical manipulation may cause an unstable signal due to insufficient contact between elec-trodes and vocal folds, 4) The EMG tube may not be applicable in patients who have had tracheostomy or in patients who require tracheostomy for general anesthesia and 5) If the EMG tube is not routinely used, replacing a regular tube with an EMG tube may be difficult in case IONM is unexpectedly required during surgery. There-fore, a novel alternative recording method that is much more convenient and reliable is necessary.

» 17:05-17:20

» IONM IN REMOTE ACCESS THYROIDECTO-MY



HANYANG UNIVERSITY,


KYUNG TAE

Temporary RLN palsy is significantly higher in the re-mote access robotic and endoscopic thyroidectomy com-pared to conventional thyroidectomy especially in steep learning curve, due to limited working space and difficult technique. Intraoperative neural monitoring of the RLN in thyroidectomy has been used as an addition to direct visual identification, in order to decrease the rate of RLN palsy and improved the identification of RLN. Special-ly, IONM is very useful in robotic and endoscopic thy-roidectomy to identify and confirm the RLN in narrow working space and limited surgical view. I would like to evaluate the feasibility and efficacy of IONM in robotic and endoscopic thyroidectomy via facelift and transoral approach. In results, the failure rate of IONM in re-mote access thyroidectomy is relatively higher compared to conventional thyroidectomy. Also there is a learning curve for not only IONM technique but also robotic/endoscopic technique. It is difficult to perform standard IONM procedure, and also it is difficult to follow the troubleshooting algorithm for LOS because of difficult laryngeal twitch and contralateral vagal assessment. How-ever, IONM in Robotic/endoscopic Thyroidectomy has many advantages such as identification and confirmation of RLN and EBSLN in the limited surgical space and an-gle of view, aid in dissection of RLN, predict postopera-

» 16:35-16:50

» PAEDIATRIC THYROID SURgERY IN A TER-TIARY REFERRAL CENTRE

MANCHESTER UNIVERSITY FOUNDATION TRUST

SEAN LOUGHRAN

Paediatric thyroid and parathyroid surgery is an uncom-mon procedure. This presentation will show the senior authors current practice over the last 7 years. The char-acteristics and demogoraphics of the patient population will be presented as well as complications which are equivalent to those seen in adult surgery. In addition, there will be comparison with a second series from an allied instituion where surgery was performed principally by paediatric general surgeons.

» 16:50-17:05

» ADvANCES IN IONM

DEPARTMENT OF OTOLARYNGOLOGY - HEAD

AND NECK SURGERY, KAOHSIUNG MEDICAL

UNIVERSITY, TAIWAN

FENG YU CHIANG

Stimulating probe and EMG endotracheal tube are nec-essary facilities for nerve stimulation and EMG record-ing during intraoperative neuromonitoring (IONM) of recurrent laryngeal nerve (RLN) in thyroid surgery. However, there are several limitations of use in clinical practice. The hand-held stimulating probe provides an intermittent stimulation. The functional integrity of the RLN is limited to the short time interval of the direct nerve stimulation. The RLN is still at risk of damage in the time gap between two stimulations, and the nerve injury is recognized by the occurrence of loss of signal. To overcome the limitation of intermittent IONM, real-time IONM is necessary. EMG endotracheal tube is popularly used for EMG signals recording in the current monitored thyroidectomy. Several limitations were encountered during clinical use, including the followings: 1) Good contact quality between electrodes and vocal cords must be maintained for EMG signals recording, 2) Verification of proper electrodes-cords position after neck positioning is necessary with direct laryngoscopy or laryngofiberos-copy and repositioning an EMG tube is troublesome


April27(Sat)




MANCHESTER ROYAL INFIRMARY,

MANCHESTER, UK

NAVIN MANI

Anaplastic thyroid carcinoma is recongnosed to have a poor prognosis, with a propensity for early airway comp-timise dur to local invasion. Management of the airway in these patients can be challenging. We analysed a series of patients to provide guidance on airway management in this group of patients. METHODS: Patients with histo-logically confirmed ATC were identified from our insti-tutional database. The data were retrospectively analyzed using hospital case notes. RESULTS: Twenty-six patients were identified with ATC, 25 of who died from the dis-ease. Five of 26 patients (19%) had stridor at presenta-tion. A further 6 of 26 patients (23%) developed stridor during or soon after radiotherapy. Nine patients (36%) died of airway obstruction. CONCLUSION: Tracheot-omy can facilitate completion of palliative treatment in those patients with ATC and stridor. Given the short life expectancy of these patients, a balanced decision must be made regarding the role and timing of tracheotomy.

tive RLN function. Also we can elucidate the mechanism of the RLN injury and improve surgical technique.

» 17:20-17:35

» PARATHYROID LOCALIzATION AND MAP-PINg USINg AUTO FLUORESCENCE

PROFESSOR, DEPT OF OTOLARYNGOLOGY HEAD

AND NECK SURGERY, KOSIN UNIVERSITY GOSPEL

HOSPITAL, BUSAN, KOREA

KANG-DAE LEE

Education Background - 1984 : graduated from Busan National University College of Medicine - 1994 : Ph.D in Busan National University. - 1989 : Residency at Bu-san National University Hospital Professional Career - 1989 ~ present : Professor in Kosin University College of Medicine Major interests -Thyroid Surgery, Head and Neck Laser Surgery Publications (the latest 5 articles. 1. Near-Infrared Autofluorescence Image-Guided Parathy-roid Gland Mapping in Thyroidectomy. Kim SW, Lee HS, Ahn YC, Park CW, Jeon SW, Kim CH, Ko JB, Oak C, Kim Y, Lee KD. J Am Coll Surg. 2017 Nov 6. [Epub ahead of print] 2. Current trends of practical issues con-cerning micropapillary thyroid carcinoma: The Kore-an Society of Thyroid-Head and Neck Surgery. Lee YS, Lee BJ, Hong HJ, Lee KD. Medicine (Baltimore). 2017 Nov;96(45):e8596. 3. Intraoperative Real-Time Lo-calization of Normal Parathyroid Glands With Autoflu-orescence Imaging. Kim SW, Song SH, Lee HS, Noh WJ, Oak C, Ahn YC, Lee KD. J Clin Endocrinol Metab. 2016 Dec;101(12):4646-4652 4. Voice outcome accord-ing to surgical extent of transoral laser microsurgery for T1 glottic carcinoma. Lee HS, Kim JS, Kim SW, Noh WJ, Kim YJ, Oh D, Hong JC, Lee KD. Laryngoscope. 2016 Sep;126(9):2051-6. 5. Clinical significance of mel-anoma-associated antigen A1-6 expression in sputum of patients with squamous cell carcinoma of the larynx and hypopharynx. Lee KD, Lee HS, Kim SW, Park T, Hong JC, Chang HK, Jung SB, Jeon CH, Park JW. Head Neck. 2016 Apr;38 Suppl 1:E736-40.

» 17:35-17:50

» AIRWAY MANAgEMENT IN ANAPLASTIC THYROID CANCER

UNIVERSITT DEPARTMENT OF

April27(Sat)




Korean Session ORLSP Audiologist

Room 3-1 (Emerald A)Chair : JUN HO LEE

Application of audiologic tests for auditory neuropathy spectrum disorder?

» 10:40-11:00

» WHAT IS AUDITORY NEUROPATHY SPEC-TRUM DISORDERS (INTRODUCTION)

KYUNGPOOK NATIONAL UNIVERSITY HOSPITAL,

DAEGU, KOREA

KYU-YUP LEE

Auditory Neuropathy (AN) – also known as Auditory Neuropathy Spectrum Disorder (ANSD) – is a type of hearing disorder in which the cochlea can detects sound, but has a problem with sending sound signal from the cochlea to the brain. It can affect people of all ages, from child through adult. The prevalence of ANSD is not known, but current information suggests that ANSD plays a substantial role in hearing impairments. When their hearing sensitivity is tested, people with ANSD may have normal hearing threshold or hearing loss ranging from mild to severe. They always have poor speech-dis-crimination abilities, meaning which they have difficul-ties understanding speech clearly. People with ANSD have greater impairment in speech discrimination than hearing.

» 11:00-11:20

» TEOAE 와 DPOAE 검사의 해석과 임상 적용

DEPARTMENT OF OTOLARYNGOLOGY, ULSAN

UNIVERSITY COLLEGE OF MEDICINE, ASAN

MEDICAL CENTER, SEOUL, KOREA

JOONG HO AHN

이음향 방사(otoacoustic emission, OAE)란 와우 내 외유모세포(outer hair cell)에서 기원하는 유모세포의 능동적인 움직임을 측정하는 검사로 검사방법이 비교적 간단하고 비침습적이며, 객관적인 결과를 보여주기 때문에 신생아 난청 선별검사 및 소음성, 노화성 난청의 진단과 경과 관찰에

사용되고 있습니다. 이번 강의에서는 이비인후과 외래에서 널리 사용되는 일과성 이음향 방사(transient evoked OAE, TEOAE)와 주파수 변조 이음향 방사(distortion product OAE, DPOAE)를 중심으로 이음향 방사 검사의 결과 판독 및 임상 적응 및 환자 증례 등에 관해서 강의할 예정입니다.

» 11:20-11:40

» ELECTROCOCHLEOgRAPHY



COLLEGE OF MEDICINE

SUNG IL CHO

Auditory neuropathy spectrum disorder (ANSD) is hear-ing dysfunction characterized by abnormal transmission to or within the auditory nerve with relative sparing of cochlear function. The site of lesion appears to have prognostic significance: abnormalities restricted to the inner hair cells, the synapse, and the terminal dendrites of the auditory nerve allow for better CI outcomes than abnormalities of spiral ganglion cells, myelination, or the central nervous system. Diagnostic findings of ANSD in-clude the absence of auditory brainstem response (ABR) and the presence of cochlear outer hair cell function as determined by otoacoustic emissions (OAEs) and cochle-ar microphonic (CM). Electrocochleography (ECochG) is a technique for recording evoked potentials from the inner ear, generally believed to originate from hair cells and nerve fibers, and is a useful tool in the diagnosis of ANSD. The three main components of the ECochG are the CM, summating potential (SP), and action poten-tial (AP). The CM is generated by the outer hair cells (OHC). When the stereocilia bend back and forth, they produce an electrical response at the apex of the hair cell, which is recorded as a CM. The SP arises primarily from the inner hair cells (IHC), although there may be oth-er contributions from the rest of the cochlea including the stria vascularis. And, the AP which arises from the afferent fibers in the distal portion of VIIIth nerve near-est to the cochlea is exactly the same response as ABR wave I. ECochG helps to differentiate OHC from IHC or presynaptic losses, and from auditory nerve fiber or postsynaptic losses. Detailed information about the site of lesion lead to proper management of patients suspect-ed of ANSD.

April27(Sat)



April 27(Sat) ORLSP

liable results can be obtained with round window stimu-lation, alternating stimulus polarity and eABR recording with broad filter settings (0.5 Hz – 3 kHz) from the con-tralateral side. Supported by Interacoustics, Denmark

» 12:20-12:40

» BEHAvIORAL TEST FINDINgS AND AIDED PERFORMANCE FOR ANSD



YONSEI UNIVERSITY COLLEGE OF MEDICINE,

SEOUL, KOREA

EUN JIN SON

Auditory Neuropathy spectrum disorder (ANSD) is a hearing loss characterized by elevated or abnormal au-ditory brainstem (ABR) waves with evidence of normal cochlear outer hair cell function as demonstrated with presence of cochlear microphonics or optoacoustic emis-sions. Sites of lesion may occur at various locations along the auditory pathways, including the inner hair cells, the synapse with the auditory nerve, or the auditory nerve itself. ANSD presents with varying degrees of hearing loss, ranging from normal to profound, and the hearing thresholds may fluctuate or progress. More importantly, speech perception impairments may be worse than ex-pected from the pure tone audiogram. Also, patients may experience more difficulty in understanding speech in noise, which has been attributed to temporal processing deficits. Current options for hearing rehabilitation for ANSD patients include hearing aids, cochlear implants and frequency-modulated technology. In this presenta-tion, current practice of hearing aid fitting in children with ANSD will be described with review of available evidence that indicates some children can benefit from hearing aids, although the audiological and language out-comes not correlate to typical sensorineural hearing loss.

» 11:40-12:00

» ABR FOR AUDITORY NEUROPATHY SPEC-TRUM DISORDER




YONG-HO PARK

Auditory neuropathy sepectrum disorder is mostly easy to overlook and often difficult to diagnose, but it can be diagnosed by various electrophysiological methods. In this lecture, we will discuss the role of the auditory brainstem response in diagnosing auditory neuropathy sepectrum disorder.

» 12:00-12:20

» eABR AND TRANS-TYMPANIC EEABR PRO-CEDURES AND CLINICAL ExAMPLES


HEAD AND NECK SURGERY, AUDIOLOGY AND

PEDIATRIC AUDIOLOGY, COCHLEAR IMPLANT

CENTER, UNIVERSITY OF COLOGNE, GERMANY.

MARTIN WALGER

Recording of electrically evoked auditory brainstem re-sponses (eABR) provides a useful tool for the pre-, peri- and postoperative evaluation of auditory function on brainstem level in Cochlear Implant candidates. Especial-ly in difficult clinical cases like malformations of the co-chlea and/or auditory nerve, acoustic neuroma surgery or auditory synaptopathy/neuropathy (AS/AN) a preopera-tive transtympanic eeABR recording can provide import-ant indication criteria or prognostic factors regarding the rehabilitation outcome after cochlear implantation. The eeABR results from different clinical cases with inner ear malformations, during and after acoustic neuroma sur-gery as well as auditory synaptopathy/neuropathy (AS/AN) will be presented. For electrical stimulation we used a free programmable neurostimulator “ISIS” (inomed company, Germany) and evaluated the influence of elec-trode positions, filter settings and stimulation parameters to reduce the electrical artifact for optimal and reliable detection of eeABR components. The best and most re-

April27(Sat)






CHAN IL SONG

Approximately 40% of people over 75 years of age are suffering from hearing impairment. Because presbycusis is permanent and irreversible, there is no specific treat-ment to restore hearing impairment. Because hearing loss in the elderly is closely related with quality of life, hear-ing rehabilitation programs using hearing aids are very important. Hearing aids partially overcome the deficits associated with a hearing loss. For a sensorineural hear-ing loss, there are several deficits to be overcome. Some sounds are inaudible and other sounds can be detected because part of their spectra is audible. Also, some sound may not be correctly identified because the part of their spectra remain inaudible. A hearing aid has to amplify weak sounds more than it amplifies intense sounds. In addition, a person with a sensorineural hearing impair-ment needs a signal-to-noise ratio greater than normal to communicate effectively, even when sounds have been amplified by a hearing aid. However, a conductive im-pairment simply attenuates sounds as they pass through the middle ear. To understand how hearing aid work, the physical characteristics of signals must be understood: frequency, period, wavelength, diffraction, pressure (sound pressure level), spectrum, octave, critical bands, and impedance. The amplifiers inside hearing aides can be classified as linear or nonlinear. Hearing aides are de-scribed according to where they are worn: body, specta-cle, behind-the-ear (BTE), in-the-ear (ITE), in-the-canal (ITC), completely-in-the-canal (CIC), invisible-in-canal (IIC), and receiver-in- canal (RIC).

» 11:20-11:40

» 음성질환



UNIVERSITY BORAMAE MEDICAL CENTER

DOH YOUNG LEE

음성의 변화는 다양한 성대 점막 질환 및 후두 근육 및 신경 이상에 의해 발생할 수 있어, 이에 대한 기본적인 해부 및 생리를 이해하는 것이 중요하다. 음성질환은 그 원인에 따라 감염/염증성, 성대 점막 병변, 기능적 이상, 신경학적 문제 등으로 분류를 할 수 있으며 다음의 표와 같다.

Korean Session ORLSP Nurse 1

Room 3-2 (Emerald B)Chair : 홍현준

외래에서 자주 접하는 이비인후과 질환의 진단과 치료

» 10:40-11:00

» 외래에서 흔히 접하는 어지럼




MYUNG HOON YOO

어지럼증은 일차 의료기관을 찾는 환자들의 9번째로 흔한 주 증상으로, 65~75세에서는 3번째로 흔한 주 증상이며 그 이상의 고령에서는 가장 흔한 주 증상이다. 어지럼은 현훈, 불균형, 머리가 텅 빈 느낌, 실신 또는 자세불안정 등의 여러 형태로 나타날 수 있는데, 그 중 “실제로 움직이지 않는데도 본인 또는 세상이 도는 듯한 느낌”으로 정의할 수 있는 현훈은 전체 일생에서 발병률이 1~7%까지 보고되고 있다. 이렇게 어지럼은 이과 영역에서 가장 흔한 증상 중 하나로, 대부분 말초평형기관의 질환에 의해 생긴다. 이런 현훈의 원인은 다양한데, 그 중 소위 ‘이석증’으로 알려진 양성 돌발성 체위성 현훈 benign paroxysmal positional ver-tigo (BPPV) 이 가장 많고, 그 뒤를 전정신경염 vestibular neuritis (VN), 전정편두통 Vestibular migraine, 메니에르병 Meniere’s disease (MD) 등이 흔한 것으로 알려져 있다. 현훈의 감별질환을 위해서는 과거력, 임상양상 등에 대한 문진이 필수적이며, 이에 더하여 이학적 검사 및 전정기능검사를 시행함으로써 진단을 내리게 된다. 심각한 합병증이 동반될 수 있는 중추성병변이 의심되는 경우에는 신경학적 검사 또는 자기공명영상 등의 영상학적 검사도 시행될 수 있다. 본 강의에서는 외래에서 흔히 접할 수 있는 어지럼증 질환 의 진단과 치료 과정을 소개하고, 임상적으로 중요한 소견들을 정리하여, 현훈 환자의 진료업무에 도움이 되고자 한다.

» 11:00-11:20

» HOW TO USE HEARINg AIDS FOR HEARINg IMPAIRMENT PATIENTS


April27(Sat)



April 27(Sat) ORLSP

» 12:00-12:20

» DIAgNOSIS AND TREATMENT FOR OB-STRUCTIvE SLEEP APNEA



UNIVERSITY COLLEGE OF MEDICINE, BUCHEON

HOSPITAL, BUCHEON, REPUBLIC OF KOREA

JI HO CHOI

Obstructive sleep apnea (OSA) is a chronic sleep disor-der characterized by intermittent complete or/and par-tial upper airway collapse that disrupts the normal sleep architecture and respiration. The prevalence of OSA was estimated to be 9–16% in women and 24–27% in men based on the severity of OSA such as apnea-hypopnea index (AHI) difined as the number of apneas plus hypo-pneas per hour of sleep. OSA may induce various symp-toms including morning headache, memory impair-ment, excessive daytime sleepiness, poor concentration, impotence and decreased quality of life. If OSA remains without diagnosis and treatment, serious complications such as hypertension, coronary artery disease, arrhyth-mia, insulin resistance, and cerebrovascular sequelae can occur. There are various treatments including positive airway pressure (PAP), oral appliance, surgical therapy, weight control, and positional therapy. Of these, PAP, oral appliance, surgical therapy are main treatment. PAP has an important role as a pneumatic splint to prevent obstruction of the upper airway during sleep. Oral ap-pliance such as mandibular advancement device (MAD) protrude the mandible to maintain the upper airway pa-tency and to increase the pharyngeal muscle tension. Sur-gical therapy is desinged to improve respiratory distur-bances by surgical modification of dysfunctional upper airway anantomy. Positional therapy is desinged to avoid a supine position or persist a non-supine position during sleep. Weight control is recommended for overweight or obese patients with OSA. If OSA is suspected, accurate diagnosis and appropriate treatment are needed.

» 12:20-12:40

» 만성 부비동염의 치료



음성질환의 치료를 약물치료, 음성치료, 후두주입술, 후두미세수술 등으로 다양하며 각 질환에 따라 적절하게 사용해야 한다. 저자는 각각의 질환의 이해 및 치료 방법에 대해 설명하고자 한다.

» 11:40-12:00

» 갑상선 종물의 진단적 접근방법

DEPT OF OTORHINOLARYNGOLOGY-HEAD NECK

SURGERY, CHA UNIVERSITY,

BUNDANG MEDICAL CENTER

SO-YOON LEE

갑상선 종물의 가장 정확한 진단은 초음파를 통하여 이루어진다. 초음파 기기의 발전과 국민들의건강에 대한 관심의 증가로 갑상선 결절의 진단과 치료에 대한 관심 또한 증가하고 있다. 갑상선 종 물의 진단을 위하여 가장 많이 시행되는 초음파를 포함한 다양한 검사와 방법에 대하여 알아보고 검사 전 준비와 검사 진행과정 및 양성, 악성이 의심되는 갑상선 종물의 각각의 진단학적 특징을 알 아본다. 또한 갑상선 종물의 발견 시 모두 수술적 치료가 필요하 지는 않아 수술적 치료가 필요한 경우와 정기적 경과관찰이 필요 한 예를 알아보도록 한다. The most accurate diagnosis of thyroid carcinoma is through ultrasound. With the devel-opment of ultrasound devices and the increased interest in public health, interest in diagnosis and treatment of thyroid nodules is also increasing. The purposes of this lecture are to investigate various diagnostic methods in-cluding ultrasound for the diagnosis of thyroid tumors, to examine the preparation, test procedure, and diagnostic features of suspicious and malignant thyroid carcinoma. In addition, when the thyroid tumor is found, surgical treatment is not always necessary, so it is necessary to look for cases requiring surgical treatment and cases requiring periodic follow – up.

April27(Sat)





HYUN MIN LEE

Chronic ear disease includes acute otitis media, chron-ic otitis media, chronic otitis media with cholesteatoma, serous otitis media and adhesive otitis media. These dis-eases are various spectrum of otologic disease, ranging from asymptomatic findings to critically ill patients with intracranial complications. Treatment of these otological diseases is done by various methods such as close obser-vation, medication and surgical operation. Among them, various surgical treatments are used ranging from simple ventilation tube insertion to tympanoplasty, canal wall up / canal wall down mastoidectomy, endoscope assisted ear surgery, and ossiculoplasty for postoperative hearing improvement. To determine the method of operation, previous history of ear disease, general condition of the patient, status of mastoid cavity, extent of disease, func-tion of Eustachian tube and complication of ear disease should be considered. Various complications may occur during or after ear surgery. Intraoperative complication include ossicular dislocation, facial nerve injury, labyrin-thine fistula vascular injury and dural injury. To minimize postoperative dysfunction, operator should remind the appropriate treatment method for each situation. Post-operative complications include hematoma, bleeding, surgical site infection, pain, labyrinthitis, and hearing impairment. If the patient continues to complain of diz-ziness or hearing loss after postoperatively, basic physical examination such as tuning fork test or nystagmus test should be performed to avoid late recognition of surgical complication. Postoperative management is an import-ant factor that affects the success of surgery as well as the operation itself. Ear surgery which used retroauricular ap-proach, most of the compression dressing will be done. If too much pressure is applied in this case, pressure necrosis may occur on the face area. Compression dressing is per-formed in most ear surgery with retroauricular approach. In this case, care should be taken as pressure necrosis may occur on the facial area if too much pressure is applied. In myringotomy or simple endoscopic ear surgery, only sim-ple dressing is performed without compression dressing. If excessive drainage is drained from the ear canal after removal of the compression dressing, the ear canal should be kept dry. Postoperative Antibiotics should be used for more than 1 week after surgery, and the packing of the external auditory canal is removed at 2 or 3 weeks af-ter surgery. For canal wall down mastoidectomy, packing should be maintained for 1 week more. In addition, this session summarizes the opinions of ontological experts

JAE-MIN SHIN

만성 부비동염의 치료는 크게 약물치료와 수술치료로 구분할 수 있다. 약물치료는 국소용 스테로이드제, 전신적 스테로이드제, 항생제 등을 사용하고 보조치료로 생리식염수 세척을 시행한다. 만성 부비동염의 급성악화가 아닌 평상시의 항생제 치료는 아직 논란의 여지가 있다. 화농성 비루가 있고 배양 검사에서 Staphylococcus aureus, Pseudomo-nas aeruginosa 같은 균주가 나오는 경우는 적절한 항생제 사용이 필요할 때이다. 한편, 유럽 등 일부 국가에서는, 비용종 동반에 따라 표현형(phenotype)을 구분하고, 이에 따라 약물치료를 다르게 시행하도록 권고하고 있다. 적절한 약물치료에도 증상을 동반한 만성 부비동염이 반응을 하지 않은 경우, 수술적 치료를 고려할 수 있다. 수술치료의 원칙은 첫째, 자연공을 통한 부비동의 배액과 환기의 유지, 둘째, 발병의 선행요인이 되는 비강 내 구조적 이상을 제거하거나 교정, 셋째, 동내 점막 병변이 비가역적인 경우 동점막을 제거하는 것이다. 수술의 결과는 만성 부비동염의 표현형, 흡연 및 직업적인 노출, 약물치료 순응도 등 환자 관련 요인과 의사의 술기, 사용된 수술 방법 및 술 후 치료 등 의사 관련 요인에 따라 영향을 받은다. 최근 들어 생물학적 치료제가 개발되어 사용하고 있고, 새로운 방법들을 시도하고 있어 만성 부비동염의 치료는 지금도 현재 진행형이다. 만성 부비동염의 병태생리가 점점 밝혀짐에 따라 비용종 동반에 따른 표현형보다 특정약물의 반응정도, 특정 사이토카인의 발현정도 등에 따라 분류하는 내재형(endotype) 분류가 더 필요한 방향으로 변화하고 있다. 내재형이 더 확실히 규명되면, 환자에 따른 맞춤 치료가 가능하고 치료의 방향이 바뀔 것이다. 이런 시대가 오면 내재형을 구별하는 생체표지자(biomarker)를 같이 검사해야 하고, 수술에 대한 개념도 바뀌리라 생각된다.

Korean Session ORLSP Nurse 2

Room 2-2 (Skylark)Chair : Seung-Ho Shin

Surgical Treatment and Postoperative Care for Otorhinolaryngological Disorders

» 13:30-13:50

» SURgICAL TREATMENT AND POSTOPERA-TIvE CARE FOR CHRONIC EAR SURgERY



April27(Sat)



April 27(Sat) ORLSP

recurrent infection, restenosis, and lateralization of the neo-tympanic membrane. When the reason for revision surgery were perforation, recurrent infection (mucosal-ization of skin), and lateralization, the problem was re-solved in most cases. But when the reason for revision surgery was ABG, it was not successfully resolved in some cases. Restenosis was generally manageable but special considerations were needed to prevent additional reste-nosis. It seems that atresia-canaloplasty is an imperfect type of surgery requiring a long-term close follow up and additional managements. In some cases (8.0%), a revi-sion surgery is inevitable. Special considerations during the surgery may prevent restenosis, lateralization, and worsening of the ABG. But some problems such as new bone formation or mucosalization of the EAC skin may still remain as an intractable problem in some patients.

» 14:10-14:30

» SURgICAL TREATMENT AND POSTOP CARE FOR LARYNgEAL DISORDERS



COLLEGE OF MEDICINE

JAE-GU CHO

Surgery for benign laryngeal disorders is considered very safe, and the risk depends on the procedure. With frame-work surgery and implants, such as a thyroplasty, there can be complications related to surgery and general anes-thesia, such as bleeding or infection. The biggest risk with phonosurgery is scarring. Laser surgery of the vocal cord: Also called microlaryngoscopy or laryngeal microsurgery, this minimally invasive surgery uses special lasers to treat diseases of the vocal cord, including benign lesions, can-cer of the vocal cord, and tumors. Laser surgery is per-formed in an operating room under general anesthesia and usually lasts 60 to 90 minutes, depending on the case. Patients generally go home the same day. Laryngeal framework surgery: This surgical technique modifies the cartilage where the muscles attach to the vocal cords, to help vocal cords close better or have more tension. The result is that the vocal folds vibrate and create better sound for speaking and singing. Laryngeal framework surgery is used to treat patients with vocal cord paralysis or laryngeal stenosis, to restore the original shape of their larynx. It also can be used to treat people who have had cancer, surgery that caused nerve damage or a trauma to

about general postoperative precautions, compression and dressing methods, and the timing of external audito-ry canal packing removement.

» 13:50-14:10

» SURgICAL TREATMENT AND POSTOP CARE FOR CONgENITAL AURAL ATRESIA



MYUNG-WHAN SUH

Post-operative care after atresia-canaloplasty may be clas-sified into two categories. Fist, conservative management. Second, revision surgery. It is well known that the recon-structed ear canals are vulnerable to cerumen impaction, recurrent infection, restenosis, and lateralization of the neo-tympanic membrane (TM). Also, gradual worsening of the air bone gap (ABG) may be another major post-op-erative problem. In this talk, we may share personal expe-riences on atresia-canaloplasty, post-operative problems, and their solutions. From 2013 to 2019, a total of 62 cases of atresia-canaloplasty surgery has been performed by the presenter. Minor problems such as cerumen im-paction or moderate degree restenosis were managed in the outpatient clinic. Empty hallo shells (from hearing aids) were used to maintain the external auditory canal (EAC) lumen. Cleaning of the impacted cerumen and local dressing/cleaning were performed. The main differ-ence between atresia-canaloplasty and tympanomastoid-ectomy is that the self-cleansing mechanism of external auditory canal (EAC) does not apply to the reconstructed EAC. That is, cerumen must manually be removed reg-ularly in atresia-canaloplasty patients after surgery. Also new bone formation near the temporomandibular joint capsule should be taken into consideration. The new bone may obstruct the EAC pathway to the TM. This can lead to two significant problems: it may be difficult to remove the impacted cerumen behind the new bone formation and this new bone may lead to lateralization and conductive hearing loss. When the post-operative problems become intractable, a revision surgery is the only solution is most cases. Among the 62 cases 80.6% were primary cases while 12 cases (19.4%) were revision cases (8 primarily operated by other surgeons and 4 pri-marily operated by this presenter). The revision rate was 8.0% (4/50) for this presenter. A revision surgery was performed due to various reasons, such as perforation,

April27(Sat)




TIvE CARE FOR OTORHINOLARYNgOLOgI-CAL DISORDERS

CHOSUN UNIVERSITY COLLEGE OF MEDICINE

JI YUN CHOI

Rhinoplasty is a facial cosmetic procedure, usually per-formed to enhance the appearance or reconstruct the nose. During rhinoplasty, the nasal cartilages and bones are modified, or tissue is added, to improve the visual ap-peal of the nose. Rhinoplasty is also frequently performed to repair nasal fractures. When rhinoplasty is used to re-pair nasal fractures, the goal is to restore pre-injury ap-pearance of the nose. Septorhinoplasty is a related proce-dure performed for patients who also have nasal obstruc-tion. Septorhinoplasty not only improves the appearance of the nose, but it removes any internal obstructions and stabilizes structures that may be blocking nasal breathing. After the surgery you need to rest in bed with your head raised higher than your chest, to reduce bleeding and swelling. Your nose may be congested because of swelling or from the splints placed inside your nose during surgery. In most cases, the internal dressings remain in place for one to seven days after surgery. Your doctor also tapes a splint to your nose for protection and support. It's usually in place for about one week. Slight bleeding and drainage of mucus and old blood are common for a few days after the surgery or after removing the dressing. Your doctor may place a 'drip pad' — a small piece of gauze held in place with tape — under your nose to absorb drainage. Change the gauze as directed by your doctor. Don't place the drip pad tight against your nose. To further lower the chances of bleeding and swelling, your doctor may ask that you follow precautions for several weeks after sur-gery. Your doctor may ask you to : • Avoid strenuous ac-tivities such as aerobics and jogging. • Take baths instead of showers while you have bandages on your nose. • Not blow your nose. • Eat high-fiber foods, such as fruits and vegetables, to avoid constipation. Constipation can cause you to strain, putting pressure on the surgery site. • Avoid extreme facial expressions, such as smiling or laughing. • Brush your teeth gently to limit movement of your upper lip. • Wear clothes that fasten in the front. Don't pull clothing, such as shirts or sweaters, over your head. In addition, don't rest eyeglasses or sunglasses on your nose for at least four weeks after the surgery, to prevent pres-sure on your nose. You can use cheek rests, or tape the glasses to your forehead until your nose has healed. Use SPF 30 sunscreen when you're outside, especially on your

the larynx. The surgery is performed with local anesthe-sia, so that the doctor can talk with the patient, get his or her feedback and make adjustments to correct the voice. Vocal cord injections: Injections of collagen and other gel fillers are used to temporarily treat conditions such as vocal cord paralysis or muscle weakness. This treat-ment improves voice or swallowing function. Medicine is also sometimes injected.Injections are typically done in the office, with local anesthesia. The doctor injects the material into the vocal fold directly through the skin in neck. Cancers and other conditions that develop in the larynx, may not be commonplace, but they do present unique challenges related to preserving a patient's voice. Laryngeal surgery is generally recommended for larynge-al cancer, which affects the aerodigestive tract. Surgical Procedures Used in Laryngeal Cancer Laryngeal cancer can be treated with surgery in some cases. The surgical procedure recommended will depend on several factors, including the size and location of the cancer. Your sur-geon will discuss with you the recommended procedure, based on your situation. Common surgical procedures to treat laryngeal cancers include:Vocal cord stripping: The superficial (outermost) layers of the vocal cords are re-moved/Laser surgery: Removal of the vocal cords/Partial Laryngectomy: Removal of only the diseased parts of the larynx to spare as much of the vocal cords as possible/Total Laryngectomy: The entire larynx and vocal cords are removed. A tracheostomy (hole for breathing located in the neck) will be needed/Supraglottic laryngectomy: Removal of the supraglottis/Hemilaryngectomy: Remov-al of half of the larynx which spares the voice/Thyroidec-tomy: Partial or complete removal of the thyroid gland/Neck dissection: Removal of lymph nodes and part of the neck muscles/Tracheotomy: A hole is made in the neck for breathing/Gastrostomy tube (G-Tube) placement: Placement of a tube into the stomach for nutrition Risks associated with laryngeal cancer surgery As with any sur-gery, there are risks and possible side effects. These can be:Reaction to anesthesia (Anesthesia is the medication you are given to help you sleep through the surgery, not remember it and manage pain/Reactions can include wheezing, rash, swelling and low blood pressure/Pneu-monia/Blood clots/Infection/Loss of normal speech and/or swallowing/Throat or larynx stenosis/Breathing and/or swallowing difficulties/Fistula development (abnormal tissue opening/connections)/Carotid artery rupture/Thy-roid and/or parathyroid damage

» 14:30-14:50

» SURgICAL TREATMENT AND POSTOPERA-

April27(Sat)



April 27(Sat) ORLSP

to describing vocal function the VP can determine if be-havioral management would be an effective intervention before, after or in lieu of medical or surgical treatments, and can identify those patients that are getting secondary gains from having a voice disorder and have limited mo-tivation to change.

Korean Session ORLSP SLP

Room 3-3 (Diamond)Chair : SUNG MIN CHUNG, JIN PYEONG KIM

State of the Art Management for the Dysphonia Patients with Normal Laryngoscopy

» 11:10~11:30

» DYSPHONIA WITH NORMAL LARYNgOSCO-PY: CLINICAL AND ENDOSCOPIC FEATURES


JAE-YOL LIM

Voice is a physical phenomenon, generated by vocal fold vibration and expiratory airflow. Dysphonia is common-ly caused by abnormal vocal fold layered structure and altered biomechanics. Occasionally, larynx may look nor-mal, but actually have abnormalities. There may be unde-tected structural or functional abnormalities. Therefore, when we face dysphonia patients presented with normal larynx, we should make diagnosis through close observa-tion. In this review article, we present variable dysphonia diseases which may be presented with normal larynx. Re-view on diseases such as, vocal fatigue, vocal fold paresis, posterior glottic diastasis, muscle tension dysphonia and psychogenic dysphonia will be introduced.

» 11:30~11:50

» CORRELATION BETWEEN IN PERCEPTUAL AND ACOUSTIC ANALYSIS

DEPARTMENT OF OTORHINOLARYNGOLGY-HEAD

& NECK SURGERY, GACHON UNIVERSITY SCHOOL

OF MEDICINE, GIL MEDICAL CENTER

JOO HYUN WOO

nose. Too much sun may cause permanent irregular dis-coloration in your nose's skin. Some temporary swelling or black-and-blue discoloration of your eyelids can occur for two to three weeks after nasal surgery. Swelling of the nose takes longer to resolve. Limiting your dietary sodi-um will help the swelling go away faster. Don't put any-thing such as ice or cold packs on your nose after surgery. Your nose changes throughout your life whether you have surgery or not. For this reason, it's difficult to say when you have obtained your 'final result.' However, most of the swelling is gone within a year.

ORLSP SLP

Room 3-3 (Diamond)Chair : SEONG HEE CHOI

Special Lecture

» 10:40~11:10

» HOW THE SLP CAN ENHANCE THE vOICE CARE TEAM KNOWLEDgE, ASSESSMENT AND TREATMENT

PROFESSOR EMERITUS UNIV OF WISCONSIN,

DEP SURGERY DIV OTO H&N COM SCIE & DISORD,

USA

DIANE M BLESS

The goal of all Voice Care Teams is to produce the best voice possible for their patients. This goal may be achieved by a variety of treatments including: medical, surgical, behavioral, and psychological, or some combi-nation thereof. Making this determination is often com-plicated and takes extensive testing and integration of the case history, stroboscopic, acoustic, aerodynamic find-ings. There are many different models on how this inte-gration is achieved. Having a SLP-voice pathologist(VP) as an integral part of the Voice Care team can improve efficiency and enhance treatment outcomes. Because the VP is trained to assess the laryngeal mechanism and how it interacts with the patient’s psyche, and impacts voice production, swallowing and quality of life, the VP as-sessment can help provide a comprehensive assessment without burdening the laryngologist’s time. In addition

April27(Sat)




can be used for both qualitative and quantitative descrip-tions of laryngeal behavior. (e.g. differential diagnosis of spasmodic dysphonia, vocal tremor) To overcome the limitations of previous videokymography methods, new videokymography system was developed for the evalua-tion of the whole mucosal wave of the entire vocal cord mucous membrane. New system can be used to evaluate the static and dynamic status of vocal folds in patients with vocal cord diseases. Measures of vocal function can be obtained with high-speed digital and kymographic recordings that cannot be obtained with stroboscopy or acoustical analysis.

» 12:10~12:30

» 무진동성대점막병변의 치료방법


HEAD AND NECK SURGERY KYUNGPOOK


KYUNGPOOK NATIONAL UNIVERSITY HOSPITAL

GILJOON LEE

1. 발성의 원리 호흡과정을 통해 폐에서 후두 방향으로 형성된 기류가 성문을 지나면서 조절과 정을 거치게 된다. 발성을 위해서 크게 3가지 조건이 형성되어야 하는데 폐에 의한 적절한 성문하 압이 형성되어야 하고 정상적인 성대 운동으로 양측 성문간의 거리가 가까워져 야 하며 성대 점막이 정상적인 떨림을 가질 수 있도록 적절한 유연성과 탄력이 있어야 한다. 위에서 설명한 폐호흡과 성문 운동 및 진동에 의해 성대음이 만들어지게 되면 성문 상부로 이어지는 성도를 거치며 조음과 공명 현상에 의해 발성이 완성된 다. 2. 무진동 성대병변 ① 성대반흔 무진동 성대병변의 대표적인 질환으로 주로 성대 수술이나 외상 으로 발생하며 4가지 형태로 분류한다. 제 1형은 성대점막과 인대 손상으로 인한 반흔으로 성 문폐쇄부전과 진동 감소를 야기하고 제 2형은 성대근과 전방성대의 손상으로 전연합부위 성문폐쇄부전을 일으킨다. 제 3형은 전성문절제술 후 갑상연골 내 측 연골막의 유착으로 발생하며 제 4형은 성문 사이 격막이 형성되는 것을 뜻 한다. 성대반흔은 후두스트로보스코피 검사로 병변과 성대진동의 이상 부위 및 형태 등을 파악할 수 있다. 근본적인 치료는 수술적 치료이며 성대반흔의 정도 가 경하다면 음성치료를 시행해볼 수 있다. 양성자 펌프 억제제 등의 약물치료 는 인후두역류 치료나 예방을 통해 반흔이 형성되는 것을 줄일 수는 있으나 근 본적인 치료법은 아니다. 수술은 스테로이드 주입술이나 반흔을 제거하고 hyaluronic acid, collagen 등을 주입할 수 있으며 4형 같은 경우 격막을 제거 하고 마이토마이신 점적이나 keel insertion 등을 시행할 수 있다. ② 성대구증 성대구증

Perceptional assessment is fundamental measure of dys-phonia. Voice is an acoustic phenomenon, and its aural perception by listener is the primary means by which voice is judged in daily communication. GRBAS and Consen-sus Auditory-Perceptual Evaluation- Voice (CAPE-V) have widely been used as perpcetual assessment of voice. Acoustic analyses were most commonly included for assessment of vocal physiology. There are numerous pa-rameters related with acoustic voice assessment. Acous-tic measurements provided an objective qualification of voice in dysphonia patients and successfully distinguished them from the normal control. Pitch problem may be correlated with mean speaking fundamental frequency, Jitter, and/or phonation range. Loudness limitation may be correlated with shimmer, mean speaking intensity, and/or dynamic range in conversation. Roughness may be indirectly quantified with the harmonic-to-noise ratio (HNR). Breathiness can be assessed with cepstral peak prominence (CPP). However, there have been little con-sensus about correlation between perceptual and acoustic analysis yet, more study is needed.

» 11:50~12:10

» APPLICATION AND INTERPRETATION OF STROBOSCOPY & KYMOgRAgPHY

DEPARTMENT OF OTOLARYNGOLOGY, INHA

UNIVERSITY, COLLEGE OF MEDICINE, INCHEON,

REPUBLIC OF KOREA

JI WON KIM

Video imaging of larynx is a standard and critical part to understand the structure and function of the larynx. Cur-rently, various tools have been introduced for the assess-ment of vocal fold vibration: Videostroboscopy, video-kymography (VKG), high speed videoendoscopy (HSV), digital videokymography (DKG), and 2D scanning videokymography (2D VKG). Videostroboscopy is one of effective methods in most clinical situations. Videos-troboscopy provides information on laryngeal structure and function, and provides permanent record that can be stored. Videostroboscopy allows imaging and recording of apparent vocal fold motion, rather than cycle to cycle motion of the vocal folds. On the other hand, high speed digital imaging and kymography provide a permanent record of the actual cycle to cycle motion of vocal folds. High speed digital imaging and kymography can be used with all voice disorder regardless of dysphonia; the image

April27(Sat)



April 27(Sat) ORLSP

은 성대 유리연을 따라 움푹 패이는 형태의 구가 발생하는 것으로 주 로 염증이나 음성 남용 등에 의해 발생한다. 성대구증은 성대고유층에 발생하 므로 발성에 장애를 일으킬 수 있다. 성대구증이 발생하더라도 발성의 장애가 없는 경우가 있는데 주로 노인성 성대구증 등의 생리적 성대구증인 경우가 이 에 속한다. 발성에 지장을 주는 성대구증은 성대고유층의 손상으로 성대인대와 유착된 경우(sulcus ver-geture)와 성대인대와 성대근까지 손상되고 점막이 과 증식되는 True sulcus 가 있다. 진단은 스트로보스코피로 쉽게 진단이 가능하 며 성대진동이 비대칭적이고 진폭이 감소한다 또한 고음역에서 파동이 정지되 는 현상을 관찰할 수 있다. 치료는 아직까지 확실하게 정립된 방법은 없다. 수 술을 고려할 수 있으며 섬유화된 조직을 제거하는 성대구절제술이 있으나 수술 시 성대인대나 점막의 손상이 커지면 오히려 반흔을 형성하여 음성의 질이 나 빠지는 결과를 초래할 수 있어 주의해야 한다. 최근에는 PDL 레이저를 이용한 성대 구조 재생이 음성 회복에 도움을 준다는 결과가 보고되고 있다. ③ 후두결핵 이비인후과 영역에서 결핵의 호발 부위는 경부림프절로 이비인후과 영역에서 발생하는 결핵의 80% 이상을 차지한다. 2번째로 흔한 부위가 후두로 약 10% 정 도 차지한다. 증상은 일반적인 인후두염의 증상과 차이가 없으며 주로 목의 통 증, 연하장애, 기침 등의 증상을 호소하며 후두가 성문을 침범하게 되면 성대 진동의 감소를 초래하여 음성변화를 야기하게 된다. 후두의 결핵은 기관과 인 접하고 있는 관계로 기관 내 결핵의 침범 또한 중요하며 기관 내 결핵의 경우 전염력이 폐결핵에 비해 높으므로 감염에 주의가 필요하다. 치료는 항결핵제를 복용하며 폐외 결핵의 경우 일반적으로 9개월 이상의 치료 기간이 필요하다. ④ 후두암 성대진동의 감소 또는 소실을 유발하는 대표적인 질환으로 악성세포의 침윤의 정도에 따라 성대진동의 정도가 달라진다. 성대점막, 고유층 및 성대인대, 성 대근으로의 침윤 정도가 클수록 진동의 감소가 증가한다. 성대에 국한된 조기 성문암의 경우 구강 내 접근을 통한 성문절제술이 가능하며 성문절제술 후 치 유 과정에서 성대의 반흔 형성으로 성대진동의 감소가 유발되는 경우도 있다.

April27(Sat)




April 27 (Sat)

[IC 5] 08:00-08:40 Room 2-6 (Peacock)

OSSICLe STaTuS BaSeD STagIng FOR COngenITaL CHOLeSTeaTOMa

CHaNG HO lee (CHa UNIversItY)

[IC 6] 08:40-09:20 Room 2-6 (Peacock)

PReOPeRaTIVe CI DIagnOSTICS WITH TRanSTyM-PanIC eCOg (anD eeaBR)


[IC 7] 09:20-10:20 Room 2-6 (Peacock)

LaTeRaL TeMPORaL BOne ReSeCTIOn In eaC Ma-LIgnanCy SuRgICaL LanDMaRK anD TIPS

KI-HONG CHaNG, BeOM-CHO JUN, JUN-wOOK ParK (DePt Of OtOlarYNGOlOGY HeaD aND NeCK sUrGerY,

st PaUls HOsPItal, tHe CatHOlIC UNIversItY Of KOrea)

[IC 8] 10:40-11:20 Room 2-6 (Peacock)

HOW TO uSe COSTaL CaRTILage In RHInOPLaSTy

YONG JU JaNG (DePt Of OtlarYNGOlOGY, asaN MeDICal CeNter, UNIv Of

UlsaN COlleGe Of MeDICINe)

[IC 9] 11:20-12:00 Room 2-6 (Peacock)

COMPuTeRIzeD DaTaBaSe FOR CHROnIC OTITIS MeDIa SuRgeRy 30-yeaR exPeRIenCeS

HYUNG-JONG KIM (HallYM UNIversItY)

[IC 10] 12:00-12:40 Room 2-6 (Peacock)

OFFICe LaRyngOLOgy InJeCTIOnS, angIOLyTIC La-SeRS anD MORe

MattHew stePHeN BrOaDHUrst (QUeeNslaND vOICe CeNtre)

Instruction Course

[IC 11] 13:30-14:10 Room 2-6 (Peacock)

aSSeSSMenT OF VOCaL FOLD VIBRaTIOn

JIN-CHOON lee, sOO-GeUN waNG (BUsaN NatIONal UNIversItY)

[IC 12] 14:10-14:50 Room 2-6 (Peacock)

SuRgICaL anaTOMy OF CaVeRnOuS SInuS In en-DOSCOPIC enDOnaSaL SKuLL BaSe SuRgeRy

weIHsIN waNG (taIPeI veteraNs GeNeral HOsPItal, taIwaN)

[IC 13] 15:20-16:20 Room 2-6 (Peacock)

RHInOPLaSTy anD FaCIaL PLaSTIC SuRgeRy In PRIVaTe PRaCTICe

HONGrYUl JIN, JONGsOOK YI (Dr JINs PreMIUM NOse ClINIC)

[IC 14] 16:20-17:00 Room 2-6 (Peacock)

VIDeO HeaD IMPuLSe TeST FInDIngS FROM nOR-MaL SuBJeCTS anD PaTIenTS WITH VeSTIBuLaR DISORDeRS anD CLInICaL IMPLICaTIOnS

HONG JU ParK (DePartMeNt Of OtOrHINOlarYNGOlOGY-HeaD aND NeCK sUrGerY, asaN MeDICal CeNter,

UNIversItY Of UlsaN COlleGe Of MeDICINe, seOUl, KOrea)

[IC 15] 17:00-17:40 Room 2-6 (Peacock)

aLTeRnaTIVe PaLaTaL SuRgeRIeS In OBSTRuCTIVe SLeeP aPnea: PaTIenTS SeLeCTIOn, THeRaPeuTIC OPTIOnS anD SuRgICaL TeCHnIQueS

HYUN JIK KIM (seOUl NatIONal UNIversItY HOsPItal)

April 27(Sat) Instruction Course

April27(Sat)






CENTER, UNIVERSITY OF COLOGNE, GERMANY

MARTIN WALGER

The preoperative objective diagnosis using transtympanal ECochG plays a central role in the indication process for cochlear implantation. It is particularly useful for patients with bilateral or single-sided deafness. The main advan-tages of the ECochG are that the sensory and neural components of the inner ear can be measured in the near field and separately evaluated largely free of EEG inter-ference or problems of overhearing. If no or only strongly pathologically altered compound action potentials (CAP) can be obtained with acoustic stimulation, the use of a transtympanic eeABR can be a useful tool to evaluate the functionality of the auditory nerve and the central au-ditory processing at the brain stem level preoperatively. Especially in difficult clinical cases like malformations of the cochlea and/or auditory nerve, acoustic neuroma sur-gery or auditory synaptopathy/neuropathy (AS/AN) this technique can provide important indication criteria or prognostic factors regarding the rehabilitation outcome after cochlear implantation. Supported by Interacoustics, Denmark

IC 7

Room 2-6 (Peacock)

Instruction Course

» 09:20-10:20

» LATERAL TEMPORAL BONE RESECTION IN EAC MALIgNANCY SURgICAL LANDMARK AND TIPS

DEPT OF OTOLARYNGOLOGY HEAD AND NECK

SURGERY, ST PAULS HOSPITAL, THE CATHOLIC

UNIVERSITY OF KOREA

KI-HONG CHANG, BEOM-CHO JUN, JUN-WOOK PARK

IC 5

Room 2-6 (Peacock)

Instruction Course

» 08:00-08:40

» OSSICLE STATUS BASED STAgINg FOR CONgENITAL CHOLESTEATOMA

CHA UNIVERSITY

CHANG HO LEE

Based on our compilation of our published reports on large case series of early and advanced congenital cho-lesteatoma(CC), we propose a staging system based on ossicle status, and important landmarks for CC surgery. Although CC has importance because of its ossicle inva-sion, ossicle status is not addressed in current stagigng system. Methods: From our large 1100 cases series of CC from 2008 to 2018. Important landmarks were tensor tympanic tendon, cochleariform process, stapes tendon,-stapes superstructure.- Early is stage I, II , and adnvaced is stage III,IV Staging system require- Early vs Advanced: ossicle chain destructio nor surgical

removal - Early CC subclass: Cochleariform process invasion- Advanced CC subclass: staps superdestruction- Anteriro vs Posterior, pseudoposterior

IC 6

Room 2-6 (Peacock)

Instruction Course

» 08:40-09:20

» PREOPERATIvE CI DIAgNOSTICS WITH TRANSTYMPANIC ECOg (AND EEABR)

April27(Sat)




the aesthetic outcome. A number of original and unique surgical techniques such as the use of surgical mold for dorsal augentation and monounit alar rim grafting will also be introduced. Upon completion of this lecture, the audieince will have better understanding of the proper use of costal cartilage in rhinoplasty.

IC 9

Room 2-6 (Peacock)

Instruction Course

» 11:20-12:00

» COMPUTERIzED DATABASE FOR CHRONIC OTITIS MEDIA SURgERY 30-YEAR ExPERI-ENCES

HALLYM UNIVERSITY

HYUNG-JONG KIM

Objectives: Chronic otitis media (COM) surgery is one of the most common procedures performed in ENT clin-ic, and the residents should keep their own operation records to develop and feedback the surgical skill. The aim of this course is to show how to use a computerized database program, which was made based on the stan-dardized classification and post-operative result report-ing system for COM surgery. Methods: Clinical records of 5248 surgical cases performed at the department of otolaryngology, Hallym university college of medicine for last 30 years were registered to the database program, which was developed and released by the Korean otologic society (2005). Data were retrieved and analyzed for the subjects and results, including the type of disease, and surgical method according to time, and postoperative results, such as perforation, recurrence, and hearing re-sults, in order to demonstrate its usefulness, and to show how to use it. Results: From 1989 to 2018, 5248 cases of middle ear surgery were performed at Kangdong and Hallym university sacred heart hospital. Among them, age less than 6 years were 87, more than 90 were 15, and, male versus female was 2294(43.7%) : 2956(56.3%). Cholesteatoma surgeries were 1319 (25.1%), and re-

Squamous cell carcinoma and basal cell carcinoma are common in ear, not in the ear canal, middle ear, and tem-poral bone. Malignant tumors in the ear canal are often invasive to the surrounding structures including parotid gland, neck, or skullbase. When the tumor is found in progress, it is difficult to distinguish the primary focus of the tumor, and the diagnosis tends to be delayed be-cause it is similar to the symptoms of chronic otitis me-dia. In order to properly treat malignant tumors in the ear canal it is important to cooperate with head and neck surgeons and neurosurgeons as well as the otologist due to the location and scope of lesions. And considering the area of invasion and the scope of surgery of the ear canal malignant tumor, the role of the otologist is very import-ant. In this instruction course, we will learn about the surgical procedure of the most basic and representative lateral temporal bone resection in EAC cancer. And also we hope that attended otologist could broaden their un-derstanding of the neurotology with this course.

IC 8

Room 2-6 (Peacock)

Instruction Course

» 10:40-11:20

» HOW TO USE COSTAL CARTILAgE IN RHI-NOPLASTY

DEPT OF OTLARYNGOLOGY, ASAN MEDICAL

CENTER, UNIV OF ULSAN COLLEGE OF MEDICINE

YONG JU JANG

Costal cartilage is indispensable grafting material in rhi-noplasty. It is widely used in rhinoplasty for septal recon-struction, tip augmentation, and dorsal augmentation. Although it is invaluable material in rhinoplasty, use of this graft is complicated by difficulty in harvesting, trou-blesome carving, and frequent occurence of complica-tions. In this lecture which will be augmented by many videoclips and photographs, I will detail the harvesting technique, indications of usage, and the way to fashion the cartilage to minimize complications and maximize


April27(Sat)



IC 11

Room 2-6 (Peacock)

Instruction Course

» 13:30-14:10

» ASSESSMENT OF vOCAL FOLD vIBRATION

BUSAN NATIONAL UNIVERSITY

JIN-CHOON LEE, SOO-GEUN WANG

Various evaluation methods have been introduced. La-ryngeal videostroboscopy is standard method for assess-ment of vocal fold vibration, but it is illusory and could not provide objective results. Recently, postprocessing analytic methods from laryngeal high-speed videoendos-copy (HSV) such as 2D scanning Kymography, Digital kymography (DKG), glottal area waveform, glottal width waveform, and kymographic edge detection have been introduced. In this session, we will introduce the new-ly developed real-time multislice DKG system including HSV, 2D scanning kymography and DKG which are able to display the vibration patterns of vocal fold and provide objective outcomes. We will also have a chance to demonstrate new system and software and explain the results. Optical coherence tomography (OCT) sys-tem can provide precise delineation of vocal fold-layered microstructure and allows for better understanding of the impact of benign and malignant lesions on laryngeal function. In addition, we are going to demonstrate the anatomy of vocal fold microstructure using OCT system.

IC 12

Room 2-6 (Peacock)

Instruction Course

» 14:10-14:50

» SURgICAL ANATOMY OF CAvERNOUS SI-

vision surgeries were 574 (10.9%). And, canal wall up mastoidectomy were 2798 (53.3%), and canal wall down mastoidectomy were 867 (16.5%), and tympanoplasty only were 1175 (22.4%). Postoperative results, such as perforation, recurrence, and hearing results will be shown in this lecture. (Successful hearing criteria with post-op-erative ABG< 20 dB, hearing gain> 15 dB, or hearing level< 30 dB). Conclusion: This database management program for COM surgery will provide a set of standard that ENT surgeons should follow, and keeping up with this system, in turn, facilitate them developing surgical skills they should have. Keywords: Database manage-ment, chronic otitis media surgery.

IC 10

Room 2-6 (Peacock)

Instruction Course

» 12:00-12:40

» OFFICE LARYNgOLOgY INJECTIONS, ANgI-OLYTIC LASERS AND MORE

QUEENSLAND VOICE CENTRE

MATTHEW STEPHEN BROADHURST

This IC is designed to educate attendees on the role of awake office-based laryngeal procedures. These proce-dures can avoid the use of general anaesthetic in patients and significantly shorten the hospital stay. This course is designed to allow attendees to implement office-based la-ryngeal surgery, make careful patient selection and to re-view the precautions and safety outcomes. After perform-ing office-based awake laryngeal surgery for over 11 years, Dr Broadhurst has established a large referral base and teaching platform in Australasia for this valuable addition to the practice of laryngology. The course will cover the set up requirements, preparation of the patient, various procedures (injection laryngoplasty, Botox therapy, ste-roid injections and KTP and Blue Light laser procedures. It will also cover safety concerns and current recommen-dations for establishing an office-based laryngeal surgery clinic.

April27(Sat)




IC 13

Room 2-6 (Peacock)

Instruction Course

» 15:20-16:20

» RHINOPLASTY AND FACIAL PLASTIC SUR-gERY IN PRIvATE PRACTICE

DR JINS PREMIUM NOSE CLINIC

HONGRYUL JIN, JONGSOOK YI

As private practitioners in busy rhinoplasty/facial plastic surgery clinic, the presenters like to share their experience in the following items. Devoted years of experience as academy based hospital staff and professor can provide unique and different views on private practice as an ENT and facial plastic surgeon and will help attendants widen their views on opening their own clinic.This instruction course will include the followings:1. Presenting common cases that ENT/facial plastic sur-geons will deal with when doctors go private practice2. Characteristics of rhinoplasty surgery in private prac-tice3. How to prepare and optimize the clinic setting4. Practical tips for opening the clinic5. How to maintain professionalism in advertising

IC 14

Room 2-6 (Peacock)

Instruction Course

» 16:20-17:00

» vIDEO HEAD IMPULSE TEST FINDINgS FROM NORMAL SUBJECTS AND PATIENTS WITH vESTIBULAR DISORDERS AND CLINI-CAL IMPLICATIONS

NUS IN ENDOSCOPIC ENDONASAL SKULL BASE SURgERY

TAIPEI VETERANS GENERAL HOSPITAL, TAIWAN

WEIHSIN WANG

Objectives: To provide a detailed investigation of the sur-gical anatomy of the foramen lacerum and its adjacent structures based on anatomical dissections and imaging studies, propose several relevant key surgical landmarks, and demonstrate the surgical technique for its full expo-sure with several illustrative cases. Methods: Ten colored silicone-injected anatomical specimen were dissected us-ing a transpterygoid approach to the foramen lacerum region in a stepwise manner. Five similar specimens were used for comparative transcranial approach. The osseous anatomy was examined in 32 high-resolution multi-slice CT studies and in one disarticulated skull. Representa-tive cases were selected to illustrate the application of our findings. Results: The pterygosphenoidal fissure is the synchondrosis between the lacerum process of the pter-ygoid bone and the floor of the sphenoid bone. It con-stantly converges with the posterior end of the Vidian ca-nal in a 45-degree angle, and its postero-lateral end points directly to the lacerum foramen. The pterygoid tubercle separates the Vidian canal from the pterygosphenoidal fissure, and forms the anterior wall of the lower part of the foramen lacerum. The lingual process, which forms the lateral wall of the foramen lacerum, was identified in 53 out of 64 sides and featured an average height of 5 mm. The mandibular strut separates the foramen lace-rum from the foramen ovale and had an average width of 5 mm. Conclusion: We provide relevant surgical land-marks and a systematic approach to the foramen lacerum by defining anterior, medial, lateral, and inferior walls that may help to safely expose it for effective removal of lesions while minimizing the risk of injury to the ICA.


April27(Sat)



muscle* Expansion sphincter pharyngoplasty1) Isolate the palatopharyngeus muscle2) Rotate this muscle superoanterolaterally: to create the lateral wall tension : to remove the bulk of the lateral pharyngeal walls-> Useful and effective in patients with Friedman stage II or III and lateral pharyngeal wall collapse * Soft palate webbing flap: Aimed at addressing obstruction at the retropalatal level: Palatal surgeries to minimize surgical complications: Surgical options for primary snoring or mild OSA pa-tients

ConclusionThe procedures to address upper airway collapse in OSA patients at the palatal level: Surgical options for treating OSA - changing of the pharyngeal muscular wall properties - to splint entire collapsible pharynx- repositioning pharyngeal muscles





HONG JU PARK

After this lecture, the audience are supposed to know the below.• Basic knowledge regarding vHIT– Difference between caloric and chair tests• vHIT findings in Normal Subjects• vHIT findings in Patients with Vestibular Disorders• Clinical implication of vHIT results

IC 15

Room 2-6 (Peacock)

Instruction Course

» 17:00-17:40

» ALTERNATIvE PALATAL SURgERIES IN OB-STRUCTIvE SLEEP APNEA: PATIENTS SELEC-TION, THERAPEUTIC OPTIONS AND SURgI-CAL TECHNIQUES


HYUN JIK KIM

The surgical treatment to reduce pharyngeal collapsibility in OSA patients: Reduce the upper airway collapsibility and enlarge the airway

: Removing soft tissue from pharyngeal lumen : Mobilizing or Repositioning the surrounding tissue* Relocation Pharyngoplasty: Initiate with a bilateral tonsillectomy: Identify the palatoglossus and palatopharyngeus mus-cles

: Undermine the superior pharyngeal constrictor muscle: Section of the palatopharyngeus muscles: Covering the superior part of the tonsillar fossa- Palatine flap and upper part of the palatopharyngeus

April27(Sat)





Chair : CHUL HO JANG, BO HYUNG KIM

Middle Ear (Basic)

» OTOP-35 08:00~08:10

» RAT MASTOID BULLAE OBLITERATION US-INg MODIFIED HYDROxYAPATITE/CHITOSAN PATCH




HYUNMIN LEE, SANGHUN KIM, JAEHWAN JUNG, SUNGWON CHOI,

SEJOON OH, SOOKEUN KONG, ILWOO LEE

Objectives: Mastoid obliteration is performed to reduce complications following canal wall down mastoidectomy such as cavity problems. Various materials such as autol-ogous cartilage and hydroxyapatite are used for mastoid obliteration. The authors previously studied hydroxyapa-tite / chitosan patch (Hap/Chi patch) as a new material for mastoid obliteration. In this study, we tried to con-firm the effect of mastoid obliteration using a modified Hap/Chi patch prepared by neutralizing to reduce the in-flammatory reaction. Methods: The obliteration material was hydroxyapatite powder (Mimix®) and modified Hap / Chi patch, and mastoid obliteration was performed in 6 ears of rats to each group. Mastoid bullae of rats were collected after 12 weeks and new bone formation and in-flammatory changes were observed in each tissue. Results: Modified Hap/Chi patch group showed 25% of inflam-matory change and 40% of new bone formation, and it was statistically significantly higher than control group. Also, the modified patch group showed higher inflamma-tory change and new bone formation than the hydroxy-apatite powder group. In comparison with the previous studies, it was observed that inflammatory change was statistically significantly reduced. Conclusion: modified Hap/Chi patch group showed better new bone forma-tion than other obliteration masterials. The inflammatory change was reduced compared to the previous material,

but fibrosis formation was found to be increased. Future studies should be continued to develop obliteration ma-terials with reduced inflmmatory changes.

» OTOP-36 08:10~08:20

» SYNERgISTIC EFFECT OF ALgINATE/BMP-2/UMBILICAL CORD SERUM- COATED ON 3D-PRINTED PCL BIOCOMPOSITE FOR MAS-TOID OBLITERATION MODEL

DEPARTMENT OF OTOLARYNGOLOGY, CHONNAM

NATIONAL UNIVERSITY MEDICAL SCHOOL1,

WAKE FOREST INSTITUTE FOR REGENERATIVE

MEDICINE, TISSUE ENGINEERING LAB, BIO-

MECHATRONICS, SUNGKEUNKWAN UNIVERSITY2

CHUL HO JANG1, JI-UN LEE2, GEUN-HYUNG KIM2

Objectives: Recombinant human bone morphogenetic protein-2 (rhBMP-2) has been used widely in bone tissue regeneration;however, the use of rhBMP 2 can be limited clinically because extremely high doses can cause oppos-ing effects on bone formation. To evaluate the effect of the UCS, we studied the synergistic effect of the composite scaffold using BMP-2/UCS/alginate coated on three-di-mensional mesh- structured poly-ε-caprolactone (PCL), both in vitro and in vivo, using a rat mastoid obliteration model. Methods: Fabrication of scaffold was dividied into 4 groups; control group (3D PCL scaffold), group I (3D PCL/alginate/BMP-2), group II (3D PCL/alginate/UCS), and group III (3D PCL/alginate/BMP-2/UCS), Cellular activities. CCK8 assay were tested using preo-seoblast cells. Live/dead, DAPI/Phalloidin stain, alkaline phosphatase and alizarin red were evaluated. The each group scaffolds were obliterated in rat bullae (n=20, each group,5). 12 weeks after the surgery,bullae were harvested and stained with HE and safranin-O. Two bullae of each group were observed by SEM and AFM for surface view. Results: The proliferation of group I, II, and III was sig-nificantly higher than that of the control. The nuclei and cytoskeleton of the cells cultured on groups I, II, and III were fully occupied on the strut surface compared to the control. The mineralized matrix formation of Group III was significantly higher than that of other groups. The SEM findings of the surface morphology of the bisected bulla indicate that the pores between the struts were cov-ered by new bone in group III, compared to the control


April27(Sat)



WT mice cleared NTHi by day 7, some CCR2-/-and CCR2-/-/saline, and most CCR2-/-/clodronate, MEs were culture-positive at that time. Conclusion: The re-sults suggest that macrophages play a very significant role in OM, despite the fact that they are typically present in small numbers than neutrophils. They appear to inhibit neutrophil entry into the ME cavity, and to promote the resolution of ME infection and inflammation.

» OTOP-38 08:30~08:40

» URBAN PARTICLE INCREASES IN vITRO BIOFILM gROWTH OF STREPTOCOCCUS PNEUMONIAE AND ELEvATE BACTERIA TOx-ICITY AND COLONIzATION TO HUMAN MID-DLE EAR EPITHELIA CELL



MUKESH KUMAR YADAV, YOON YOUNG GO, JAE-MIN JEON, SUNG-WON CHAE,

JAE-JUN SONG

Objectives: In this study, we evaluated the effect of urban particles (UP) on S. pneumoniae in-vitro biofilm forma-tion and colonization on Human middle ear epithelium cells (HMEECs). Methods: S. pneumoniae in vitro bio-film grown in presence of 200μg/mL UP were quanti-fied by CV-microplate assay, cfu counts and resazurin staining. Biofilm structures were analyzed using scanning electron microscope (SEM) and confocal microscopy (CM). Gene expressions of biofilms and HMEECs were evaluated using real time RT-PCR and Microarray. Col-onization of pneumococci to HMEECs in presence of UP was evaluated using adhesion assay, and fluorescent in-situ hybridization (FISH). Reactive oxygen species (ROS) and apoptosis in HMEECs were evaluated using ROS kit and Annexin-V/PI based cytometry. Results: Presence of UP significantly (*p< 0.05) increased biofilm biomass and viable bacteria. The SEM analysis revealed thick, organized with matrix in biofilms grown with UP, however these structures were absent in control biofilm. CM also revealed thick and organized biofilms in pres-ence of UP, however, these structure were not seen in con-trol biofilm. The genes involve in bacterial pathogenesis, biofilms formation and quorum sensing were up-regu-lated in pneumococci biofilms grown in presence of UP. The HMEECs viability and bacteria colonization was

group. Group I or II showed more enhanced osteogenesis between strands compared to the control group. AFM showed that the porous architecture of the group III scaf-fold was covered completely by the new bone formation. Conclusion: Based on the results, the alginate/BMP-2/UCS coated PCL scaffolds can be used for advanced bone regeneration. (J Ind Eng Chem, 2019 in press, IF:4.841)

» OTOP-37 08:20~08:30

» OTITIS MEDIA WITHOUT MACROPHAgES



CHANGWON HOSPITAL1, DEPARTMENT OF

SURGERY/OTOLARYNGOLOGY, UNIVERSITY OF

CALIFORNIA-SAN DIEGO2

DONG GU HUR1, ARWA KURABI2, KWANG PAK2, ALLEN F RYAN2

Objectives: Macrophages are thought to play an im-portant role in otitis media (OM). These phagocytic cells, when classically activated, are important sources of pro-inflammatory mediators and chemotactic factors that attract other leukocyte classes. When alternatively activated into an M2 phenotype, they are anti-inflamma-tory and can play a major role in the resolution of inflam-mation. However, given the complex cellular landscape of the middle ear (ME) and OM, it is difficult to separate the contributions of a single cell type. Methods: To eval-uate the role of macrophages in OM, we induced OM in a mouse deficient in CCR2 (CCR2-/-) by intrabullar in-jection of nontypeable Haemophilus influenzae(NTHi). Some of these mice were also treated intravenously with liposomes containing clodronate (CCR2-/-/clodronate), which induces apoptosis in peripheral blood macro-phages. Histological analysis and immunohistochemis-try was used to evaluate the MEs of experimental and control (wild-type, inoculated with NTHi, WT; CCR2 KO saline liposome, CCR2-/-/saline) mice for OM. Results: Leukocyte infiltration was significantly greater at 7 days after inoculation in CCR2-/-/clodronate mice. The number of macrophages in the MEs on day 2 af-ter NTHi inoculation was less than 50% of that seen in WT animals in CCR2-/-mice, and only 10% in CCR2-/-/clodronate MEs, with only slight recovery of macro-phages by day 3. On day 7, WT mice had only a few macrophages in the ME, while macrophages persisted in CCR2-/-and CCR2-/-/clodronate mice. Finally, while

April27(Sat)




HBOT intolerance and tympanotomy tube placement.

» OTOP-40 08:50~09:00

» AUTOMATIC DETECTION FOR FINDINg OF TYMPANIC MEMBRANE AND MIDDLE EAR EFFUSION USINg CONvOLUTIONAL NEURAL NETWORK


HEAD & NECK SURGERY, HALLYM UNIVERSITY

DONGTAN SACRED HEART HOSPITAL1,

DEPARTMENT OF COMPUTOR SCIENCE AND

ENGINEERING COLLEGE OF INFORMATICS,

KOREA UNIVERSITY2

SUNG KYUN KIM1, SEOK MIN HONG1, JAEGUL CHOO2, SUNG MIN PARK1,

SEOK JIN HONG1

Objectives: Convolutional neural networks (CNNs) among a variety of deep neural networks have been ac-tively applied to image recognition, object detection, object localization, semantic segmentation, and object instance segmentation. Applicability of CNN-based methods in analysis of medical image increased. Herein, our results show that accuracy of automatic detection for finding of tympanic membrane (TM) and middle ear ef-fusion (MEE) from endoscopic images was high in our proposed model. Methods: 2493 endoscopic TM images were selected and classified into normal, TM perforation, and MEE. The images were augmented such as rotating and flipping of the originals to increase the number of training samples. Training was performed using various CNN architectures such as GoogleNet, VGGNet, Res-Net, and DenseNet and the accuracy of each program was compared at the end point of analysis. we conducted 10 trials to alleviate the effects of random initial values of the network during our experiments and then averaged the results to confirm the robustness. Results: The accu-racy of the 152 versions of the ResNet model was highest (94.8%) and the accuracy of the 161 version (95.4%) was higher than that of the 201 version (94.5%) for DenseN-et. In the case of VGGNet, accuracy was slightly higher in batch normalization group (94.0-94.1%) and there was little difference in accuracy between models. The per-formance of the inception V3 model, which is the most popular version of GoogleNet, is similar to ResNet and VGGNet. Conclusion: Detection of TM abnormalities

significantly elevated in co-treatment (200μg/mL UP+S.pneumoniae (MOI 10)) in compare to single treatment. Similarly, increased apoptosis and necrosis and ROS pro-duce were detected in HMEECs treated with UP+ pneu-mococci. The microarray analysis of HMEECs treated with UP or pneumococci or co-treatment revealed that the genes involve in apoptosis, cancer, inflammation and other activity were exclusively differentially regulated in co-treatment. Conclusion: Presence of UP increases S. pneumoniae biofilm, pathogenesis, and toxicity and fa-cilitates colonization to HMEECs.

» OTOP-39 08:40~08:50

» IDENTIFYINg RISK FACTORS OF OTITIS ME-DIA WITH EFFUSION FOR HYPERBARIC OxY-gENTHERAPY



COLLEGE OF MEDICINE

HANEUL LEE, YOUNG JOON SEO

Objectives: Determine whether specific risk factors, symptoms and clinical examination findings are asso-ciated with hyperbaric oxygen therapy (HBOT) intol-erance and subsequent tympanotomy tube placement. Methods: A prospective case series under IRB was con-ducted for 6 months in patients undergoing HBOT clearance at a tertiary care university hospital. Eighty-one patient were included for risk factors, symptoms and clin-ical examination findings, questionnaire, CT images re-lated to HBOT eustachian tube dysfunction and middle ear barotrauma. Relative risk was calculated for each vari-able to determine risk for HBOT intolerance and need for tympanotomy tube placement. Risk factor, symptom, physical examination and HBOT complication-suscep-tibility scores were calculated for each patient. Results: Mean risk factor, clinical and HBOT complication-sus-ceptibility scores in questionnaire were significantly high-er in patients who did not tolerate HBOT compared to patients who tolerated HBOT. Patients reporting a histo-ry of pressure intolerance and prior ear surgery were more likely to undergo tympanotomy tube placement. Patients noted to have otologic findings prior to HBOTwere at a higher risk for both HBOT intolerance and tympanot-omy tube placement. Conclusion: A physical exam by otorhinolaryngology combined with the questionnaire can potentially predict and identify patients at risk for


April27(Sat)



bilateral P-BPPV.

» OTOP-42 09:10~09:20

» COMPARISON OF BALANCE OUTCOMES ACCORDINg TO TREATMENT MODALITY OF vESTIBULAR SCHWANNOMA A SYSTEMATIC REvIEW AND META-ANALYSIS



THE CATHOLIC UNIVERSITY OF KOREA, SEOUL,

SOUTH KOREA1, THE RESEARCH INSTITUTE FOR

NURSING SCIENCE, KEIMYUNG UNIVERSITY,

COLLEGE OF NURSING, DAEGU, SOUTH KOREA2,


NECK SURGERY, OREGON HEALTH & SCIENCE

UNIVERSITY, PORTLAND, OREGON, USA3

HARAM KANG1, GAEUN KIM2, TIMOTHY E HULLAR3, JAE-HYUN SEO1

Objectives: We sought to compare balance outcomes according to treatment modality of vestibular schwan-noma (VS) via a meta-analysis that divided measuring tools of balance outcomes into three categories based on type. Methods: A thorough search of the literature from 1966 to September 2017 was conducted using PubMed, EMBASE, and Cochrane Library. A comprehensive re-view was performed of studies on balance outcomes with follow-up of at least 1 year after microsurgery (MS), ra-diotherapy (RT), or observation (OB) for VS. Outcome variables were validated dizziness questionnaires, dizzi-ness improvement rate, and symptom incidence rate of vertigo and dizziness/disequilibrium. Comprehensive meta-analysis was used to analyze effect sizes, explore possible causes of heterogeneity, and check publication bias with a funnel plot and Egger’s regression. Results: Among 633 references, 34 articles (n=5560) were includ-ed in the meta-analyses. The perceived dizziness improve-ment rate was significantly higher in the MS group than the RT group (odds ratio [OR] 1.61; 95% confidence in-terval [CI] 1.08 to 2.40; P < 0.05, I2 = 4.18), but no sig-nificant difference was observed between the two groups by validated dizziness questionnaire score (standardized mean difference [SMD] 0.04; 95% CI -0.36 to 0.44; P = 0.84, I2 = 69.61) or dizziness or disequilibrium-related symptom incidence rate (OR 0.91; 95% CI 0.50 to 1.68; P = 0.77, I2 = 0). In a subanalysis conducted within the

using CNN-based deep learning showed high accuracy. The performance of the CNN program for detecting en-doscopic TM finding and middle ear effusion was highest for DenseNet 161 in our dataset.


Chair : SEONG KI AHN, JAE YONG BYUN

Vestibular Disorder

» OTOP-41 09:00~09:10

» UNILATERAL POSTERIOR CANAL-PLUg-gINg SURgERY FOR INTRACTABLE BILATER-AL POSTERIOR CANAL-TYPE BENIgN PAROx-YSMAL POSITIONAL vERTIgO

DEP. OF OTORHINOLARYNGOLOGY, OSAKA UNIV.

GRADUATE SCHOOL OF MEDICINE

TAKAO IMAI

Objectives: To investigate the effectiveness of unilateral posterior semicircular canal (PSCC)-plugging surgery for patients with intractable bilateral PSCC-type benign par-oxysmal positional vertigo (P-BPPV). Methods: From July 2011 to December 2015, we diagnosed 136 patients with P-BPPV. Of these, 3 patients had bilateral P-BPPV, and in 2 of the 3, the condition had been refractory to conservative treatment for more than 1 year. We planned a staged PSCC-plugging surgery for these 2 patients ini-tially one side was treated, and the contralateral side was treated 6 months later. Results: After the first surgery, both patients experienced improvement in symptoms of vertigo and nystagmus on the operated side and no change on the non-operated side. Patients underwent the Epley maneuver for the non-operated side. In one case, the non-operated side was cured. In the other case, although the P-BPPV was not completely resolved, the patient was satisfied with the result of unilateral surgery because he was now able to turn in bed to the operated side without vertigo. Before surgery, he had experienced vertigo when turning even slightly in bed. Conclusion: Conclusion We propose that even unilateral PSCC-plug-ging surgery is effective for some patients with intractable

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pants conducted the VR protocol with the IMUs that use wireless synchronization to ensure multiple units collect. Data from normal subjects were considered as reference, which were compared to those from patients in predeter-mined periods (before VR and 1,4, and 8 wks after VR). 3-dimensional vector components were obtained from the IMUs, which were visualized as histograms and clas-sified by deep learning algorithms. Results: Acceleration parameter from IMU attached center of body was the most reliable parameter to classification between normal and patients. Based on the data, histogram representing body sway at the predetermined periods while perform-ing exercise were obtained, which showed a platykurtic distribution in the initial period after VR and changed to a leptokurtic distribution over time. Conclusion: The current results suggest IMUs could provide a promis-ing solution for tracking progression of VR and further refined algorithms can unlock the potential of mobile health technology for VR or home exercise monitoring.

» OTOP-44 09:30~09:40

» CHARACTERISTICS OF NYSTAgMUS DURINg ATTACK OF vESTIBULAR MIgRAINE


HEAD AND NECK SURGERY, CATHOLIC

KWANDONG UNIVERSITY SCHOOL OF MEDICINE,

INTERNATIONAL ST MARYS HOSPITAL

SOYEON YOON1, MINBUM KIM2

Objectives: Vestibular migraine(VM) is one of the emerging disorder related with recurrent vertigo attacks, however, any objective neurological findings is not con-firmative to differentiate VM from other peripheral dis-orders. The purpose of this study is to investigate charac-teristics of nystagmus during attacks of VM, and to find a distinct features compared to other peripheral vertiginous disorders. Methods: This study is a retrospective chart re-view of 30 VM patients, who presented with vertigo at-tack (ictal phase). Spontaneous and positional nystagmus provoked by various head positions were examined with video-nystagmography (VNG) in all patients. Bithermal caloric test and cervical vestibular evoked myogenic po-tential test (cVEMP) were also performed. The direction and peak slow-phase velocity (SPV) of nystagmus, uni-lateral caloric weakness and interaural difference(IAD) of cVEMP were analyzed. Results: During the acute attack, spontaneous nystagmus was seen in 27% (8/30) of pa-

groups after intervention, the MS group demonstrated a lower vertigo incidence rate (P < 0.001), and the RT group experienced a significant reduction in validated dizziness questionnaire score (P < 0.05). Conclusion: Our results indicate that MS should be considered at least equal to RT in regard to resolving long-term dizziness and improving balance outcomes. Further, well-designed studies are necessary to predict balance outcomes after VS treatment and to choose from among possible treatment options.

» OTOP-43 09:20~09:30

» DEvELOPMENT OF INERTIAL SENSOR AL-gORITHMS FOR OBJECTIvE MEASURE OF PERFORMANCE OF vESTIBULAR REHABILI-TATION IN PROgRESS



COLLEGE OF MEDICINE1, LABORATORY OF BRAIN

AND COGNITIVE SCIENCES FOR CONVERGENCE

MEDICINE, HALLYM UNIVERSITY COLLEGE OF

MEDICINE2, DEPARTMENT OF CONVERGENCE

SOFTWARE, HALLYM UNIVERSITY3

SUNG KWANG HONG1,2, HAN JAE JEON3, JYAE HYOUNG YU1,2, MIN HEE AHN1,2,

JEONG HYE PARK1,2, HYO-JEONG LEE1,2, HYUNG-JONG KIM1,2

Objectives: Vestibular rehabilitation (VR) has been known as an effective treatment modality for patient with dizziness, in which home based-exercise program is a crit-ical part for improvement of postural stability. However, objective measurements indicating progress of postural stability during VR could be carried out using expensive equipment such as posturography, so unfortunately many clinicians would be aware of an accomplishment through patient’s statements. We set the present work in the con-text of home-based program, wherein we aimed to devel-op algorithms indicating performance of postural stabil-ity using data from wearable inertial measurement units (IMUs) for VR. Methods: 45 healthy young adults and 25 patients with vertigo participated in this study. The VR protocol included four eye-head exercises, standing and walking. To collect inertial sensor data, four wearable IMUs (Shimmer, Dublin, Ireland) were attached to the head, right arm and leg, and a center of body. All partici-


April27(Sat)



injection of single-dose Gadodiamide for evaluation and quantification of endolymphatic hydrops. Images were then augmented to over one million images (10,000 times) to cope with the lack of training samples. The re-sulting image was segmented and the EH ratio was auto-matically measured by artificial neural networks (ANN). The EH ratio analysis of the same image was performed on ANN, and the results were compared with human measurements. Results: We succeeded in deep learning by using a Python to augment 119 patients MRI images to over one million images. Data preperation was per-formed and training was done. Segmentation results for unseen validation data were analyzed. Average intersec-tion over Union (IoU) value was 0.776 for the cochler, 0.814 for the vestibule. Then we took 5-fold validation to compare human measured hydrops ratios. In the reli-ability analysis, ICC (Intraclass Correlation Coefficient) of average measures for hydrops was 0.983, indicating very high reliability. Conclusion: We have demonstrated through this study that the IV-Gd inner ear MRI im-age analysis using deep learning is very fast and accurate. Currently, the value of MRI usefulness in the diagnosis of Meniere's disease is rising, and if combined with image analysis using ANN, it will have great diagnostic value.

» OTOP-46 09:50~10:00

» LONg-TERM RECURRENCE RATE (5 YEARS) AND RISK FACTORS FOR THE RECURRENCE OF BPPv


YONSEI UNIVERSITY WONJU COLLEGE


OTORHINOLARYNGOLOGY, HANYANG


MYONGJI HOSPITAL2

TAE HOON KONG1, MEE HYUN SONG2, JIN WOOK KANG2, DAE BO SHIM2

Objectives: The aim of this study is to determine the long-term recurrence rate (5 years after canalith reposi-tioning procedure (CRP)) and the correlation between recurrence rate and variable factors in patients with BPPV. Methods: This study is a prospective study. A total of 623 consecutive patients demonstrating typical posterior and horizontal BPPV according to the AAO-HNS guidelines from Jan. 2010 to Dec. 2012 were in-

tients. Horizontal nystagmus was the predominant type, and SPV was less than 2 deg/sec. Ipsi-lesional and con-tra-lesional direction was observed in 3 and 5 patients, re-spectively. Positional nystagmus was seen in 60% (18/30). Horizontal nystagmus was predominant, and SPV was less than 4 deg/sec. Caloric weakness was observed in 3 (10%) patients, however, asymmetric IAD was seen in 11 (37%). Conclusion: Although characteristics of nys-tagmus are quite variable, nystagmus with horizontal di-rections and low SPV was dominant form in the attack of VM. Along with other neurotological findings, IAD of cVEMP might play a subsidiary role in detecting ictal phase of VM.

» OTOP-45 09:40~09:50

» DEvELOPMENT OF COMPUTER AIDED DI-AgNOSIS (CADx) SYSTEM USINg MRI IN ME-NIERES DISEASE




SCHOOL OF MEDICINE1, SMART HEALTHCARE

& DEVICE RESEARCH CENTER, SAMSUNG

MEDICAL CENTER2, DEPARTMENT OF MEDICAL

DEVICE MANAGEMENT AND RESEARCH, SAIHST,

SUNGKYUNKWAN UNIVERSITY3, DEPARTMENT

OF RADIOLOGY, SAMSUNG MEDICAL CENTER,

SUNGKYUNKWAN UNIVERSITY

SCHOOL OF MEDICINE4

YOUNG SANG CHO1, GYEONG BONG KIM2, KYEONGWON CHO2, YI-KYUNG KIM4,

HYUNG-JIN KIM4, BAEK HWAN CHO2,3, WON-HO CHUNG1

Objectives: Recentlyhere are various studies that can diagnose MD by MRI-based endolymphatic hydrops (EH) analysis. However, it takes long time and inaccu-rate. Therefore, a quick, objective and accurate evaluation tool is needed.The purpose of this study is to develop an algorithm that can accurately analyze endolymphatic hy-drops using intravenous (IV) gadolinium (Gd) enhanced inner ear MRI using deep learning. Methods: The image of 119 patients (54 men, 65 women, mean age 50.0yr) who underwent an IV-Gd inner ear MRI was used in this study. We used 3T inner ear MRI scans after intravenous

April27(Sat)




disease; IT-GM and endolymphatic sac decompression in the aspects of dizziness symptom relief and hearing level. Methods: We retrospectively review the records of patients with Meniere’s disease who underwent IT-GM or Sac decompression at Samsung Medical Center from 1998 to 2016. The patients of follow-up periods over 2 years were included in this study. Ten patients with sac decompression and thirty-two patients who underwent IT-GM were included. Patient’s demographic data were collected and the outcome measured included the fre-quency of subjective dizziness attacks and hearing level. Modified version of the AAO_HNS criteria was used to evaluate degree of symptom control. Results: Over-all, there were no significant difference between IT-GM and Sac decompression in terms of symptom control and hearing aggravation. Also, there was no significant difference between pre/post hearing level between two groups. However, when we separated IT-GM group into two groups with/without complete labyrinthine ablation, patients with labyrinthine ablation showed higher rates of symptom control than without labyrinthine ablation. Conclusion: Both intratympanic gentamicin injection and endolymphatic sac decompression were equally ef-fective in management of intractable Meniere’s disease

» OTOP-48 10:10~10:20

» A ANALYSIS OF gAIT vARIABILITY IN UNI-LATERAL vESTIBULOPATHY WITH SHOE-TYPE INERTIAL MEASUREMENT UNITS



MEDICINE, BUSAN, KOREA

DONGYOUNG KIM, HWAN HO LEE

Objectives: Despite patients with dizziness were reported of revealing gait problems, there is still lack of objective quantitative measurement of gait patterns of peripheral vestibular disorders. Based on a shoe-type wearable de-vice, this paper develops gait analyzing algorithms to obtain quantitative measurements and explores the es-sential indicators from the measurements for peripheral vestibular disorder diagnosis.Methods: Between April 2017 and August 2018, 65 patients diagnosed with uni-lateral vestibulopathy(vestibular neuritis(N=60), Sudden sensory neural hearing loss with vertigo(N=5)) were en-rolled in this study. The DynaStabMotionCore Anal-ysis(shoe-type inertial measurement units(IMU))® was

cluded. They contacted by phone every 6 months for 5 years. Recurrence of BPPV was defined as recurred po-sitional vertigo after complete resolution followed by a symptom-free period of at least 7 days. We assessed the 5-year recurrence rate of BPPV and the time point of re-currence in all subjects. We analyzed the risk factors of BPPV recurrence including age, gender, involved canal, type of BPPV, number of performed CRPs, number of previous attacks of BPPV, the time between onset and treatment of BPPV, and comorbidities (hypertension, diabetes, hyperlipidemia, osteoporosis, and psychogenic disease). Independent t-test for continuous variables, and chi-square or Fisher’s exact test for categorical variables were performed for statistical analysis. Results: Among 623 patients, 165 (26.5 %) patients showed recurrence at least once; 96 (58.2%) out of 165 recurred patients had only one recurrence whereas 69 (41.8%) experienced recurrence two or more times. The recurrence occurred within a year in 112 patients (68.7%). The numbers of performed CRPs (p=0.003), number of previous BPPV attacks (p=0.017), and comorbidities including hyper-tension (p=0.007), hyperlipidemia (p=0.003) and psy-chogenic disorders (p=0.002) were significant factors influencing the recurrence of BPPV. Conclusion: The recurrence rate of BPPV was about 27% at 5 years after the initial treatment, and about 69% recurred within one year. The number of performed CRPs, number of previ-ous BPPV attacks, and comorbidities including hyper-tension, hyperlipidemia and psychogenic disorders were significant risk factors of BPPV recurrence.

» OTOP-47 10:00~10:10

» COMPARISON IN THE LONg TERM EFFICA-CY OF INTRATYMPANIC gENTAMICIN INJEC-TION (ITgM) AND ENDOLYMPHATIC SAC DE-COMPRESSION IN PATIENTS WITH MENIERES DISEASE





SONG I PARK, YOUNG-SANG CHO, WON-HO CHUNG

Objectives: The aim of this study is to compare the effi-cacy of two different second line treatment for Meniere’s


April27(Sat)



Fifty-nine ear in 56 patients with isolated ossicular abnor-malities. Interventions: Ossiculoplasty or stapes surgery using either ear endoscopes or an operating microscope. Main Outcome Measures: Postoperative audiometric re-sults, operation time, requirement of additional skin inci-sion, and complication. Results: Results: Thirty-nine ear (66.1%) was in microscopic group and 20 ears (33.9%) in TEES group. Mean preoperative air-bone gap was 30.5 dB (SD, 10.2) in microscopic group and 31.7 dB (SD, 12.8) in TEES group. Mean postoperative air-bone gap was 7.1 dB (SD, 6.0) in microscopic group and 6.8 dB (SD, 4.6) in TEES group. The differences in preoperative and postoperative air-bone gap between the two groups were not statistically significant (p = 0.697 and p=0.844, respectively). Operation time in TEES group was signifi-cantly shorter than that in microscopic group (P=0.001). Patients in TEES did not require additional skin in-cision, while it was required in two patients in micro-scopic group. The difference was statistically significant (p = 0.045). Postoperative sensorineural hearing loss oc-curred in one patient in microscopic group. Conclusion: Conclusion: TEES for isolated ossicular abnormalities has comparable audiometric results and complication rates to conventional microscopic surgery. TEES appears to have advantage of shorter operation time and less re-quirement of additional skin incision.

» OTOP-50 11:20~11:30

» RESULTS OF vENTILATION TUBE INSER-TION ACCORDINg TO THE MICROBIOLOgY - MULTICENTER REgISTRY STUDY ON THE EFFECTIvENESS OF vENTILATION TUBE IN PEDIATRIC PATIENTS WITH OTITIS MEDIA WITH EFFUSION-PART III


AND NECK SURGERY, SCHOOL OF MEDICINE,

KYUNGPOOK NATIONAL UNIVERSITY1,


AND NECK SURGERY, SAMSUNG MEDICAL




SURGERY, KOREA UNIVERSITY COLLEGE OF

MEDICINE, KOREA UNIVERSITY ANSAN HOSPITAL3,


AJOU UNIVERSITY SCHOOL OF MEDICINE4,

used to analysis subjects. We assessed normalized stride length, cadence, time of toe off, directional stride regular-ity(SR), gait variability(GV), Phase Coordination Index-(PCI) and gait asymmetry(GA) of data from shoe-type IMU sensors during leveled treadmill walking. We tested 1,217 healthy volunteers and classified them as different groups. Results: We identified time of toe off rate among the parameters of the human walking pattern. The time of toe off rate of patients with unilateral vestibulopathy was increased to 60.93±2.04 compared to 60.38±1.88 in healthy volunteer. In addition, there were differences in PCI, GA and related gait parameters, when comparing peripheral vestibular disorders groups and healthy volun-teers. Conclusion: Gait analysis by the use of shoe-type IMU could provide important information regarding vestibular pathophysiology in patients with unilateral vestibulopathy. Gait performance tests can examine gait variability quantitatively. It will be taken into consider-ation as a vestibular function test for patients with ver-tigo.


Chair : YOUNG SEOK CHOI, BYEONG DON LEE

Otitis Media & Cholesteatoma

» OTOP-49 11:10~11:20

» MICROSCOPIC vERSUS ENDOSCOPIC EAR SURgERY FOR ISOLATED OSSICULAR AB-NORMALITIES


HEAD AND NECK SURGERY, CHUNGNAM


JAE-YOON KANG, JAE-IN CHANG, BONG-JIK KIM, YONG-HO PARK,

JIN WOONG CHOI

Objectives: Objective: To compare surgical outcomes of transcanal endoscopic ear surgery (TEES) for isolated os-sicular anomalies with those of conventional microscopic surgery. Methods: Study Design: Retrospective case re-view. Setting: Tertiary referral academic center. Patients:

April27(Sat)




Objectives: Culture from middle ear effusion frequent-ly done during ventilation tube insertion, but it is un-clear as to what impact the microbiological results have on extrusion and complication rates. This part III study was conducted to evaluate the postoperative results es-pecially according to the status of effusion and culture results. Methods: Patients <15 years old who were diag-nosed as having otitis media with effusion and received ventilation tube insertion were prospectively enrolled in 15 tertiary hospitals from June 2014 to December 2016. Follow-up data were collected until December 2017. After excluding patients with missing data, the data of 401 patients (727 operated ears) were analyzed among a total of 432 enrolled patients. Results: Average follow-up duration after tube insertion was 313 ± 238 days (range 3 to 1377 days). The status of effusion was serous in 221 patients (33.1%), mucoid in 200 (29.9%), glue in 220 (32.9%), and purulent in 27 (4.0%). Intra-operative culture was done in total of 337 ears (46.4%) and positive results were found in only 16.3% (55 ears) among them. According to the status of effusion, there were statistically significant different time to recurrence of otitis media with effusion (p<0.001), but there was no significant difference of time to extrusion (p=0.424). Dif-ferent effusion status also showed significant difference in tube otorrhea (p=0.008) and revision tube insertion rate (p<0.001) during follow-up period. But positive culture ears didn't show significant difference in time to extrusion (p=0.084) or time to recurrence (p=0.357) when compared with negative culture ears. Also culture results didn't affect revision insertion, perforation, and tube otorrhea rates. Conclusion: The status effusion in-fluenced time to recurrence of otitis media and also re-vision tube rate. However positive culture results didn't show significant difference in outcome of tube insertion. So when counseling after ventilation tube insertion, we should consider the status of effusion.

» OTOP-51 11:30~11:40

» IS THE PROTYMPANIC AERATION ON PRE-OPERATIvE CT SCANS A gOOD PROgNOS-TIC FACTOR FOR HEARINg IMPROvEMENT IN REvISION SURgERIES




COLLEGE OF MEDICINE


SCHOOL OF MEDICINE, HANYANG UNIVERSITY5,


HEAD & NECK SURGERY, ASAN MEDICAL CENTER,



AND NECK SURGERY, GACHON UNIVERSITY

OF MEDICINE AND SCIENCE, GRADUATE



UIJEONGBU ST MARYS HOSPITAL, COLLEGE

OF MEDICINE, THE CATHOLIC UNIVERSITY OF

KOREA8, DEPARTMENT OF OTOLARYNGOLOGY-

HEAD AND NECK SURGERY, DAEJEON ST

MARYS HOSPITAL, COLLEGE OF MEDICINE,

THE CATHOLIC UNIVERSITY OF KOREA9,



MEDICINE, INHA UNIVERSITY10, DEPARTMENT

OF OTORHINOLARYNGOLOGY, SEOUL


SEOUL NATIONAL UNIVERSITY HOSPITAL11,







NECK SURGERY, BUCHEON ST MARYS HOSPITAL,


UNIVERSITY OF KOREA14, DEPARTMENT OF


SURGERY, SCHOOL OF MEDICINE,

KYUNG HEE UNIVERSITY15

MYUNG HOON YOO1, YANG-SUN CHO2, JUNE CHOI3, YUN HOON CHOUNG4,

JAE-HO CHUNG5, JONG WOO CHUNG6, GYU CHEOL HAN7, BEOM CHO JUN8,

DONG-KEE KIM9, KYU SUNG KIM10, JUN HO LEE11, KYU-YUP LEE1,

SEUNG HWAN LEE5, IN SEOK MOON12, HONG JU PARK6, SHI NAE PARK13,

JIHYE RHEE3, JAE HYUN SEO14, SEUNG GEUN YEO15


April27(Sat)



NATIONAL UNIVERSITY HOSPITAL1, DEPARTMENT

OF PEDIATRIC PLASTIC AND RECONSTRUCTIVE


COLLEGE OF MEDICINE, SEOUL NATIONAL

UNIVERSITY CHILDRENS HOSPITAL2

JAYOUNG OH1, SUK HWA KIM2, MYUNG-WHAN SUH1, JUN HO LEE1, SEUNG HA OH1, MOO KYUN PARK1

Objectives: Otitis media (OM) with effusion is a very common finding in children with cleft palate. Dysfunc-tion in the opening of Eustachian tube caused by abnor-mality in paratubal muscles, especially tensor veli palatini (TVP) muscle, is believed to be the main cause. However, since it is unclear whether the aberrant anatomical inser-tion of TVP muscles in cleft palate patients actually leads to OM with effusion or not, the effect of various surgical technique applied to TVP muscle still remains question-able. In this study, we aim to assess the impact of relaxing incision of TVP muscle during cleft palate repair on the short-term otological outcome by performing retrospec-tive review. Methods: A retrospective chart review of 99 pediatric patients (167 ears) who received cleft palate sur-gery was carried out to evaluate the relationship between the relaxing incision of TVP muscle and the short-term otological outcomes, which are represented as ventilation tube (VT) extrusion time and the number of addition-al VT insertion during the 3-year follow-up period. The factors we additionally analyzed include age, gender, the existence of OM with effusion before the surgery, and the first onset of OM with effusion. Results: Relaxing incision of TVP muscle was performed in 59 of 99 cases during the cleft palate repair. When right ears were eval-uated, the patients with relaxing incision of TVP muscle had shorter VT extrusion time (mean=10.4 months) and lower number of additional VT insertion (mean=1.29), but the difference was statistically insignificant (p=0.323, 0.786>0.05, respectively). Left ear cases also showed no significant differences between two groups. Conclusion: The surgical management of TVP muscle, especially re-laxing incision, turned out to have no significant effect on middle ear problems of cleft palate patients, thus not necessarily helpful. Further long-term studies might be needed to confirm this study.

» OTOP-53 11:50~12:00

» ENDOSCOPIC EAR SURgERY (EES) FOR CONgENITAL CHOLESTEATOMA IN CHIL-

JE YEON LEE, MIN YOUNG KWAK, JI WON SEO, HONG JU PARK

Objectives: Tympanic aeration is an important factor for successful hearing improvement in revision surgeries for chronic otitis media. We aimed to evaluate the inci-dence of successful hearing restoration after revision sur-gery and correlate between preoperative aeration around the protympanum and postoperative hearing outcome. Methods: The 58 patients who diagnosed chronic oti-tis media without tympanic membrane perforation and underwent revision surgery were enrolled retrospectively. We measured aeration of protympanum on preoperative CT scans. Aeration was classified by 2 groups.(Group 1 : good aeration, Group 2 : relatively poor aeration or total opacification). Average air and bone conduction hearing thresholds (0.5, 1, 2, and 4-kHz) were calculated and postoperative air-bone gap (ABG) ≤ 20 dB was consid-ered successful ABG. Results: In Group 1, preoperative and postoperative ABG was 32.4±9.8 dB and 20.3±10.4 dB and the improvement of ABG was 12.1±12.4 dB. In Group 2, preoperative and postoperative ABG was 31.9±11.4 dB and 29.4±9.5 dB and the improvement of ABG was 2.5±11.7 dB. Preoperative ABG was not different from two groups, but postoperative ABG was statistically poorer in group 2 (p=0.01). The successful closure of ABG ≤ 20 dB was obtained in 63% (30 of 48) in group 1 and 20% (2 out of 10) in group 2, which was significantly different (p=0.03). Conclusion: When the protympanum was well-aerated, successful hearing restoration was possible even in revision ear surgeries. Measurement of protympanum aeration is an import-ant factor for successful postoperative hearing outcome, suggesting that the aerated protympanum is a marker for good function of Eustachian tube.

» OTOP-52 11:40~11:50

» A RETROSPECTIvE STUDY TO ASSESS THE IMPACT OF SURgICAL MANAgEMENT OF TENSOR vELI PALATINI MUSCLE ON SHORT-TERM OTOLOgICAL OUTCOME REgARDINg OTITIS MEDIA WITH EFFUSION IN CLEFT PAL-ATE PATIENTS




April27(Sat)




» OTOP-54 12:00~12:10

» EFFICACY OF FOLLOW-UP TEMPROAL BONE CT AND ENDOSCOPIC ExAMINATION IN CONgENITAL CHOLESTEATOMA



UNIVERSITY HOSPITAL

HYUNJUN WOO1, SANG-YEON LEE2, JUN HO LEE2

Objectives: The incidence of congenital cholesteatoma of middle ear is increasing due to developments in diagnos-tic skills using endoscopy. In advanced congenital choles-teatoma, detection of recurred cholesteatoma after first operation is essential. In this study we report a retrospec-tive study of more than one hundred cases of congenital cholesteatoma. Methods: From January 2009 to January 2019, 111 pediatric congenital cholesteatoma patients were reviewed. Congenital cholesteatoma was confirmed by TBCT followed by endoscopic exam of TM at out-patient clinic. Patient information, pre-op endoscopic findings, TBCT, audiometry and post-op TBCT, audi-ometry were reviewed. Presence of recurred cholesteato-ma after first operation and types of second stage oper-ation were also reviewed. Potsic staging was applied to classify the extent of congenital cholesteatoma. Results: Among 111 patients reviewed, 40 patients presented with Potsic stage I congenital cholesteatoma. 31 Potsic stage I patients underwent endaural cholesteatoma removal and showed no recurrence. Among 29 patients presented with Potsic stage 2 congenital cholesteatoma, 10 patients underwent atticoantrostomy during first operation. 23 patients and 19 patients presented with Potsic stage 3 and Potsic stage 4 congenital cholesteatoma respective-ly. They underwent ICW with T0 during first operation. Then second stage ossiculoplasty was done. Soft tissue regrowth was identified in TBCT in 9 patients with Pot-sic stage 4 congenital cholesteatoma after first operation, but during second stage ossciuloplasty later, those lesions were found to be soft tissue growth which was removed. Overall there was no recurrence in these patients group. The audiometry results will be analyzed further. Average follow-up period was 17 months, ranging from 1 to 38 months. Conclusion: In this study congenital cholestea-toma could be successfully removed without recurrence. Postoperative TBCT and endoscopic examination can be applied to monitor recurrence or residual cholesteatoma.

DREN




ASAN MEDICAL CENTER

YEONJOO CHOI, MIN YOUNG KWAK, JONG WOO CHUNG

Objectives: Endoscopic approach for ear surgery has be-come one of the most promising techniques for removing congenital cholesteatoma (CC). The aim of this study is to describe our experience in managing CC with endo-scopic approach, and compare with conventional micro-scopic approach. Methods: The study was retrospective-ly reviewed the records of patients who were diagnosed with CC at Asan medical center from Jan. 2013 to Dec. 2018. Operation time, hospital stay, postoperative com-plication, and recurrence were observed. Results: A 36 pediatric patients aged from 19 months to 7 years were enrolled; 13 for microscopic approach (non-EES group), and 23 for endoscopic approach (EES group). The mean follow-up period were 41.58 months (non-EES group) and 21.31 months (EES group) (p=0.013). There were no difference in the baseline parameter between two groups; age (p=0.113), gender (p=0.259), eroded ossi-cles status (p=1.00), cholesteatoma size (p=0.099), site (p=0.923), type(closed or open) (p=0.075) and Postic’s stage (p=0.712). There were no significantly difference in operation time between two groups; 1.31 hours for non-EES group, 1.69 hours for EES group (p=0.186). No re-sidual CC and postoperative sensorineural hearing loss were reported in both groups. No significant differences were shown between two groups regarding postoperative complications and recurrence (p=0.328, p=0.609). No audiologic differences were reported between two groups by comparing preoperative and postoperative pure tone audiometry; 1.25dB and 1.59dB were improved after surgery, respectively regardless of ossiculoplasty (p=0.925). There were significantly shorter hospital days in EES group(2.39 days) than non-EES group(3.15 days) (p=0.006). Conclusion: EES is not inferior to conven-tional microscopic approach, even it representes superi-ority in terms of postoperative recovery. Endoscopic ap-proach for removing CC is feasible and valuable methods allowing good surgical control of cholesteatoma in hid-den area especially in young patients.


April27(Sat)



CROSCOPIC TYMPANOPLASTY WITHOUT CA-NAL SKIN INCISION



UNIVERSITY COLLEGE OF MEDICINE, BUSAN

MINSIK KIM, YONGIL CHEON, SUNGWON CHOI, HYUNMIN LEE, SEJOON OH, SOOKEUN KONG,

ILWOO LEE

Objectives: Traditionally, microscopic tympanoplasty has been performed as an operative treatment for tym-panic membrane perforation. In recent years, endoscop-ic tympanoplasty has become commonplace due to the development of endoscopy. Therefore, we compare the hearing and recurrence rates of the two groups with mi-croscopic tympanoplasty and endoscopic tympanoplasty. Methods: The 30 patients each of chronic otitis media treated with endoscopic tympanoplasty and those with microscopic tympanoplasty were analyzed. A total of 60 patients were evaluated according to operation time, preoperative pure tone audiometry, postoperatively 3 months, 6 month pure tone audiometry in operated ear and recurrence rate in 3 months and 6 months. Results: There was no statistically significant difference between the two groups in terms of age, gender, sex, and preop-erative hearing level of lesion side. The mean preopera-tive hearing in normal ear was significantly better in the microscopic tympanoplasty group. Operative time was significantly shorter in the endoscopic tympanoplasty group.(83 min in the endoscopic tympanoplasty group and 97 min in the microscopic tympanoplasty group) (p = 0.007). Both groups showed statistically significant im-provement in air conduction hearing level and air-bone conduction gap at 6 months postoperatively compared with preoperative hearing level, but the treatment effect of both groups was not statistically different. At 6 months postoperatively, the endoscopic tympanoplasty group recurred 4%, whereas the microscopic tympanoplasty group had 16.7% recurrence. However, there was no sta-tistically significant difference in recurrence rate between the two surgical methods. Conclusion: Endoscopic tympanoplasty can reduce the operation time compared with microscopic tympanoplasty. There was no signif-icant difference in postoperative hearing improvement and recurrence rate between the two groups. Therefore, endoscopic based tympanoplasty is considered to be an effective treatment for chronic otitis media.

» OTOP-55 12:10~12:20

» TRANSCANAL ENDOSCOPIC EAR SURgERY FOR ATTIC CHOLESTEATOMA



ASAN MEDICAL CENTER, UNIVERSITY OF

ULSAN COLLEGE OF MEDICINE

MIN YOUNG KWAK, YEONJOO CHOI, WOO SEOK KANG, JONG WOO CHUNG

Objectives: To evaluate the efficacy of endoscopic ear sur-gery for primary acquired attic cholesteatoma. Methods: Participants : Thirty-one patients with attic cholesteato-ma were enrolled in this study from Aug 2014 to Aug 2018. Main outcome measures : We evaluated the extent of cholesteatoma in the endoscopic approaches compared with the preoperative CT findings based on the JOS(Ja-pan Otological Society) staging system. The hearing pres-ervation outcomes, recurrence and complication rates were also analyzed. Results: We determined the applica-tion of endoscopic ear surgery for attic cholesteatoma by preoperative CT findings. Total 31 patients showed the cholesteatoma confined to the attic region with or with-out involving tympanum and antrum. Twenty patients had the same extent of cholesteatoma as shown in preop-erative CT. The extent of cholesteatoma in seven patients showed smaller than preoperative CT findings, and in 4 patients showed severer than preoperative CT findings. We were able to remove the cholesteatoma completely by endoscopic approach alone without any complications in 28 out of 31 patients. Combination of microscopic mastoidectomy was needed to remove cholesteatoma in 3 patients. The mean follow-up period was 13 months. Average thresholds of the preoperative and postoperative air-bone gap were 17.94+-11.12dB and 12.70+-9.75dB respectively. Recurrence cholesteatoma was found in 1 of 31 patients (3%). Conclusion: Transcanal endoscopic ear surgery is useful in the primary acquired attic cho-lesteatoma. Temporal bone CT alone cannot provide the extent of cholesteatoma in one-third of the cases. There-fore, more evaluation tool is needed, and microscopic combination surgery is sometimes required..

» OTOP-56 12:20~12:30

» COMPARISON OF TREATMENT OUTCOME OF ENDOSCOPIC TYMPANOPLASTY AND MI-

April27(Sat)





Chair : EUN JU JEON, JONG DAE LEE

Vestibular Disorder

» OTOP-58 15:20~15:30

» POSITIONAL AUDIOMETRY IN PATIENTS WITH LIgHT CUPULA


HEAD AND NECK SURGERY, KONKUK UNIVERSITY

SCHOOL OF MEDICINE, KONKUK UNIVERSITY

MEDICAL CENTER

KYUJIN HAN, HYE RANG CHOI, JUNG EUN SHIN, CHANG-HEE KIM

Objectives: To investigate if hearing level is influenced by the change of head position in light cupula under the assumption that relative density difference similarly oc-curs between the tectorial membrane and endolymph. Methods: Twelve patients with unilateral light cupula underwent positional audiometry were included in this study. Pure tone thresholds were compared among three head positions. Results: Hearing threshold in pure tone audiometry (PTA) of the affected ear was not different from that of the healthy ear. PTA thresholds of the af-fected side were not significantly different in three head positions; upright seating, cochlear apex-up and cochlear apex-down positions. Conclusion: Although positional change of nystagmus direction is the most significant clinical feature of light cupula, positional change of hear-ing level was not observed in those patients. The lack of positional influence on hearing may be explained as fol-lows; (1) the light cupula phenomenon occurs only in the vestibular end organ without involving the cochlea, and (2) the light cupula phenomenon is more likely to occur due to light debris mechanism rather than heavier endolymph or lighter cupula mechanism.

» OTOP-59 15:30~15:40

» IS ASYMMETRIC HEARINg LOSS A RISK FACTOR FOR vESTIBULAR DYSFUNC-

» OTOP-57 12:30~12:40

» SPONTANEOUS CEREBROSPINAL FLUID (CSF) OTORRHOEA IN WESTERN AUSTRALIA (WA)

DEPARTMENT OF EAR, NOSE AND THROAT

SURGERY, FIONA STANLEY HOSPITAL,

PERTH, WA

THOMAS HENDRIKS1

Objectives: Spontaneous CSF otorrhoea appears to be an emerging clinical entity. The aetiology, characteris-tics and treatment outcomes of these group of patients are poorly described so we aimed to further investigate this growing cohort. Methods: A retrospective review of 30 patients with spontaneous, non-iatrogenic, and non-traumatic spontaneous CSF otorrhoea was per-formed over a five-year period. Baseline demographics, presenting symptoms, past medical history, clinical ex-amination, investigation (biochemical and radiological), management and outcomes were recorded. Results: The majority of patients were obese females presenting with a unilateral middle ear effusion and conductive hearing loss. Beta trace protein sampling of the fluid was positive for CSF for all patients. The most frequent site of leak was at the tegmen mastoideum and middle cranial fos-sa repair was the most commonly performed procedure with good outcomes. Only one patient had confirmed benign intracranial hypertension. Two patients presented with meningitis which was thought to be due to the CSF leak. Conclusion: Spontaneous CSF otorrhoea should be suspected in unilateral middle ear effusion of unknown cause. Clinical or radiological diagnosis alone appears in-adequate in diagnosing a spontaneous CSF leak unless cli-nicians have a high index of suspicion. This entity appears to occur in the absence of raised intracranial pressure and further studies to elucidate the cause are required.


April27(Sat)





SEOUL, KOREA2

JI HYUNG KIM1, MIN PYO HONG1, GEUN CHEOL SHIN1, INON KIM1, JOO AE LIM2,

JEANHONG JEON2, SEUNG HWAN HAN2, EUN JIN SON1

Objectives: Difficulty during walking can be disabling in patients with vestibular dysfunction. While visual ex-amination during walking is easy to perform, it requires experience and expertise from the examiner. The inertial measurement unit (IMU)-based gait analysis systems of-fer clinically applicable method that is both convenient and able to provide comprehensive analysis during the gait cycle. Here we introduce a novel method to ana-lyze forward walking using IMU to compare gait char-acteristics during eyes open and eyes closed conditions in vestibular dysfunction patients, who are expected to rely on visual inputs to compensate for vestibular deficits. Methods: The study included 49 normal subjects(mean age 37.6±11.0 yrs) and 23 dizziness patients (mean age 49.3±15.2 yrs). Subjects were instructed walk at a com-fortable pace for 10m in two conditions: eyes open(EO) and eyes closed(EC). Spatiotemporal parameters, kine-matic and simulated kenetics were analyzed using the shoe-type inertial measurement unit (IMU, DynaS-tabTM, JEIOS, South Korea). Results: In normal sub-jects, mean cadence was 118.0±8.7 steps/min in EO, and 112.3±11.6 steps/min, in EC and comparable in either mild dizziness or mod/severe dizziness group.Difference of phase coordination index (PCI) between EO and EC was -8.4±32.9 in normal subjects, which was compara-ble in mild dizziness group (p=0.77) and significantly increased in patient groups (-79.6±139.6, p= 0.0009), supporting increased gait instability without visual input. Also, the difference of gait asymmetry(GA) between EO and EC showed similar correlations. Conclusion: Our novel method to compare gait parameters between eyes open/ eyes closed conditions using IMU can detect ab-normality during gait in patients with vestibular dysfunc-tion that may not be readily evident in visual examina-tions. Such protocol is easy to adapt in dizziness clinics and provides useful information about potential changes in sensory reweighting during locomotion.

» OTOP-61 15:50~16:00

» SUPERIOR SEMICIRCULAR CANAL FUNC-

TION-LESSON FROM BIg DATA ANALYSIS BASED ON THE KOREAN NATIONAL HEALTH AND NUTRITION SURvEY


JEJU NATIONAL UNIVERSITY COLLEGE

OF MEDICINE1,DEPARTMENT OF

OTORHINOLARYNGOLOGY, YONSEI UNIVERSITY


JEE YOUNG SUH1, SUNG HUHN KIM2

Objectives: The purpose of this study was to investigate whether asymmetric auditory deprivation affects vestibu-lar dysfunction. Methods: Study Design: Retrospective cross-sectional Study Patients: Data from the 2010 Ko-rean National Health and Nutrition Survey for adults aged 40 years or more were used. Interventions: Modified Romberg test and pure-tone audiometry were performed. Data were analyzed using complex sample χ2-test of inde-pendence and complex sample logistic regression analysis. Results: The overall prevalence of vestibular dysfunction was 3.3% (95% confidence interval [CI], 2.5–4.3%). In adults aged more than 40 years, multivariate linear regression analyses showed that the odds ratio (OR) of vestibular dysfunction was increased by 3.067 times com-pared with reference for an asymmetric hearing threshold difference of 30 dB (CI, 1.481–6.351; p=0.007), after adjusting for factors associated with vestibular dysfunc-tion. Among these individuals, the risk of equilibrium disturbance was increased with low-frequency asymmet-ric hearing loss (OR, 2.148; CI, 1.216–3.793; p=0.009); on the other hand, high-frequency asymmetry did not increase this risk. Conclusion: As low-frequency asym-metric hearing threshold difference tends to coexist with vestibular dysfunction in adults, those with asymmetric hearing loss should be closely monitored.

» OTOP-60 15:40~15:50

» NOvEL PARAMETERS IN gAIT ANALYSIS USINg INERTIAL MOTION SENSORS DURINg FORWARD WALKINg




SEOUL, KOREA1, DEPARTMENT OF ORTHOPEDICS,

April27(Sat)




» OTOP-62 16:00~16:10

» DISCREPANCY BETWEEN vHIT (vIDEO HEAD IMPULSE TEST) AND CALORIC TEST IN PATIENT WITH DIzzINESS



SANG HYUN KWAK, SUNG HUHN KIM

Objectives: This study was performed to identify the discrepancy between vHIT and Caloric test. We tried to determine characteristics of the patient showing the discrepancy between vHIT and Caloric test. Methods: Total of 1906 patients complaint about dizziness symp-toms and underwent vHIT and caloric test on same day. We divided three groups as normal caloric and abnormal vHIT results, abnormal caloric test and normal vHIT, and abnormal caloric test and abnormal vHIT. Their age, duration of disease and diagnosis were carefully analyzed. Results: Among 1906 patients, 495 patients (27.5%) showed abnormal test results on at least one of the ex-ams. 62 Patients (3%) showed normal caloric test and abnormal vHIT. 169 patients (9%) showed abnormal ca-loric test and normal vHIT. Whereas 256 patients (13%) showed both abnormal results. Longer duration of dis-ease symptoms and old age seems to be influence on the discrepancy between vHIT and caloric test. Conclusion: Delayed testing of vHIT and caloric test and old age should be carefully considered while interpreting results of vHIT and and caloric test.

» OTOP-63 16:10~16:20

» ANALYSIS OF CORRELATION BETWEEN SERUM vITAMIN D LEvEL AND vEMP TEST SCORE IN BPPv PATIENTS


NECK SURGERY, INCHEON ST MARYS HOSPITAL,



HYUN JIN LEE, HYUN IL SHIN, EUN-JU JEON

Objectives: Benign paroxysmal positional vertigo (BPPV) is the most common cause of dizziness in the general pop-ulation. It is a condition with potential impact of reduced

TION AFTER SURgICAL REPAIR WITH PLUg-gINg IN SUPERIOR CANAL DEHISCENCE SYNDROME




JAE JOON HAN, JAE-JIN SONG, BYUNG YOON CHOI, JA-WON KOO

Objectives: Superior semicircular canal dehiscence (SCD) was surgically repaired with canal plugging with soft tissue/bone wax and covering with bone patte/fas-cia via middle cranial fossa approach. In this study, we evaluate the patency of SC and its function after surgical plugging. Methods: A total of 6 patients, who underwent SCD repair via MFA from Dec. 2015 to Jan 2018, were included in this study. Median age of patients was 51 years (28-61) and follow-up duration after surgery was 12 months. Vestibulo- ocular reflex (VOR) function in-cluding gain and compensatory saccade were evaluated with head impulse test (HIT) pre- and postoperatively. To evaluate the patency of SC, heavily T2-weighted images of MRI were taken postoperatively. Results: Preoperative averaged VOR gain of ipsilateral SC was 0.90±0.14. After surgical plugging, VOR gain of SC showed a temporary decrease at 1 weeks after surgery (0.56±0.21), then re-covered up to near normal range (post- 2m, 0.79±0.08; post-6m, 0.69±0.23; post-12m, 0.74±0.16). Although most of patients showed normal range of VOR gain of SC (0.71~0.90) postoperatively, one patient under-went a progressive decrease of VOR gain at 6 months after surgery (pre, 0.82; post-2m, 0.76; post-6m, 0.29; post- 12m, 0.52). The VOR gains of lateral and posterior semicircular canal were not significantly changed up to 12 months after surgery. Among the three patients whom successful plugging of SC lumen was verified with heav-ily T2-weighted images, two patients show normal VOR gain of SC (0.74 and 0.90), whereas one patient show decreased VOR gain of SC (0.52). Conclusion: Despite of successful surgical plugging and complete atelectasis of SC, the VOR function of SC was maintained after sur-gery in some patients. The preserved VOR function of SC might be explained with the loss of inhibitory con-tribution of contralateral posterior semicircular canal or with the persistent canal function of ipsilateral remaining SC after plugging.


April27(Sat)



of acute vestibular neuritis. Methods: Between October 2017 and August 2018, 27 cases of AVN patients were participated in this prospective study. All patients under-went serial follow-ups with video-nystagmography, video head impulse test paradigm (HIMP), and suppression head impulse test paradigm (SHIMP) initially and at 1 month after symptom onset. Patients were also asked to complete dizziness handicap inventory (DHI) and visu-al analog scale (VAS) initially, 1 month, and 6 months after symptom onset of AVN. We divided patients into three groups according to both DHI score and VAS at 1 month after symptom onset of AVN: Group 1, DHI < 10 and VAS < 3; Group 2, DHI ≥ 10 and VAS < 3 or DHI < 10 and VAS ≥ 3; Group 3, DHI ≥ 10 and VAS ≥ 3. We also divided patients into two groups according to both DHI score and VAS at 6 months after: Group F (symptoms free), DHI = 0 and VAS = 0; and Group R (symptoms residual), DHI > 0 or VAS > 0. We compared measured parameters among Groups 1, 2, and 3 and be-tween Group F and R. Results: VOR gain, gain asymme-try (GA), occurrence of covert corrective saccade (CS), occurrence and peak velocity of overt CS, and PR score in HIMP a month after symptoms onset showed signifi-cant differences among Groups 1, 2, and 3 (all p < 0.05). VOR gain, GA, occurrence and peak velocity of anti-CS, and PR score in SHIMP a month after symptoms on-set also showed significant differences among Groups 1, 2, and 3 (all p < 0.05). Furthermore, these parameters a month after symptoms onset showed significant dif-ferences between Group F and R. Conclusion: In this study, we could obtain that various clinical parameters of both HIMP and SHIMP a month after symptoms onset were correlated with the chronic subjective dizziness in the recovery of AVN. If these clinical parameters do not recover within a month, chronic subjective dizziness may persist for a long time in patients with AVN.

» OTOP-65 16:30~16:40

» RELATIONSHIP OF MR SPECTROSCOPY AND CEREBRAL gRAY MATTER vOLUME IN THE COMPENSATION OF vESTIBULAR NEU-RITIS PATIENTS


NECK SURGERY, SCHOOL OF MEDICINE,

KYUNG HEE UNIVERSITY1

JEONG WOOK KANG1, YOUNG MIN HAH1, SANG HOON KIM1, SEUNG GEUN YEO1,

levels of vitamin D. The aim of this study was to evalu-ate the difference in cervical vestibular evoked myogenic potentials (cVEMPs) between patients with BPPV and normal controls and the correlation between vitamin D and cVEMPs in BPPV patients. Methods: Retrospective chart review was performed for 24 patients who were di-agnosed with posterior and lateral canal BPPV. The diag-nosis of BPPV was based on the complaint of positional vertigo in certain specific head positions (Dix-Hallpike manoeuver and head roll test). Positional test induced nystagmus lasted for less than a minute in dominant site. Otolith function in all subjects is investigated through cVEMPs and vitamin D concentrations were evaluated. The upper limit value of cVEMP abnormality was 26%. Results: The average level of vitamin D was 16.3±7.7 ng/ml for the BPPV group and 23 patients (95.8%) showed abnormal value compared with normal range (>30 ng/ml). The average P1 latency was longer than normal value (19.8±3.1 vs 17.8±2.8 msec). The average N1 la-tency was comparable with normal value (26.8±3.1 vs 26.3±3.5 msec). The average P1 amplitude was slightly higher than normal value (-5.4±2.7 vs -4.6±2.1V). The average of N1 amplitude was higher than normal value (7.4±4.1 vs 6.1±3.0V). The average of P1N1 inter-am-pulitude was much larger than normal value (-12.9±6.4 vs -10.7±3.3.8V). The rate of abnormality of cVEMPs test was 20.8%. No significant correlation was identified in cVEMPs abmormality according to Vitamin D level (P>0.05). Conclusion: The values of cVEMPs abnormal-ity (P1 latency, P1 ampulitude, N1 ampulitude, P1N1 inter-amplitude) were showed in BPPV group. The study showed a low level of serum vitamin D3 in most BPPV patients, however, there were no significant correlations between in the vitamin D3 serum level and cVEMPs test.

» OTOP-64 16:20~16:30

» PROgNOSTIC CLINICAL PARAMETERS OF CHRONIC SUBJECTIvE DIzzINESS IN THE RE-COvERY OF ACUTE vESTIBULAR NEURITIS




KANGBUK SAMSUNG HOSPITAL

JUNG-YUP LEE, MIN-BEOM KIM

Objectives: To evaluate various clinical parameters which can predict chronic subjective dizziness in the recovery

April27(Sat)






MUNMUNYOUNG CHANG1, XIAN-YU PIAO1, SEUNG-HA OH2

Objectives: Previously, we showed that hearing loss is a risk factor for the cognitive impairment associated with the hippocampus and the loss of synapse in the hippo-campus using a subthreshold amyloid-β (Aβ) model of Alzheimer's disease. In the present study, we investigated microRNAs which are related with the loss of synapse in the hippocampus after hearing loss. Methods: We utilized microarray and quantitative RT-PCR methods to reveal expression of microRNAs in the hippocampus. Twenty rats were randomly divided into two groups: a normal hearing-subthreshold Aβ group (NH-SA; n = 10) that underwent a sham surgery and the infusion of subthresh-old Aβ and a deaf-subthreshold Aβ group (deaf-SA; n = 10) that underwent bilateral cochlear ablation and the infusion of subthreshold Aβ. The infusion of subthresh-old Aβ for two weeks began 9 weeks after surgery using a brain infusion cannula that was connected to a mini-os-motic pump. All rats were sacrificed at 11 weeks after sur-gery and hippocampus tissues were harvested. Microarray analysis was performed using the hippocampus tissues from three rats of each group. Then, we performed quan-titative RT-PCR methods to verify the microarray results using the hippocampus tissues from 7 rats of each group. Results: Microarray results showed that two microRNAs were more than 1.5-fold upregulated (p-value < 0.1), and five microRNAs were more than 1.5-fold downreg-ulated (p-value < 0.1) in the deaf-subthreshold Aβ group compared to the normal hearing-subthreshold Aβ group. The quantitative RT-PCR results indicated that miR-873-3p and miR-376-3p might be involved in the loss of synapse in the hippocampus. Conclusion: We suggested that miR-873-3p and miR-376-3p might be related with the loss of synapse in the hippocampus after hearing loss.

» OTOP-67 15:30~15:40

» NAvIgATION-ASSISTED BALLOON EUSTA-CHIAN TUBOPLASTY FOR EUSTACHIAN TUBE DILATORY DYSFUNCTION


AND PUSAN NATIONAL UNIVERSITY SCHOOL OF

MEDICINE, BIOMEDICAL RESEARCH INSTITUTE,

MOON SUH PARK1, JAE YONG BYUN1

Objectives: We found the difference of changes in gray matter volume between both side brain in each side ves-tibular neuronitis(VN) patients from the recent study. So, we wanted to find the same feature in MR spectroscopy (MRS) in the same way. Methods: This study examined MRI and MRS in 15 normal controls and 27 unilateral VN patients (Right: 14, Left: 13), from 2016 to 2018. We analyzed gray matter volume and MR spectroscopy of the vestibular cortex. Results: Right VN patients showed increased ipsilateral glutamate(Glu) and glutamine(Gln) concentration rather than controls. (p=0.012) They also showed increased contralateral Glu and Gln concentra-tion rather than controls. (p=0.049) Their GMV of the ipsilesional vestibular cortex was increased than controls but not in the contralesional side. On the other hand, Left VN patients didn't show statistical significance in ipsilateral Glu and Gln concentration. Although they didn't show ipsilateral significance, they showed a signif-icant increase in Glu concentration on the contralateral side. (p=0.017) Their GMV didn't show any statistical changes. Conclusion: In conclusion, We found the dom-inance of the right side vestibular cortex in the compen-sation of vestibular neuritis patients through GMV and MRS. Also, we could see the similarity between GMV changes and MRS metabolite concentration changes.


Chair : KYUNG WOOK HEO, SUNG HO KANG

Others Clinical

» OTOP-66 15:20~15:30

» IDENTIFICATION OF MICRORNAS RELATED WITH THE LOSS OF SYNAPSE IN THE HIPPO-CAMPUS AFTER HEARINg LOSS



CHUNG-ANG UNIVERSITY COLLEGE




April27(Sat)



type A tympanogram at the time of their final visit. 3 of 9 ears with retracted TM appeared normal, although 6 of these cases had still retraction, but showed significant improvement of total ETDQ-7 score compared with pre-operative score. Conclusion: Preliminary findings indi-cate that the image-guided navigation balloon catheter insertion is a potentially valuable and useful tool in pa-tients with ET dilatory dysfunction. It is also technically feasible. The application of an image-guided navigation balloon catheter during BET is simple, convenient, and effective. It provides surgeons with real-time feedback of the position of the catheter tip during BET. We believe that this device could be an essential guide and naviga-tor for otology surgeons, especially for BET. Larger and more detailed studies are needed. The application of an image-guided navigation system during BET is strongly recommended.

» OTOP-68 15:40~15:50

» EUSTACHIAN TUBE DYSFUNCTION ANIMAL MODEL- DIFFERENT EMBOLIzATION MATERI-ALS AND CONCENTRATIONS

DEPARTMENT OF RADIOLOGY AND

RESEARCH INSTITUTE OF RADIOLOGY, ASAN

MEDICAL CENTER UNIVERSITY OF ULSAN


OTORHINOLARYNGOLOGY-HEAD & NECK

SURGERY, ASAN MEDICAL CENTER, UNIVERSITY

OF ULSAN COLLEGE OF MEDICINE2

ZHE WANG1, SUNG HWAN YOON1, JUNG-HOON PARK1, HONG TAO HU1,

MIN YOUNG KWAK2, HO-YOUNG SONG1, HONG JU PARK2, WOO SEOK KANG2

Objectives: To describe the clinical and histological pro-gression of a rat model of eustachian tube (E-tube) dys-function using different embolic materials with and with-out lipopolysaccharide (LPS) introduction. Methods: A total of 36 Wistar rats were used in our current study. All rats underwent the surgical exposure of the tympanic bulla in the left ear. And the microcatheter was inserted to the tympanic end of the E-tube through the bullec-tomy. The animals were randomly assigned to 6 groups with 6 animals per group (Group A to Group F) accord-ing to the different embolic agents infused through the catheter. Group A underwent saline injection. Group

PUSAN NATIONAL UNIVERSITY HOSPITAL1,


AND PUSAN NATIONAL UNIVERSITY SCHOOL OF

MEDICINE, BIOMEDICAL RESEARCH INSTITUTE,

PUSAN NATIONAL UNIVERSITY

YANGSAN HOSPITAL

SUNG-WON CHOI1, HYE-JIN PARK1, SEOK-HWAN LEE1, SE-JOON OH1,

HYUN-MIN LEE, IL-WOO LEE, SOO-KEUN KONG1

Objectives: We propose the technical feasibility of an im-age-guided navigation balloon catheter in patients with Eustachian tube (ET) dilatory dysfunction. Methods: Each patient underwent balloon Eustachian tuboplasty by using both the Naviloon (balloon and guide catheter) and the NET-Navigation (image guided navigation Sys-tem) (Medicore, Sungnam, Korea). The balloon catheter is designed to be inserted and inflated in the cartilaginous portion of the ET for treatment of ET dilatory dysfunc-tion. The balloon catheter consists of a flexible proximal shaft, an actuator for advancing and retracting the bal-loon catheter, a rigid shaft that passes through the guide catheter, a balloon (length 16 mm, diameter 6 mm at 12 atm) at the distal end of the shaft for ET dilation, and a distal atraumatic tip that contains an electromag-netic navigation sensor. The guide catheter is designed to provide a means to access the ET. Unlike other guide catheters, this device consists of a flexible shaft with a central lumen instead of a rigid shaft. Results: A retro-spective review identified 38 ears (29 patients, 9 bilateral, 21 right ears and 17 left ears), comprising 20 males and 9 females aged 18 to 62 years (38.6 ± 13.1 years) received image-guided navigation-assisted BET. Six ears had otitis media with effusion (OME) with type B tympanograms, 9 ears had retracted tympanic membranes with type B or C tympanograms (Table 2). To evaluate the effectiveness of the surgery, we analyzed the clinical records on the fi-nal visit at 3 months post-procedure. The average total score of ETDQ-7 was 25.4 ± 7.1, 17.5 ± 6.2 at 1 month and 15.2 ± 7.0 at 3 months. Comparison of preoperative and follow up average total score of ETDQ-7 showed a statistically significant difference both at 1 month and 3 months (p < 0.0001) (paired t-test) (Figure 3). All pa-tients were able to perform a Valsalva maneuver at the time of their final visit at 3 months post-procedure. Oto-microscopy demonstrated that 6 of 6 (100%) ears with OME with type B tympanograms appeared normal with

April27(Sat)




Objectives: To prospectively evaluate the mid-term out-comes of fluoroscopic Eustachian tube (E-tube) balloon dilation using a flexible guide wire in patients with ob-structive E-tube dysfunction. Methods: From October 2016 to September 2017, we prospectively enrolled adult outpatients with persistent otitis media who were unable to perform the Valsalva maneuver. Participants underwent fluoroscopic E-tube balloon dilation with a 0.035-in. flex-ible guide wire and a 6 mm by 20 mm balloon catheter. Clinical examinations to check for ability to perform the Valsalva maneuver and otomicroscopy were conducted 1 week, 1 month, 3 months, 12 months, 18 months, and 24 months after the procedure. Results: The analysis in-cluded 32 E-tubes from 31 patients (18 women, 13 men; mean age 47 years, range 25-72 years). Balloon dilation was technically successful in all E-tubes. The mean time required for the procedure was 6.9 minutes (range, 5.8-10.3 minutes). The Valsalva maneuver was possible for 25 of 32 of E-tubes (78.1%) 3 months after balloon dilation. During the median follow-up of 15.9 months, aggrava-tion of Valsalva maneuver occurred in 4 of 25 improved E-tubes (16%), yielding a 2-year patency rate of 84%. Conclusion: The mid-term fluoroscopic balloon dilation results were encouraging, and using a flexible guide wire for E-tube balloon dilation helped the balloon catheter pass smoothly into the E-tube preventing the creation of a false passage.

» OTOP-70 16:00~16:10

» TRANSTYMPANIC TRIPOD-TIPPED ANgIO-CATHETER INSERTION FOR PATIENTS WITH INTRACTABLE PATULOUS EUSTACHIAN TUBE




JUNG MEE PARK, JUNG JU HAN, SO YOUNG PARK, SHI NAE PARK

Objectives: Patulous Eustachian tube (PET), a failure of the Eustachian tube to close appropriately, is a distressing condition that may significantly lower quality of life, as it may cause severe voice distortion, autophony, and even phonophobia. Despite the efforts to treat patients with PET, intractable symptoms of PET may require surgical intervention. In this study, we will introduce our meth-od of transtympanic Tripod-tipped Angiocatheter (TTA) insertion and evaluate the safety and efficacy of the proce-

B received LPS perfusion in the tympanic cavity (TC). Group C received 300-μm polyvinyl alcohol (PVA) in-jection in the E-tube. Group D received PVA injection in the E-tube with LPS perfusion in the TC. Group E re-ceived tissue adhesive glue (TAG) injection in the E-tube. Group F received TAG injection in the E-tube with LPS perfusion in the TC. All animals were weekly evaluated by otomicroscopy. All rats were sacrificed 12 weeks af-ter the surgery, and the E-tube specimens were obtained for histological analysis. Results: During the first three weeks, most of the rats in groups B to F showed a various degree of bulging of the tympanic membrane. In Group E and F, the retracted tympanic membrane with mucus middle ear effusion was found in the treated ears over the few weeks after the procedure. Whereas, in groups B to D, the tympanic membranes gradually recovered to the normal state. Histology analysis showed a chronic in-flammatory reaction of the middle ear in groups E and F. Also, we can find the larger width of epithelium and submucosa layer and more dilated vessels in Groups E and F. Conclusion: The application of a new procedure combined with tissue adhesive glue injection in rats prob-ably can make eustachian tube dysfunction animal mod-el. Persistent and long-lasting otitis media with effusion can be reliably caused in the rat.

» OTOP-69 15:50~16:00

» MID-TERM RESULTS OF FLUOROSCO-PY-gUIDED BALLOON DILATION USINg A FLExIBLE gUIDE WIRE TO TREAT OBSTRUC-TIvE EUSTACHIAN TUBE DYSFUNCTION


HEAD & NECK SURGERY, ASAN MEDICAL

CENTER, UNIVERSITY OF ULSAN COLLEGE

OF MEDICINE1, DEPARTMENT OF RADIOLOGY,

CHONBUK NATIONAL UNIVERSITY HOSPITAL2,

DEPARTMENT OF RADIOLOGY AND RESEARCH

INSTITUTE OF RADIOLOGY, ASAN MEDICAL


MEDICINE3, DEPARTMENT OF REHABILITATION,



MIN YOUNG KWAK1, KUN YUNG KIM2, JUNG-HOON PARK3, SUNG HWAN YOON3,

JAE YOUG JEON4, HO-YOUNG SONG3, HONG JU PARK1, WOO SEOK KANG1


April27(Sat)



ENoG is usually performed between 3 and 14 days after the onset of acute facial palsy. We investigated the accura-cy of ENoG according to the days after the onset of acute facial palsy. Methods: Total 213 patients with symptom of acute facial palsy who visited Korea University Ansan hospital in Korea, from March 2014 to December 2018 were initially included in this study. Study inclusion cri-teria were; 1) patients of all age; 2) no other initial med-ication had been administered; 3) follow-up had been completed until any recovery from initial facial paralysis or 1 months from onset of the disease; 4) management had to have begun within 14 days of the onset of the fa-cial palsy; and 5) patients with sufficient and meticulous medical records. Patients who rejected further follow up (n=75), with insufficient medical records (n=36), visited too late (n=20), with inappropriate conduction time of ENoG (n=22) were excluded from this study. Retrospec-tive chart review done on every patient. The results of the ENoG were translated as follows: remnant function 100% as grade 1, remnant function 75~99% as grade 2, remnant function 50~74% as grade 3, remnant function 25~49% as grade 4, remnant function 1~25% as grade 5. It was confirmed whether or not each translated grade corresponds to the grade in the House-Brackmann sys-tem. All patients were classified into two groups accord-ing to gap between the date of the ENoG and the on-set date of acute facial palsy: early study(gap days 3~6) and late study(gap days 7~13). Results: The degree of correspondency between House-Brackmann system and ENoG was higher in the early study group than in the late study group(Mann-Whitney test, p<0.032) Conclusion: In the aspect of accuracy of ENoG, it is best to perform the test within 3 to 6 days after onset of acute facial palsy.

» OTOP-72 16:20~16:30

» LACK OF EvIDENCE OF INTRATYMPANIC STEROID INJECTION FOR ACUTE PERIPHER-AL FACIAL PALSY


EULJI UNIVERSITY

JUN LEE, HO YUN LEE

Objectives: An adjunctive intratympanic dexamethasone (IT-DEX) injection has been used for treatment of periph-eral facial palsy. However, the validity of this treatment has led to controversies. In this study, we aimed to verify whether this has an additional effect or not. Methods:

dure in patients with intractable PET. Methods: Between the years 2011 and 2018, 32 cases (26 patients) diagnosed with PET and surgically treated with TTA insertion were included in this study. Their clinical characteristics, surgi-cal results, complication rates, and the level of satisfaction by questionnaires which consisted of a visual analog scale of 5 symptoms of PET were retrospectively reviewed for evaluation. Results: The mean age of enrolled patients was 40.9±19.5 years with slight male gender predomi-nance. Both ears were operated in 6 patients, simulta-neously in 3. All patients successfully received the inser-tion of TTA, with no immediate complication. Eleven cases were reinserted due to the recurrence of symptoms (n=9) or spontaneous extraction of TTA (n=2). Minor complications after TTA insertion were otitis media with effusion (n=10), tympanic membrane (TM) perforation (n=3), and TM retraction (n=1). In 1 case, TTA was re-moved due to severe discomfort 3 years after the inser-tion. No major complications were observed during the follow-up period of 1 to 79 months (mean 24.4 months). The average VAS score of PET symptoms was significant-ly decreased (P < 0.05) along with 78% of patients with complete or significant relief of symptoms. Conclusion: TTA insertion is a relatively easy procedure that can be performed in a short period of time under local anesthe-sia. Surgical intervention of TTA insertion for patients with intractable PET symptoms seems promising with a high success rate.

» OTOP-71 16:10~16:20

» CORRELATION BETWEEN ELECTRONEU-ROgRAPHY AND HOUSE-BRACKMANN SYS-TEM IN ACUTE FACIAL PALSY- WHEN IS THE BEST TIME TO DO AN ENOg



ANSAN HOSPITAL

KUK JIN NAM, KANG HYEON LIM, MIN KYU LEE, SEONGBIN PARK,

YOUNG-SOO CHANG, YOON CHAN RAH, JUNE CHOI

Objectives: In patients with acute facial palsy, electro-neuronography(ENoG) is often performed to evaluate prognosis regardless of etiologies. Congruence between House-Brackmann system and ENoG was investigated.

April27(Sat)




garding the FND in the treatment of FNP. Following the screening, 36 full text articles were assessed for the eligibility. After the exclusion of recurrent FNP, pediat-ric FNP, absence of the conservative treatment group, and review articles, 13 studies were included in the sys-tematic review. Among them, 8 studies with modified House-Brackmann (H-B) grading system were subject to meta-analysis for comparison of therapeutic efficacy between FND and conservative treatment. The grading of recovery after treatment was assessed at postoperative 12months and classified into complete (H-B Gr. I), fair (H-B Gr. II~III), and failed recovery (H-B Gr. IV~VI), respectively. Results: For the meta-analysis, complete (H-B Gr V or VI) FNP patients were comprised of pa-tients with FND (n=244) and conservative treatment (n=207), respectively. Interestingly, patients who under-went FND had an exclusively higher chance of complete recovery with odds ratio of 2.27 [1.13-3.93]. The odds ratios of both fair recovery (H-B Gr. II~III) and failed recovery (H-B Gr. IV~VI) rate were not significantly dif-ferent between FND and conservative treatment group. The therapeutic effect of FND on complete recovery was higher in early FND (<14 days of onset) than in delayed FND (>14 days of onset). In addition, the risk of po-tential complications after FND was minimal on the ba-sis of qualitative analysis. Conclusion: FND could be a safe and possible therapeutic approach in patients with complete FNP if they had no improvement after con-servative treatment, especially for complete facial nerve restoration.

» OTOP-74 16:40~16:50

» SHORT TERM SURgICAL RESULT OF COM-BINED AURICULO-MEATOPLASTY WITH MED-POR IN MICROTIA

SOREE EAR CLINIC1, PROFILE PLASTIC

SURGICAL CENTER2

HO-KI LEE1, JAIHO CHUNG2

Objectives: The goal of microtia surgery is to create both good function and good appearance of the ear. There continues to be controversy over who should operate first, the plastic or the ear surgeon. There are advantages and disadvantages of each meatoplasty before, and after auriculoplasty. The purpose of this study is to review the surgical result of combined auriculo-meatoplasty per-formed by plastic and ear surgeon together to overcome

Patients’ individual data who were treated at one local university hospital for acute peripheral facial palsy and whose follow-up were available more than 3 months were collected and analyzed. Results: A total of 108 patients were enrolled in this study. They consisted of 57 men and 51 women, with a mean age of 48 ± 15.67 years (range: 18-85 years), with a mean duration from onset of symp-toms to treatment of 1.6 ± 2.0 days (range: 0 – 7 days). For laterality, 53 patients were affected in the right side and 55 patients were affected in the left side. With regard to diagnosis, 82 patients were diagnosed as Bell’s palsy (75.9%) and the others had Ramsay-Hunt syndrome (24.1%). IT-DEX was performed in 36 (43.9%) of Bell’s palsy patients and 9 (34.6%) of Ramsay-Hunt syndrome. Repeated measures ANOVA revealed that the severity of facial paralysis at each point was different according to whether IT-DEX was performed or not in Bell’s palsy; Patients treated with adjunctive IT-DEX tended to have higher House-Brackmann grade (p=0.014). On the oth-er hand, patients with Ramsay-Hunt syndrome did not show any difference in the facial grade according to IT-DEX (p>0.05). Logistic regression analysis revealed that two times of IT-DEX or more in Bell’s palsy was associ-ated with poor prognosis (OR=3.290, 95% CI=1.008-10.736, p=0.048). In contrast, no significant prognos-tic factors were observed in Ramsay-Hunt sysndrome. Conclusion: Adjunctive treatment effect of intratympan-ic steroid injection was not found. Thus, use of IT-DEX for treatment of acute peripheral facial palsy should be reconsidered.

» OTOP-73 16:30~16:40

» EFFICACY OF FACIAL NERvE DECOMPRES-SION IN THE TREATMENT OF COMPLETE FA-CIAL NERvE PALSY A SYSTEMATIC REvIEW AND META-ANALYSIS


BORAMAE MEDICAL CENTER, SEOUL NATIONAL


JEON SEONG, SANG YEON LEE, YOUNG HO KIM

Objectives: We, herein, aimed to investigate the thera-peutic efficacy of facial nerve decompression (FND) in patients with complete Bell’s palsy using meta-analysis. Methods: Primary database search was performed in PubMed, Medline (n=6803) and EMbase (n=561) re-


April27(Sat)



YONG-HWI AN

Objectives: To determine characteristics and their prog-nostic value of video head impulse test (vHIT) in pa-tients with idiopathic sudden sensorineural hearing loss (ISSNHL) and vertigo. Methods: Of the 612 patients with a diagnosis of ISSNHL from 2010 to 2018, 110 pa-tients (18.0%) with vertigo and 40 patients (6.5%) with vHIT results were recruited. The patients were evaluated for their pure-tone hearing average and speech discrim-ination scores (at initial, 1-month and 6-month visit), the presence of catch-up saccade and gains at vHIT, the canal paresis (CP) at Caloric test, ipsi-lesional benign paroxysmal positional vertigo (BPPV) at positional nys-tagmus test. Results: Patients with saccade (+) showed higher pure-tone averages than those with saccade (-) on initial and follow-up audiograms. The improvement in pure-tone averages was less in the saccade (+) group than in the saccade (-) group. The improvement in speech discrimination scores was less in the saccade (+) group than in the saccade (-) group. There was no significant difference of hearing improvement between patients with normal gain and those with decreased gain. The improve-ment in pure-tone averages was less in the CP (+) and/or BPPV (+) group than in the CP (-) and BPPV (-) group. Conclusion: Comorbid catch-up saccade at video head impulse test is a negative prognostic indicator of audito-ry function in ISSNHL. Concurrent catch-up saccade in ISSNHL suggest combined damage to the vestibule and may indicate severe and widespread labyrinthine damage, leading to the poor prognosis.

» OTOP-76 16:50~17:00

» TINNITUS-RELIEvINg EFFECT OF HEARINg AIDS FOR PATIENTS WITH HIgH-FREQUENCY HEARINg LOSS


SCHOOL OF MEDICINE, KANGWON NATIONAL

UNIVERSITY1,INSTITUTE OF MEDICAL

SCIENCE, SCHOOL OFMEDICINE, KANGWON

NATIONAL UNIVERSITY2,DEPARTMENT OF

OTOLARYNGOLOGY, KANGWON NATIONAL


EUI-CHEOL NAM1, NATALIA YAKUNINA2, YOON-JONG RYU1, WOO HYUN LEE3

the disadvantages of each microtia surgery. Methods: Ten patients (average age: 13 years old, ranging from 6 to 27) underwent the combined meatoplasty and Medpor au-ricular reconstruction with endoscope-assisted temporo-parietal fascia flaps since August 2018. Physical outcome of auricle and meatus (location, appearance, and compli-cation rate), hearing results, and surgical time were eval-uated. Surgical procedure and reconstruction techniques are reviewed. Results: Skin flap showed edematous state until postoperative 3 months, but no infection sign was identified. All patients showed successful healing process without any major complications. No exposed Medpor from auricle was noted. A patient, who is the first case of combined surgery, has lower lying auricle than we de-signed preoperatively. Postoperative average hearing gain was 35 dBHL when the tympano-ossiculoplasty was per-formed. A case with sensorineural hearing loss worse than 10 dBHL after surgery was identified. Combined surgi-cal time averaged 9 hours. Conclusion: Combined auri-culo-meatoplasty performed by plastic and ear surgeon together has many advantages including fewer surgical stages, immediate ear projection, and early hearing res-toration. This procedure with Medpor can be performed at young age, and the cosmetic and functional ear recon-struction can be completed before entering school.


Chair : HYONG HO CHO, BEOM CHO JUN

Inner Ear Disease

» OTOP-75 16:40~16:50

» COMORBID CATCH-UP SACCADE AT vIDEO HEAD IMPULSE TEST IN IDIOPATHIC SUDDEN SENSORINEURAL HEARINg LOSS_ AN OMI-NOUS SIgN FOR HEARINg RECOvERY


HEAD AND NECK SURGERY, EULJI UNIVERSITY

SCHOOL OF MEDICINE, EULJI MEDICAL CENTER,

SEOUL, KOREA

YONG TAE CHO, HYEON SIK OH, MIN SUK CHAI, HYUN JOON SHIM,

April27(Sat)




Objectives: Inflammatory cytokines and related proteins have been reported as potential markers in many cellular processes. However, to date, the role of inflammatory cyto-kines, specifically those in unilateral SSHL, to our knowl-edge, has not been extensively investigated. Few studies have discussed the involvement of inflammatory cyto-kines in SSHL. We evaluated the levels of TNF-α, IL-10, IL-12, and IFN-γ, peripheral blood mononuclear cells, CD 17c, and CD 86 in unilateral sudden sensorineural hearing loss (SSNHL). Methods: Twenty-four patients with unilateral SSNHL and 24 normal bone conduction hearing patients without a history of SSNHL attending the clinic for other problems were recruited to serve as the control group. Peripheral blood monocyte(PBMC)s, CD 11c, and CD 86 were isolated and analyzed by two-color cytometry analysis using fluorescence-activated cell sort-ing (FACS) . Plasma and supernatant levels of TNF-α, IFN-, IL-10, and IL-12 were measured by ELISA. Sta-tistical significance was analyzed by the Student’s t-test for unpaired observations, and the differences were checked for statistical significance by one-way analysis of variance (ANOVA) followed by Bonferroni’s post-hoc test. Results: There were no significant differences with respect to mean age . The monocyte population (mean ± SE) in the SSNHL group (26.36±4.3) was significantly higher than control group (14.32 ± 2.3). The dendrit-ic cell markers CD11c and CD86 were identified in the SSNHLgroup.The CD11c-positive cell population was insignificantly different between both groups. However, CD86 expression was significantly higher in the SSNHL group, compared to that in the control group. The mean TNF-αlevel in the SSNHL group (15.8±9.3) was signifi-cantly increased than control group (12.4±8.7). Howev-er, IFN-γ and IL-12 levels in the SSNHL group were sig-nificantly decreased compared to the control group.The difference in the mean IL-10 level between the groups was insignificant Conclusion: Increased level of TNF-α and the monocyte population might play critical roles in SSNHL. This warrants detailed investigation and further studies on the role of dendritic cells in SSNHL.

» OTOP-78 17:10~17:20

» TREATMENT OUTCOME OF PATIENTS WITH IDIOPATHIC SUDDEN SENSORINEURAL HEARINg LOSS AND BENIgN PAROxYSMAL POSITIONAL vERTIgO

DEPARTMENT OF OTOLARYNGOLOGY, DONGSAN

MEDICAL CENTER, KEIMYUNG UNIVERSITY

Objectives: Hearing aids (HA) have been used for tin-nitus management for decades, but a recent Cochrane review reported evidence of their effectiveness lack-ing. Frequency lowering strategies have been used for high-frequency hearing loss (HFHL), but their effect on tinnitus has not been studied. We investigated and compared effectivity of conventional type HA vs frequen-cy-lowering HA on tinnitus suppression in patients with HFHL through a randomized double-blind clinical tri-al following CONSORT (consolidated standards of re-porting trials) guidelines. Methods: 94 chronic tinnitus patients with HFHL were randomized into three groups (A: conventional HA, B: HA with frequency translation, C: HA with linear frequency transposition). Participants wore HA for 3 months; the final follow-up was 3 months after cessation of wearing HA. The primary outcome was Tinnitus Handicap Inventory (THI) score; additional variables were matched tinnitus loudness and VAS of subjectively perceived tinnitus loudness, daily duration and annoyance. Results: Per-protocol reults showed that THI score and most of the additional outcomes were sig-nificantly improved both at 3 and 6 months compared to their initial value in all three groups (mean THI A: 48.6, 31.6, 38.3, B: 49.5, 30.3, 35.2, C: 50.3, 33.3, 35.6 at initial visit, 3 and 6 months, respectively). Incidence of patients who improved THI at least 20% compared to the initial value was 71.0, 72.7, and 74.3% at 3 months, and 54.8, 51.6, and 59.4% at 6 months for A, B, and C group, respectively. Conclusion: Regardless of ampli-fication strategy types, HA were effective in suppressing tinnitus in patients with HFHL, with the effect lasting at least 3 months after removing HA. Our study is the first study exploring effect on tinnitus of HA alone without accompanying counselling or other treatments.

» OTOP-77 17:00~17:10

» INFLAMMATORY CYTOKINES AND MONO-NUCLEAR CELLS IN SUDDEN SENSORINEU-RAL HEARINg LOSS

DEPARTMENT OF OTOLARYNGOLOGY, CHONNAM

NATIONAL UNIVERSITY MEDICAL SCHOOL1,

DEPARTMENT OF LIFE SCIENCE, BK 21-PLUS,

COLLEGE OF NATURAL SCIENCE, CHOSUN

UNIVERSITY2

SUNG-HO YOON1, MI-EUN KIM2, HEE-YOUNG KIM1, JUN-SIK LEE2,

CHUL HO JANG1


April27(Sat)




HEAD AND NECK SURGERY AND BIOMEDICAL

RESEARCH INSTITUTE, PUSAN NATIONAL

UNIVERSITY HOSPITAL, BUSAN, SOUTH KOREA1,



MEDICINE, PUSAN NATIONAL UNIVERSITY,

BUSAN, SOUTH KOREA2, DEPARTMENT OF

NEUROSURGERY, MEDICAL RESEARCH

INSTITUTE, PUSAN NATIONAL UNIVERSITY

HOSPITAL, PUSAN NATIONAL UNIVERSITY

SCHOOL OF MEDICINE, BUSAN, SOUTH KOREA3,

DEPARTMENT OF DIAGNOSTIC RADIOLOGY,

MEDICAL RESEARCH INSTITUTE, PUSAN

NATIONAL UNIVERSITY HOSPITAL, PUSAN

NATIONAL UNIVERSITY SCHOOL OF MEDICINE,

BUSAN, SOUTH KOREA4

SE-JOON OH1,2, DEOKSOO KIM1,2, JAE IL LEE3, SUNG-WON CHOI1,2, SOO-KEUN KONG1,2,

EUI-KYUNG GOH1,2, TAE HONG LEE4

Objectives: This study aimed to evaluate the safety and efficacy of transvenous stent-assisted coil embolization for dehiscent high jugular bulb (DHJB) with tinnitus and contralateral hypoplastic venous sinus. Methods: From September 2008 to June 2018, a series of patients with DHJB presenting with intractable pulsatile tinnitus abated only by ipsilateral jugular vein compression were included. Patients underwent transvenous stent-assisted coil embolization for selective obstruction to the dome of the high jugular bulb (HJB) due to hypoplastic con-tralateral transverse or sigmoid venous sinus. Results: Subjects included five patients with DHJB and trouble-some pulsatile tinnitus who refused surgery (n=4), or who experienced recurrence after surgical covering and reinforcement using autologous cartilage (n=1). The mean age of the five patients (only female) was 45 years. Transvenous stent-assisted coil embolization was techni-cally successful in all patients with symptomatic DHJB, with no procedure-related complications. Temporary postprocedural headache was observed in two patients, but resolved within 3 days. Symptoms were completely resolved in all cases. There was no recurrence or aggra-vation of tinnitus during follow-up period. Conclusion: Transvenous stent-assisted coil embolization for DHJB with tinnitus and contralateral hypoplastic transverse or sigmoid venous sinus could be a technically safe and clin-

SCHOOL OF MEDICINE, DAEGU, KOREA

TAE WOO GIM, SEOK CHAN YOO, SEOK YOON LEE, JI RYONG KIM,

JAE RYUNG LEE, SUNG IL NAM

Objectives: Vertigo is appeared in about 30% of sudden sensorineural hearing loss patients. This is considered to be a poor prognostic factor. BPPV is common cause of vertigo and it could accompany sudden sensorineural hearing loss. But there is controversy that BPPV could be a poor prognostic factor. The objectives of this study were to determine characteristics and recovery outcome of patients who had SSNHL with BPPV. Methods: Retrospective study of all patients with evidence of SSNHL at Keimyung university Dongsan medical cen-ter between August 2013 and July 2018. We reviewed medical records, results of vestibular function test, au-diogram. Results: Among 551 idiopathic sudden senso-rineural hearing loss patients, 25 patients was diagnosed with unilateral BPPV with SSNHL.. The average PTA of SSNHL without BPPV patients was moderate to se-vere hearing loss, the averave PTA of SSNHL with BPPV patients was profound hearing loss. Among 526 patients who had only SSNHL, 364 patients (69%) had impro-ment. 162 patients(31%) had no response. Among 25 patietns who had SSNHL with BPPV, 11 patients(44%) had improvement 14 patients (54%) had no response. Among 25 patients who had SSNHL with BPPV, 13 pa-tients had posterior SCC BPPV and 12 patients had lat-eral SCC BPPV. Among SSNHL with lateral SCC BPPV patients, 6 patients had improvement, 6 patients had no response. Among SSNHL with posterior SCC BPPV patients, 5 patients had recovered, 8 patients had no re-sponse. Conclusion: Patients with BPPV had higher av-erage PTA score at initial, and more poor recovery after treatment than patients with only SSNHL.. Patients with lateral SCC BPPV had better prognosis than posterior SCC BPPV, and patients with contralateral BPPV had better prognosis.

» OTOP-79 17:20~17:30

» TRANSvENOUS STENT-ASSISTED COIL EM-BOLIzATION FOR MANAgEMENT OF DEHIS-CENT HIgH JUgULAR BULB WITH TINNITUS AND CONTRALATERAL HYPOPLASTIC vE-NOUS SINUSES

April27(Sat)




ANATOMY OF CHRONIC SUBJECTIvE TINNI-TUS IN MILD NEUROCOgNITIvE DISORDER PATIENTS

DEPARTMENT OF OTORHINOLARYNGOLOGY1,

DEPARTMENT OF NUCLEAR MEDICINE2,

DEPARTMENT OF PSYCHIATRY AND

NEUROSCIENCE RESEARCH INSTITUTE3, SEOUL

NATIONAL UNIVERSITY BORAMAE MEDICAL

CENTER, SEOUL NATIONAL UNIVERSITY COLLEGE

OF MEDICINE

SANG YEON LEE1, HEEJUNG KIM2, YU KEONG KIM2, JUN-YOUNG LEE3,

YOUNG HO KIM1

Objectives: The hypothesis is that if tinnitus is a symp-tom occurring as a part of neurodegeneration, mild cog-nitive impairment (MCI) patients handicapped from tinnitus would exhibit relatively greater involvement of cortical and subcortical auditory pathways and non-au-ditory areas involved in the processing of sensory stim-uli, when compared with MCI patients without tinnitus handicap. The purpose of this study is to determine areas of the brain that show significant metabolic or volumet-ric changes in MCI patients handicapped from tinnitus. Methods: Twenty-three MCI patients (M:F=13:10, age 73.4±6.1 years) were retrospectively studied. Within this cohort, 12 patients reported being handicapped from tin-nitus while 11 patients experienced no handicap based on the Tinnitus Handicap Inventory questionnaire. Vol-umetric changes were evaluated using Voxel-Based Mor-phometry (VBM), while changes in metabolism were identified using FDG-PET. Furthermore, neuroanatom-ical changes relative to tinnitus severity were evaluated using multiple regression. Results: Compared with MCI patients without tinnitus handicap, patients with hand-icap had reduced metabolism in superior temporal pole and increased metabolism in right postcentral gyrus. Meanwhile, at the same statistical threshold, no changes in volume were found. Paired-T-test analysis with brain images taken 2 years prior to tinnitus evaluation showed a more severe and extensive decrease in metabolism in the temporal lobe of the handicapped tinnitus group. Although a correlation between THI score and metab-olism could not be found, the higher the THI score, a greater decrease in volume of the right superior frontal gyrus and left superior orbitofrontal gyrus were observed. Conclusion: The results support previous works regard-

ically effective treatment strategy while preserving cranial venous drainage.

» OTOP-80 17:30~17:40

» RECURRENT SUDDEN SENSORINEURAL HEARINg LOSS, REvIEW OF 30 CASES WITH THE CLINICAL MANIFESTATIONS AND OUT-COMES

DEP. OF OTOLARYNGOLOGY-HEAD AND NECK

SURGERY, TRI-SERVICE GENERAL HOSP.,

NATIONAL DEFENSE MEDICAL CENTER

PEI-HSUAN WU

Objectives: To evaluate the correlation between the hear-ing recovery between the first and recurrent idiopathic sudden sensorineural hearing loss (ISSNHL). Methods: A retrospective cross-sectional study was conducted in Tri-Service General Hospital. Patients with at least two events of ISSNHL were enrolled in the current study after exclusion via several criteria. The basic characters, laboratory profiles, otological examinations including the pure-tone average (PTA) and the treatment program for each patient were obtained and analyzed. The SDRGs criteria was applied to divided patients into four sub-group according to the recovery status. Results: A total numbers of 30 patients were included. The basic charac-ters revealed a mean age of 45.90 and 50.66 at the first and recurrent events of ISSNHL with a male-to-female ratio of 16 to 14. The laboratory profiles and otological examinations did not show significant difference between the two events except a higher High-density lipoprotein in the first episode (P= 0.034). The PTA had significant improved after treatment in both the first event (from 53.67 dB to 39.81 dB, P= 0.007) and the recurrent event (from 62.90 to 42.33, P<0.001), and a complete recov-ery was achieved in 46.67 and 30.00 percent of patients in the first and recurrent events. A significantly positive correlation of therapeutic outcome between the first and secondary events was found while the addition of HBOT and the laterality of recurrence did not influence the out-come. Conclusion: The hearing recovery in the recurrent ISSNHL are significantly correlated to the degree of hear-ing recovery in the preceding episode.

» OTOP-81 17:40~17:50

» STRUCTURAL AND FUNCTIONAL NEURO-


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ing somatosensory modulation and limbic/paralimbic network. Handicapped tinnitus may induce a more ex-tensive decrease in metabolism in the temporal lobe at an earlier stage, which may be inferred that tinnitus acceler-ates neurodegeneration.

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RHOP-6Room 4-2 (Convention B)

Chair : DONG JOON PARK, BAKI YILMAZ

Plastic Surgery and Facial Trauma

» RHOP-30 08:00~08:10

» REvISION SEPTOPLASTY - CAUSE OF FAIL-URE OF PRIMARY SURgERY AND HOW TO IMPROvE THE SURgICAL OUTCOME


AND BIOMEDICAL RESEARCH INSTITUTE, PUSAN


OF OTORHINOLARYNGOLOGY AND RESEARCH

INSTITUTE FOR CONVERGENCE OF BIOMEDICAL

SCIENCE AND TECHNOLOGY, PUSAN NATIONAL

UNIVERSITY YANGSAN HOSPITAL2

DONG-JOO LEE1, HYE JIN PARK1, KEUN IK YI1, SUNG-DONG KIM1, SUE-JEAN MUN2, HWAN JUNG ROH2, KYU-SUP CHO1

Objectives: Septoplasty is one of the most commonly per-formed procedures to improve nasal obstruction. Howev-er, some patients still have persistent nasal obstruction after their primary surgery and require a revision septo-plasty to relieve nasal obstruction. The purpose of this study was to analyze the common site of persistent septal deviation, type of deviation, and the efficacy of revision septoplasty on subjective nasal obstruction. Methods: 35 patients who underwent only revision septoplasty alone at our hospital between 2011 and 2018 were reviewed. We investigated common site of septal deviation, type of deviation (C-shape, reverse C-shape, S-shape, reverse S- shape in the anteroposterior and cephalocaudal dimen-sions) using CT images and periods between primary and revision surgery, type of hospitals performed primary septoplasty. All the subjects were questioned regarding subjective nasal obstruction before surgery and 3 months after surgery using a visual analogue scale. Results: 35 patients completed the study. The most common site of septal deviation was caudal septum (46%) and most common type was both C-shape in the anteroposterior (43%), cephalocaudal (48%) dimensions. The mean pe-

riod between primary and revision septoplasty was 14.6 years. Most of the patients were performed septoplasty in primary hospital (63%). The mean subjective symp-tom scores were significantly decreased from 8.5 to 2.6 after surgery. Conclusion: Caudal septum was common sites of deviation after primary septoplasty. Most of the patients improved their subjective nasal obstruction after revision septoplasty. The correction of caudal septum is the most important part of the revision septoplasty.

» RHOP-31 08:10~08:20

» ALAR-COLUMELLAR DEFORMITIES IN KO-REAN PRIMARY RHINOPLASTY


EULJI UNIVERSITY HOSPITAL, EULJI UNIVERSITY



SURGERY, KYUNG HEE UNIVERSITY HOSPITAL AT

GANGDONG2

SU JIN KIM1, TAE HYUN KIM2, KUN HEE LEE2

Objectives: Alar-columellar relationship plays an im-portant role in the aesthetic balance of the nose. Classi-fication of the deformities helps with diagnosis and suc-cessful surgical correction. We analyzed alar- columellar discrepancies and evaluated the personality traits and pa-tients’ expectations. Methods: Three hundred thirty six patients who underwent primary rhinoplasty at a single medical center were enrolled. We analyzed alar-columel-lar deformities and categorized it into hanging columel-la (HC), retracted columella (RC), hanging ala (HA), retracted ala (RA), convex ala (VA), concave ala (CA), thick ala (TA) and combination of above. We evaluat-ed personality traits of patients, complaints about their nose, and patients’ expectation using the questionnaire for rhinoplasty. Results: The study population consist-ed of 336 patients: 71 women and 265 men. The mean patient age was 29.9 years and mean BMI was 23.1 kg/m2. The most prevalent type was HA (59.2%), followed by VA (53.3%) and TA (32.1%). HA was correlated with RC, VA, TA; VA was correlated with HA and TA. Male patients were more likely to have VA and RC than female patients. Patients with VA or TA complained of wide middle third; Patients with TA complained of poorly defined tip (p=0.010), wide alar base (p=0.001). More than half of the patients (n=191, 56.8%) had two or more deformities. These patients who had multiple

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gous costal cartilage was used for creating L-strut in two different ways: the first one is integrating dorsal implant with columellar strut , the second method is fashioning one piece of reverese L-shaped graft using 6th rib carti-lage. After partial dissection of membranous septum, a properly designed L-strut graft was placed bypassing the nasal dorsum and fixated on the anterior nasal spine or interposed between medial crus without dissection of dorsal septal mucoperichondrium. Medical records were assessed for cause of septal injury, types of nasal defor-mities, autologous L-strut graft type, combined surgical procedures, aesthetic outcome, and postoperative com-plication. Results: 18 (90%) had saddle nose deformity, 1 had tip deformity and 1 had septal perforation without saddle. Prior surgical procedures (n=14) were the most common causes of saddle nose deformity, followed by electrocautery (n=3), congenital deformity (n=1), but-ton battery(n=1), and Wegener’s granulomatosis (n=1). . Two-piece integrated type L-strut graft was used in 11 pa-tients (55%) and one piece type L-strut graft was used in 9 patients (45%). Additional dorsal augmentation with crushed costal cartilage and tip grafting were performed in almost all cases. In postoperative assessment of surgical outcome, 10 patients had excellent, 7 patients had good, 3 patients had fair aesthetic outcomes and there was no poor outcome. Functionally, all 20 patients experienced an improvement in nasal breathing. There were 5 cases of postoperative complications which included 2 recur-rent saddles, 1 tip overprojection, and 2 infections. 3 of 5 cases required revision revision rhinoplasty. Conclusion: Bypass L-strut graft using costal cartilage is useful surgical maneuver of septal reconstruction in particular nasal de-formity when the creation of the septal mucopericondrial pocket is difficult or better to be avoided

» RHOP-33 08:30~08:40

» COMPARISON OF DORSAL AUgMENTATION USINg SILICONE IMPLANT OR HOMOLOgOUS FASCIA LATA


EULJI UNIVERSITY SCHOOL OF MEDICINE, EULJI

MEDICAL CENTER

YONG-TAE CHO, JI-SUN KIM

Objectives: Autogenous grafts are regarded as the most suitable graft materials in rhinoplasty. However, alloplas-tic implants and homologous tissues are commonly used

alar deformities tended to younger (p=0.002), had more psychological risk factors (p=0.002), and needed mul-tiple surgical corrections (p<0.001). Patients with mul-tiple alar deformities desired narrow tip (p=0.036) and responded that they preferred Western nose than Asian nose. Conclusion: The most common alar-columellar deformities were HA, followed by VA and TA. More than half of the patients had two or more deformities and they had more psychological risk factors and needed multiple surgical corrections. Surgeons need to consider these fac-tors to obtain satisfactory results in patients undergoing rhinoplasty.

» RHOP-32 08:20~08:30

» RECONSTRUCTION OF SEvERELY DAM-AgED CARTILAgINOUS SEPTUM USINg A BY-PASS L-STRUT gRAFT USINg COSTAL CARTI-LAgE


ASAN MEDICAL CENTER, ULSAN UNIVERSITY

COLLEGE OF MEDICINE

WOO RI CHOI, YONG JU JANG

Objectives: Weakened and damaged septal cartilage framework commonly predisopose to the deformed nos-es such as saddle and deviation. Reconstruction of the weakened septal cartilage is usually achieved by dissec-tion of septal mucoperichondrium and skeletonization of the damaged L-strut, followed by reinforcing the L-strut with extended spreader grafts and caudal septal exten-sion graft. However, in certain situation where the car-tilage is totally missing, septal mucosa is thin and badly damaged, and big septal perforation is coexisting, dis-section of the septal mucoperichondrium is technically challenging and better to be avoided. In this extremely difficult scenario, we still need to reconstruct the septal cartilage framework without creating septal mucoperi-chondrial pocket, bypassing the damaged septal cartilage in a exo-skeletal manner. This study is purposed to dis-cuss our experience about treating patients with severely damaged septal cartilage using bypass L-strut graft using costal cartilage. Methods: We retrospectively reviewed 20 patients (5 males, 15 females; mean age, 42.1 years; age range, 17-72 years) who underwent rhinoplasty using by-pass L-strut graft using costal cartilage from September, 2008 through December, 2018. The follow-up period ranged from 1 to 41 months (mean, 9 months). Autolo-

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idea that development of diced cartilage mold would be helpful. Here we introduce our diced cartilage mold and consequent clinical experience. Methods: We designed a diced cartilage mold for dorsal implantation, which is consisted of three parts: base template, guarding frame with side holes, and compressor with handle. The 10 dif-ferent prototypes having lengths varying from 1 to 4.5 cm and depths of 2.5 and 5 mm are made by biocom-patible polymer using 3-D printing technology. The final mold will be produced using metallic cobalt chrome. To make the dorsal implant using the mold, one layer of fas-cia or perichondrium is placed at the base template, then the finely- diced cartilages are placed on the top of the soft tissue, shaped by guarding frame and affixed with fibrin glue. Finally, glued diced cartilage with soft tissue cap is fashioned by compressor with handle, while the excess glue and fluid is drained through the side holes of the guarding frame. Results: Molded diced cartilage has been used for dorsal augmentation in 52 (31 male and 21 female) patients from June to December of 2018. Costal cartilage was used in all 52 cases. 9 homologous fascia, 40 costal perichondrium, and 8 fascia from the chest mus-cle were used as soft tissue cap of dorsal implant, while diced cartilage without soft tissue cap was used in 2 cases. Surgical outcome was gratifying in most of the cases, but there were 4 patients who complained aesthetic dissatis-faction: 1 with excessive augmentation, 1 with wide nasal dorsum, 2 showing uneven dorsal line. Conclusion: Our diced cartilage mold facilitated a finer shaping and easier insertion of glued diced cartilage with soft tissue cap for autologous dorsal augmentation my rhinoplasty practice.


Chair : JIN SOON CHANG, JOO HYUNG LEE

Others

» RHOP-35 08:00~08:10

» INDUCED PLURIPOTENT STEM CELLS DE-RIvED FROM HUMAN NEURAL CREST DE-RIvED NASAL TURBINATE STEM CELLS AND THEIR APPLICATION


for dorsal augmentation in Asian rhinoplasty to over-come some limitations of autogenous tissue. The aim of this study is the comparison of dorsal augmentation with silicone or homologous fascia lata. Methods: Sev-enty five patients who underwent dorsal augmentation between January 2014 an September 2018 were reviewed retrospectively. The patients were divided into two groups with silicone implant or homologous fascia lata. Chang-es in dorsal height and radix height were measured by preoperative and postoperative profile views. Other an-thropometric measurement were analyzed. Postoperative complications were also evaluated. Results: A total of 75 patients who underwent augmentation rhinoplasty were reviewed in this study, including 58 men (77.3%) and 17 women (22.7%). The silicone group included 19 pa-tients, and the homologous fascia group comprised 56 patients. The mean aesthetic outcome scores were compa-rable between the 2 groups: The change of dorsal height and radix heights were increased after augmentation in both groups but the dorsal height of the silicone group after augmentation showed greater increase compared to the homologous fascia lata group (P <.001). The compli-cation rate was higher in the silicone group:5.3%(1/19 case) in silicone group and 3.5% (2/58) in homologous fascia lata group. Conclusion: Homologous fascia and silicone can be useful graft for dorsal augmentation in Asian rhinoplasty even though dorsal augmentation with silicone implant showed better results. The silicone group showed higher complication but tolerable. If these grafts would be used appropriately, dorsal augmentation can be achieved effectively.

» RHOP-34 08:40~08:50

» DEvELOPMENT OF SURgICAL MOLD FOR DICED CARTILAgE DORSAL IMPLANT

DEPARTMENT OF OTOLARYNGOLOGY, ASAN



DIGITAL CONTENT, COLLEGE OF DESIGN AND

ARCHITECTURE, UNIVERSITY OF ULSAN 2

YONG JU JANG, SHINAE1, DON HAN KIM2

Objectives: Diced cartilage is useful dorsal augmentation material in rhinoplasty. But it is difficult to insert diced cartilage onto the nasal dorsum. In an effort to perform dorsal augmentation using diced cartilage in a more so-phisticated and controlled manner, we came up with an

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eration the contribution of mucosal immune responses and have also inquired into the immune-regulatory roles played by the commensal microbes residing in respiratory mucosa. Here, we sought to determine the interactions between the nasal microbiome, Staphylococcus epider-midis and interferon (IFN)-related innate immune re-sponses against influenza A virus (IAV). Methods: S. epi-dermidis strains were isolated from nasal mucus samples of healthy individuals. The effects of these mucosa-de-rived commensal strains on interferon (IFN)-dependent innate immunity and IAV infection dynamics were tested in vitro using normal human nasal epithelial (NHNE) cells and human turbinate mucosa. The effects of S. epi-dermidis on antiviral immunity were also tested in vivo using acute IAV infection mouse model. Results: Expo-sure of NHNE cells to nasal mucosa-derived S. epider-midis increased IFN-λ mRNA and secreted protein levels in the absence of viral stimulation. In the context of IAV infection, such NHNE exposure to S. epidermidis pre-vented an increase in the viral burden, as revealed by IAV PA mRNA abundance, IAV nucleoprotein levels, and vi-ral titers. S. epidermidis also enhanced transcription of IFN-stimulated genes independently of Toll-like receptor 2 and further induced IFN-λ production in IAV-infected cells by promoting phosphorylation of interferon regula-tory factor 7. In a murine infection model, S. epidermidis prevented the spread of IAV to the lungs by stimulating IFN-λ innate immunity and suppressing IAV replication in the nasal mucosa. Conclusion: These findings suggest that human nasal microbiome S. epidermidis mediates IFN-λ-dependent innate immune responses in nasal mu-cosa, thereby demonstrating the importance of host-bac-teria commensalism in shaping front-line anti-viral re-sponses in respiratory tract.

» RHOP-37 08:20~08:30

» EFFECT OF CHAMAECYPARIS OBTUSE ES-SENTIAL OIL ON AIRBORNE FUNgI INDUCED MUCIN gENE ExPRESSION IN NASAL EPITHE-LIAL CELLS



SCHOOL OF MEDICINE

BO-MUN KIM, YOUN-TAE SEO, BYUNG-JUN KANG ,MI-KYUNG YE,

SEUNG-EHON SHIN

NECK SURGERY, SEOUL ST MARYS HOSPITAL,


UNIVERSITY OF KOREA, SEOUL, KOREA

DO HYUN KIM1, SOO WHAN KIM1, SUNG WON KIM1

Objectives: human neural crest derived nasal turbinate stem cells (hNTSCs) are the part of the airways that re-spond to air pollutants and are the first cells infected with respiratory viruses. They are also involved in many airway diseases through their innate immune response and inter-action with immune and airway stromal cells. We made induced pluripotent stem cells derived from hNTSCs and discussed about their application. Methods: It is de-sirable to develop a minimally invasive simple method to create induced pluripotent stem cells (iPSCs). hNTSCs can be easily harvested during turbinoplasty. In this study, we generated hNTSCs-derived iPSCs (hNTSCs –iPSCs) by gene transduction with Sendai virus (SeV) vectors. SeV carries no risk of altering the host genome, which provides an additional level of safety during gen-eration of human iPSCs. Results: hNTSCs-iPSCs ex-press pluripotent cell markers, can differentiate into all three germ layers in vivo and in vitro, similar to ESCs. Conclusion: hNTSCs are an excellent tissue source to generate iPSCs. Detailed characterization of the resulting iPSC lines would help us better understand the repro-gramming process and retention of epigenetic memory. hNTSCs -iPSCs can be a tool for providing unlimited material for patient-specific research in diverse areas of airway epithelial biology, including asthma and COPD research.

» RHOP-36 08:10~08:20

» A UNIQUE HOST-BACTERIAL SYMBIOSIS IN NASAL MUCOSA CORROBORATES ANTIvIRAL INNATE IMMUNITY IN RESPIRATORY TRACT



COLLEGE OF MEDICINE

HYUN JIK KIM, ARA JO, JINA WON, CHAN HEE CHIL, CHAE-SEO RHEE

Objectives: The studies on the clear reaction of muco-sal microbiome with host increasingly take into consid-

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Methods: Pediatric adenoid tissues and lavage fluids were collected from total 38 subjects. Limulus amebocyte ly-sate test and bacterial colony counting were performed using adenoid tissues. Expression of IL-17RE in adenoid was analyzed using real-time polymerase chain reaction (PCR) and Western blot assay. The expression of IL-17C was evaluated by Western blot assay, immunohistochem-istry and the level of expression was compared between allergic rhinitis (AR) and control subjects. The level of Hsp27, Hsp70, and IL-17C in adenoid lavage fluids were evaluated by ELISA assay, and the correlation between these molecules was statistically analyzed. The function of IL-17C was evaluated using Staphylococcus aureus and immunoprecipitation assay. Results: Adenoid con-tained endotoxin, and substantial number of bacteria. IL-17RE was highly expressed in epithelium of adenoid. IL-17C was expressed in adenoid tissue, but the level was not different between AR and control subjects. IL-17C was positively detected in 50 % of adenoid lavage fluids and it was associated with Hsp 70 level. Depletion of IL-17C from adenoid lavage fluids decreased the number of Staphylococcus aureus. Conclusion: Our findings sug-gest that pediatric adenoid epithelial cells are involved in innate immunity by production and as a target organ of IL-17C.

» RHOP-39 08:40~08:50

» LONg-TERM EFFECT OF AIRFLOW DEPRI-vATION AFTER LARYNgECTOMY ON THE PA-RANASAL SINUSES A RADIOLOgIC STUDY



COLLEGE OF MEDICINE

MI RYE BAE, YOO-SAM CHUNG, YONG JU JANG, JI HEUI KIM,

MYEONG SANG YU

Objectives: Deprivation of nasal airflow can leads to pathological changes in the nasal epithelium and pre-dis-position to infection, especially paranasal sinusitis. Com-plete abolition of nasal airflow associated with laryngec-tomy can provide an opportunity to examine the role of nasal airflow in sinonasal pathology. The aim of this study was to analyze the radiologic changes of paranasal sinuses before and after laryngectomy. Methods: We an-alysed preoperative and postoperative computed tomog-raphy (CT) scans in 31 patients who underwent total

Objectives: Chamaecyparis obtusa essential oil (COEO) has immunomodulatory properties with antibacterial, antifungal, and antiinflammatory actions. Airborne fungi can enhance mucin gene expression from nasal epithelial cells. The aim of this study was to investigate the effect of COEO on mucin gene expression in nasal epithelial cells Methods: Nasal epithelial cells were obtained from chronic rhinosinusitis patients. Cultured epithelial cells were stimulated by 50 and 100 ug/ml of Alternaria alter-nata and Aspergillus fumigatus for 48 hours. MUC5AC, MUC5B and MUC8 mRNA expressions were analyzed using real-time RT-PCR. Nuclear factor-κB (NF-κB) and activator protein-1 (AP-1), and mitogen activated protein kinase (MAPK) expressions were determined western blot analysis. To determine the effect of mucin gene and transcription factor expression in nasal epithe-lial cells, cells were pretreated with 0.001, 0.005, and 0.01% of COEO. Results: MUC5AC mRNA expression was significantly increased by Alternaria and Aspergillus, however MUC5B and MUC8 mRNA expressions were increased only by Alternaria. These mucin gene expres-sions were significantly inhibited by 0.01% of COEO. Fungi enhance significantly enhanced NF-κB and p38 expression. 0.01% of COEO significantly inhibited NF-κB and phosphorylated NF-κB expression. Conclusion: COEO can suppresse the mucin gene expression from nasal epithelial cells through NF-κB pathway. Therefore, COEO could use as a modulator to control the mucus production in nasal mucosa.

» RHOP-38 08:30~08:40

» IL-17C IS ExPRESSED IN PEDIATRIC ADE-NOID AND INCREASE STAPHYLOCOCCUS AU-REUS POPULATION


- HEAD AND NECK SURGERY, COLLEGE OF

MEDICINE, CHUNG-ANG UNIVERSITY,


HYUN JIN MIN, KYUNG SOO KIM

Objectives: Interleukin-17 (IL-17) C is an epithelial cell originated cytokine, which is produced in response to bacterial stimulation and signals through IL-17C re-ceptor. These characteristics define IL-17C as a unique cytokine of IL-17 family which contributes epithelial cells to the innate immune response. We investigated the expression and function of IL-17C in pediatric adenoid.

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turbinate (64.7%) followed by nasal septum (52.9%). Paranasal sinuses were involved in 3 cases. There were no cases impressed as tuberculosis at the initial examination. Only 8 cases (47.1%) were thought as granulomatous diseases or lymphoma for the first impression. Diagnosis and treatment were delayed in 4 cases because of missed diagnosis such as conventional acute or chronic rhinosi-nusitis. Conclusion: Nasal tuberculosis is extremely rare disease. Diagnosing nasal tuberculosis requires a high index of suspicion. Excessive nasal crust formation, ul-ceration, granular mucosal inflammation on inferior tur-binate or nasal septum are the highly suspicious clues for the nasal tuberculosis.


Chair : JAE HWAN KWON, SEOK WON PARK

Sleep Related Breathing Disorders II

» RHOP-41 09:00~09:10

» PREDICTION OF OxYgEN DESATURATION BY USINg SOUND DATA FROM NON-CON-TACT DEvICE



UNIVERSITY BUNDANG HOSPITAL, SEOUL


SEONGNAM, KOREA, 2MUSIC AND AUDIO

RESEARCH GROUP, GRADUATE SCHOOL OF

CONVERGENCE SCIENCE AND TECHNOLOGY,

SEOUL NATIONAL UNIVERSITY, SUWON, KOREA

SUNG-WOO CHO1, TAEHOON KIM2, JAEYOUNG SHIN2, KYOGU LEE2,

JEONG-WHUN KIM1

Objectives: The oxygen desaturation index (ODI) is commonly used to evaluate the nocturnal hypoxemia se-verity in obstructive sleep apnea (OSA) and is known be correlated with the severity of cardiovascular disease. This study was aimed to predict ODI by machine learning in patients with OSA from breathing sound during sleep

laryngectomy. The time intervals between preoperative and postoperative CT scans were at least 3years. The pa-ranasal sinus volume, and Lund-Mackay (LM) score for each sinus were measured for both scans. The differences in pre-operative and post-operative LM scores was ana-lyzed utilizing paired t-tests. Results: 31 patients under-went total laryngectomy and had both preoperative and postoperative CT scans. The mean interval between pre-operative and postoperative CT scans was 61.0 months (33-118 months). There were no significant differences in the LM scores between pre-operative and postoperative scans within each sinus (frontal sinus, p=1.0; ethmoid sinus, p=0.78; maxillary sinus, p=0.18; sphenoid sinus, p=0.63) or in the total LM scores (p=0.14). Furthermore, the paranasal sinus volume also showed no significant change post-operatively (frontal sinus, p=0.38; ethmoid sinus, p=0.15; maxillary sinus, p=0.38; sphenoid sinus, p=0.57). Conclusion: Our study shows that the disrup-tion of nasal airflow results in no significant changes in radiographic evidence of paranasal sinuses. This result may provide evidence that reduced nasal airflow alone causes no significant sinusitis.

» RHOP-40 08:50~09:00

» NASAL TUBERCULOSIS ANALYSIS OF 17 CASES ExPERIENCED IN A SINgLE TERTIARY INSTITUTE

DEPARTEMENT OF OTORHINOLARYNGOLOGY-


MEDICINE, CHUNGNAM NATIONAL UNIVERSITY1

JAE HYUNG HEO1, YOUNG HOON YOON1, YONG MIN KIM1, KI-SANG RHA1

Objectives: Nasal tuberculosis is a distinctly rare disease. Initial symptoms of tuberculosis involving the nasal cavi-ty and paranasal sinuses are nonspecific, making early di-agnosis difficult. We analyzed the clinical characteristics of 17 nasal tuberculosis cases experienced in a single ter-tiary institute. Methods: Retrospective clinical analysis of the patients who diagnosed as nasal tuberculosis from January, 1989 to December 2018 in Chungnam national university hospital. Results: For the last 30 years, total 17 patients (female: 12, male: 5) were diagnosed and treated for nasal tuberculosis. The age varied from 16 to 80 years (mean age: 37, median age: 43). Common presenting symptoms were nasal obstruction, rhinorrhea and exces-sive crust formation. Common involved site was inferior

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fluctuating weakness related to fatigue of the voluntary muscles. MG patients showed a high prevalence of ob-structive sleep apnea (OSA) with a rate of 36 to 64% when compared to general population. In our previous study, most of MG patients with OSA (85.7%) showed positional OSA, and their supine AHI was 11-fold high-er than non-supine AHI. The cause of high prevalence of positional OSA in MG patients compared to general population was not revealed. Therefore, we investigated the obstruction pattern of the upper airway during sleep in patients with MG using drug-induced sleep endoscopy (DISE). Methods: Between May 2016 and March 2018, patients diagnosed with mild stable MG were included in this prospective study. Non-MG patients diagnosed with OSA were enrolled as a control group to compare ob-struction pattern of OSA between patients with MG and without MG. Patients underwent polysomnography and DISE. VOTE classification was used to describe obstruc-tion patterns observed by DISE. Results: Total 18 pa-tients with MG and 38 OSA patients without MG were included in this study. Among 18 MG patients showed velum obstruction in 12 patients (66.7%); lateral wall of oropharynx in 2 patients (11.1%); tongue base obstruc-tion in 9 patients (50.0%); epiglottis obstruction in 7 pa-tients (38.9%). A 7 out of 18 MG patients (38.9%) was diagnosed as OSA. In the comparison of DISE between OSA with MG and without MG, anteroposterior ob-struction of velum and epiglottis were significantly high-er in the OSA with MG compared to OSA without MG (P = 0.015 and P = 0.034, respectively). Conclusion: In MG patients with OSA, anteroposterior obstruction was significantly dominant than lateral or concentric obstruc-tion. These results may attribute to not only an under-standing of the pathophysiology of MG, but also indi-cates that anteroposterior obstruction is more vulnerable when muscle fatigue occurs.

» RHOP-43 09:20~09:30

» SURgICAL OUTCOME OF TONgUE BASE RESECTION IN SLEEP APNEA PATIENTS WITH TORUS MANDIBULARIS



THE AIRWAY MUCUS INSTITUTE,


SANG HYEON AHN1, JONG-GYUN HA1, JEONG JIN PARK1, JOO-HEON YOON1,2,

using a non-contact device. Methods: Patients who un-derwent attended, in-laboratory, full-night polysomnog-raphy were included. A total of 116 patients were ana-lyzed. For all patients, audio recordings were concurrent-ly performed with an air- conduction microphone during polysomnography. Analyses included breathing sound from all sleep stages. After noise reduction preprocessing, the audio data were segmented and sound features were extracted. Prediction models were firstly established by binary classification models using simple logistic regres-sion and were separately conducted for three different threshold criteria at ODI of 5, 15, and 30/hr. Estimation of ODI by regression analysis had been performed with the random forest and simple linear regression. Predic-tion models were validated with 10-fold cross-validation. Results: Accuracies of binary classifiers at ODIs of 5, 15, and 30 were 85.3%, 86.2%, and 87.1%, respectively. Pre-diction performances as measured by AUC for the clas-sifiers at ODIs of 5, 15, and 30/hr were 0.88, 0.93, and 0.91. Performances on estimation of ODI by regression resulted in correlation coefficient (0.80) with mean abso-lute error 9.60/hr and root mean squared error 13.46/hr by random forest model. Estimation performance of sim-ple linear regression was comparable, and the correlation coefficient, mean absolute error, and root mean squared error was 0.79, 10.09/hr and 13.30/hr respectively. Conclusion: This study showed that ODI could be pre-dicted using breathing sound generated during sleep. Al-though the performance should be further increased, our prediction model may be useful for pre-screening but also for a follow up after treatment in patients with OSA.

» RHOP-42 09:10~09:20

» PATTERNS OF UPPER AIRWAY OBSTRUC-TION IN MYASTHENIA gRAvIS PATIENTS OB-SERvED BY DRUg-INDUCED SLEEP ENDO-SCOPE

DEPARTMENT OF NEUROLOGY1,


SURGERY2, SCHOOL OF MEDICINE, KYUNGPOOK

NATIONAL UNIVERSITY, DAEGU, SOUTH KOREA

JIN-SUNG PARK1, JIN-SUN JUN1, HO-WON LEE1, JUNG SOO KIM2, SUNG JAE HEO2

Objectives: Myasthenia gravis (MG) is an autoim-mune chronic neuromuscular disease characterized by a

April27(Sat)




Objectives: Vitamin D contributes to maintaining the musculoskeletal system by controlling the metabolism of calcium and phosphorus in the body. Vitamin D is known to be activated by sun exposure, but in modern society it is highly likely to be deficient in Vitamin D due to increased indoor activities and lowered outdoor activities. In addition, several studies have shown that vi-tamin D is associated with various diseases. In addition, proper sleeping duration is also associated with various diseases. So we studied the relationship between sleeping duration and vitamin D by studying these relationships. Methods: Among the 25534 subjects in the 5th National Health and Nutritional Examination Survey from 2010 to 2012, 14490 adults excluding the missing values of the factors included in the statistics were surveyed. The relationship between Sunlight exposure, Sleep duration, and Vitamin D level was examined after adjustment of basic characteristic variable, physical characteristic vari-able, life-style variable and sociodemographic variable. Results: Sleep duration was statistically significant ac-cording to age, sex, obesity, HTN, DM, dyslipidemia, smoking status, alcohol drinking, region, family income, education level, occupation, exposure to sunlight. There was a statistically significant difference in vitamin D lev-els according to age, sex, obesity, HTN, DM, dyslipid-emia, smoking status, alcohol drinking, regular exercise, region, family income, education level, occupation, ex-posure to sunlight. In the group with high sun exposure, there was no significant relationship between sleep time and vitamin D level, but in the group with low sun expo-sure, the longer the sleeping time, the lower the vitamin D level. Conclusion: Therefore, proper sun exposure is important, and if sun exposure is low, excessive sleep may reduce the vitamin D level.

» RHOP-45 09:40~09:50

» INTER-RATER RELIABILITY OF A SCORINg SYSTEM FOR DRUg-INDUCED SLEEP ENDOS-COPY BETWEEN ExPERIENCED AND INExPE-RIENCED OTOLARYNgOLOgISTS


BUSAN SAINT MARYS HOSPITAL1

SOO-KWEON KOO1, SANG-HOON LEE1, TAE-KYUNG KOH1, YOUNG-JUN KIM1,

JI-SEUNG MOON1, HO-BYUNG LEE1, GEUN-HYUNG PARK1

CHANG-HOON KIM1,2, HYUNG-JU CHO1,2

Objectives: Various anatomical factors of the upper air-way affect obstructive sleep apnea (OSA) severity. Torus mandibularis causes OSA by affecting the space of the oral cavity or the tongue position. Therefore, we deter-mined its effect on the outcomes of tongue base resection (TBR) in patients with OSA. Methods: We retrospec-tively analyzed medical records of a total of 669 patients with a history of sleep disturbances who visited the hos-pital sleep center in 2010–2017, among whom 104 un-derwent sleep surgery with TBR. Patients were divided into groups with and without torus mandibularis. De-mographic data, anatomical characteristics of the upper airway, and pre/postoperative polysomnography results were analyzed. Results: The control and torus mandibu-laris groups included 69 and 35 patients, respectively. All patients had improved sleep quality after TBR. The postoperative apnea–hypopnea index decreased from 42.1 to 23.9 in the control group (p<0.001) and from 45.2 to 22.5 in the torus mandibularis group (p<0.001). Sleep efficiency improved from 90.0 to 92.8 in the con-trol group (p=0.033) and from 90.3 to 93.6 in the torus mandibularis group (p=0.019). However, the two groups did not differ significantly in the change from preopera-tive to postoperative results. Conclusion: Sleep quality improved after tongue base resection regardless of torus mandibularis. However, no significant difference oc-curred between the two groups in the improvement of polysomnographic results. Therefore, the presence of to-rus mandibularis is not associated with unfavorable out-comes after TBR in sleep apnea patients.

» RHOP-44 09:30~09:40

» RELATIONSHIP OF SLEEP DURATION, SUN ExPOSURE, AND SERUM vITAMIN D LEvEL IN THE KOREAN POPULATION





UNIVERSITY SCHOOL OF MEDICINE2

JI HO CHOI1, JAE YONG LEE1, DONG YOUNG KIM2, HYUN JUN KIM2,

DO-YANG PARK2

April27(Sat)




now, but there is no agreement on the association be-tween age and OSA. In addition, there is few research on the association between age and polysomnographic features. Therefore, the aim of this study is to investigate differences in the results of polysomnography (PSG) fea-tures. Methods: Of the 1200 Patients diagnosed with OSA and underwent PSG from Jan 2014 to December 2018 at Kyung-Hee University Hospital, 291 non-obese and adult male patients were enrolled in the study. Pa-tients are divided into two groups in age: 20~60 years old and >60 years old group. The differences of PSG param-eters were analyzed between two groups retrospectively. Results: Of the 1200 patients, 955(79.6%) patients were male and of these, 229 (72.7%) patients were between 20 and 60 years old and 62 (19.7%) patients were over 60 years old.There was no difference in apnea hypopnea index (AHI) between the two groups, but the propor-tion of AHI severity increased with age (p<0.05).In other PSG features, sleep efficiency(%), non-rapid eye move-ment(NREM)3/total sleep time(TST)(%), and rapid eye movement(REM)/TST(%) were lower in old age group, but NREM/TST(%), NREM1/TST(%),wake after sleep onset(WASO)(min) and WASO(%) were higher in old age group than young age group (p<0.05). In oxygen sat-uration data, old age group has lower baseline oxygen-(O2) saturation (%) and higher cumulative O2 satura-tion <90% (min) than Young age group(p<0.05). In cor-relation study,sleep efficiency (%),NREM3/TST (%) and baseline O2 saturation(%) showed a decreasing tendency with age, but NREM1/TST (%), WASO(min),and Cu-mulative O2 saturation<90%(min) showed an increasing tendency with age(p<0.05). Conclusion: In non-obese OSA male patients, the severity of sleep apnea increases with age. In addition, as the age increases, sleep efficiency and sleep structure change rather than changes in other PSG features.

» RHOP-47 10:00~10:10

» RELATIONSHIP BETWEEN ADAMTS-13 AND OBSTRUCTIvE SLEEP APNEA




KOREA UNIVERSITY ANSAN HOSPITAL

SUN JIN HWANG, MIN YOUNG SEO, MUN SOO HAN, YONG JUN JEONG,

SEUNG HOON LEE

Objectives: An ideal, drug-induced sleep endoscopy (DISE) scoring system should cover all the upper airways, be simple and practical, and quantify the severity of ob-struction. Excellent validity and reliability are essential. We explored the inter-rater reliability of our new DISE scoring system in the hands of experienced and inexpe-rienced otolaryngologists. Methods: We retrospectively analyzed video images of 100 patients who underwent DISE examination in our hospital from 2015 to 2018. Three experienced and three inexperienced otolaryngol-ogists reviewed and scored all images. We calculated the inter-rater reliabilities of the two groups of otolaryngol-ogists. Results: Independent of the extent of experience with DISE, the detection of retropalatal obstructions (overall agreement: 0.61, kappa value: 0.37) and the ex-tents of such obstructions (overall agreement: 0.87, kappa value: 0.60) were more consistent than at the retrolingual level (overall agreement: 0.61, kappa value: 0.37). Inex-perienced observers were in very good agreement in terms of palatal obstructions and experienced observers in very good agreement in terms of tongue-base obstructions. All professionals found it difficult to detect the lateral pha-ryngeal wall at the retrolingual level. Conclusion: Inex-perienced observers tended to overlook tongue-base ob-structions, focusing rather on relatively simple retropala-tal obstructions. Although our DISE scoring system thus has certain limitations, the extent of agreement between experienced and inexperienced observers in terms of the diagnosis and extent of obstructions was high.

» RHOP-46 09:50~10:00

» INFLUENCE OF AgE IN THE POLYSOMNO-gRAPHIC FEATURES IN NON-OBESE ADULT MALE PATIENTS WITH OBSTRUCTIvE SLEEP APNEA


& NECK SURGERY, KYUNG HEE UNIVERSITY

SCHOOL OF MEDICINE,

KYUNG HEE MEDICAL CENTER1

DAE-WOONG KANG1, OH-EUN KWON1, JIN-YOUNG MIN1, KUN-HEE LEE1,

SUNG WAN KIM1

Objectives: Risk factors of Obstructive sleep apnea (OSA) like age, sex, BMI, menopausal status, smoking status, and upper airway closure are well known until

April27(Sat)




MEDICINE, KOREA UNIVERSITY COLLEGE OF

MEDICINE, KOREA UNIVERSITY ANSAN HOSPITAL 3DEPARTMENT OF PUBLIC HEALTH SCIENCES,

GRADUATE SCHOOL, KOREA UNIVERSITY 4DEPARTMENT OF OTORHINOLARYNGOLOGY,


KOREA UNIVERSITY ANSAN HOSPITAL 5DEPARTMENT OF OTORHINOLARYNGOLOGY,



HOSPITAL

SEUNG-NO HONG1, CHOL SHIN2, HANA YI3, DAE WOO KIM1, SEUNG HOON LEE4,

DONG-YOUNG KIM5, CHAE-SEO RHEE5

Objectives: Despite the clinical significance of obstruc-tive sleep apnea (OSA), the disease mechanism still re-mains rather unclear. Current evidence suggests that the endothelial dysfunction play a pivotal role in the patho-genesis. Microbiome has a great impact on human health and disease, particularly in the mucosal system where it can have direct interactions. This study aims to analyze the microbiome composition in the upper airway mu-cosa in patients with OSA. Methods: Subjects from a population based cohort were evaluated in this study. All subjects underwent sleep study with a home-based sleep testing device. Upper airway swab samples were collect-ed from the nasopharyngeal mucosa. Microbiome were assessed based on 16S rRNA gene-pyrosequencing. The microbiome composition were compared and analyzed according to sleep study parameters. Results: A total of 92 subjects were enrolled (mean age: 62.7±5.8, male-to-female ratio: 0.74). The average AHI was 7.75±6.5. Proteobacteria, Firmicutes, and Actinobarcterias were the three predominant phyla in the nasopharyngeal micro-biota of all subjects. Alpha-diversity measured by inverse Simpson and Shannon index showed a trend to be high-er in the OSA group (AHI ≥ 5) compare to non-OSA group (AHI<5) but without statistical significance. Al-though the microbiome signatures of OSA subjects were altered in the genus level, there was no correlation be-tween the microbiome change and the severity of OSA. Conclusion: The upper airway microbiome displayed a diverse composition in OSA patients. Investigation of the relationship between airway microbiota and OSA may help understanding the pathomechanisms of OSA.

Objectives: Obstructive sleep apnea (OSA) is a com-mon sleep-related respiratory disease with a prevalence of about 5-13%. It causes sympathetic nervous system activation, systemic inflammation, oxidative stress, endo-thelial dysfunction and hypercoagulability, increasing the risk of cardiovascular disease. Recently, various substances have been studied to predict the risk of obstructive sleep apnea and cardiovascular complications. In this study we investigated the relationship between ADAMTS-13 and obstructive sleep apnea syndrome, which is related to car-diovascular diseases as an enzyme involved coagulation. Methods: From February 2018 to September 2018, 101 patients with obstructive sleep apnea-related symptoms visited. Of these, 40 patients who agreed to this study and completed the standard overnight polysomnography, blood test, questionnaire were finally included. Apnea-hy-popnea index (AHI) ≥ 5 was diagnosed sleep apnea and classified as 5≤AHI<15 mild, 15≤AHI<30 moderate, and 30≤AHI severe. The concentration of ADAMTS-13 was measured by enzyme-linked immunosorbent assay (ELI-SA) using the plasma sample of patients. Results: The mean age of the 40 patients was 42.45 years (SD: 14.91), the mean body mass index (BMI) was 27.87 kg/m2 (SD: 4.60), and the mean apnea - hypopnea index (AHI) was 31.29 events/hr (SD: 27.17). In the non-OSA group and the OSA group, the concentrations of ADAMTS-13 were 6.91±0.57 ng/ml and 5.63±1.02 ng/ml (p=0.00), respec-tively. Concentrations of ADAMTS-13 were significantly different between non-OSA group and mild, moderate, severe OSA groups (p=0.02). In the correlation analy-sis between AHI and ADAMTS-13 concentration, the rho value was -0.43 (p = 0.01), and the concentration of ADAMTS-13 tended to decrease with increasing AHI. Conclusion: ADAMTS-13 has a significant negative cor-relation with AHI, indicating that ADAMTS-13 may be associated with OSA. These results suggest that coagula-tion-related diseases may be related to OSA, and further studies are needed.

» RHOP-48 10:10~10:20

» UPPER AIRWAY MICROBIOME IN PATIENTS WITH OBSTRUCTIvE SLEEP APNEA


SEOUL NATIONAL UNIVERSITY COLLEGE

OF MEDICINE, BORAMAE MEDICAL CENTER 2DIVISION OF PULMONARY, SLEEP, AND CRITICAL

CARE MEDICINE, DEPARTMENT OF INTERNAL

April27(Sat)




meability. Pretreatment with NAC reduced the degree of UPM-mediated ER stress in HNECs and restored nasal epithelial barrier disruption. Conclusion: These data suggested that particulate matter may induced nasal epithelial barrier dysfunction by targeting tight junction through the activation of ER stress in HNECs. Further-more, disrupting this process with an inhibitor targeting ER stress responses could represent a novel promising therapeutic target in UPM induced sinonasal disease.

» RHOP-50 11:20~11:30

» DEvELOPMENT OF NASAL AIRWAY ORgAN-OID IN MURINE MODEL



KOREA 2THE AIRWAY MUCUS INSTITUTE, YONSEI

UNIVERSITY COLLEGE OF MEDICINE, KOREA 3KOREA MOUSE SENSORY PHENOTYPING

CENTER (KMSPC), YONSEI UNIVERSITY COLLEGE

OF MEDICINE, KOREA 4MEDICAL RESEARCH

CENTER (MRC), YONSEI UNIVERSITY COLLEGE OF

MEDICINE, KOREA

SOO-IN KIM4, JONG-GYUN HA1, JOO-HEON YOON1,2,3, HYUNG-JU CHO1,2,3,

CHANG-HOON KIM1,2,3,4

Objectives: We aimed to set up three-dimensional cul-ture method for nasal airway organoid, which self-renew and generate epithelium of nasal mucosa which including differentiated ciliated cells and secretory cells. Methods: We harvested mucosal tissue from nasal septum and isolated cells from the mucosa. The cells were cultured with specialized media and matrigel(1:1) in 24 trans-well plate. We incubated cells in MTEC/plus media for 7days, and MTEC/SF media for 14days. We performed H&E, PAS, Alcian blue staining for histology, and immunoflu-orescence staining with ciliated cell marker (Acetylated tublin) and basal cell marker (Krt5) to confirm the dif-ferentiation of cells. Results: During 7days culture in MTEC/plus, 200-1000um size of spheroid was formed in matrigel. After culture in MTEC/SF, ciliated cells were observed at the liminal side of organoid, but basal cells were observed at the outer layer of organoid by immuno-fluorescence. Secreted mucin was found in the lumen of organoid by PAS and Alcian blue staining. Differentiated organoid had similar structure with mouse nasal respira-


Chair : YONG DAE KIM, YONG MIN KIM

Rhinosinusitis (Basic)

» RHOP-49 11:10~11:20

» URBAN PARTICULATE MATTER INDUCES NASAL EPITHELIAL BARRIER DYSFUNCTION BY TARgETINg TIgHT JUNCTIONS IN HUMAN NASAL EPITHELIAL CELLS


HEAD AND NECK SURGERY, CHUNGNAM


SOO KYOUNG PARK, SUN HEE YEON, MI-RA CHOI, KI SANG RHA, YONG MIN KIM

Objectives: Exposure to airborne urban particulate mat-ter (UPM) has been closely related to development and aggravation of respiratory disease, including sinonasal disorders. However, the influence of UPM on the na-sal epithelial barrier and the underlying mechanism has not been investigated previously. The aim of this study is to investigate the effect of UPM on nasal epitheli-al tight junctions (TJs) and mucosal barrier function, and delineate these underlying mechanism. Methods: In this study, human RPMI 2650 cells and cultures of primary human nasal epithelial cells (HNECs) were ex-posed to particulate matter (PM 10) and fine particulate matter (PM 2.5). TJ and endoplasmic reticulum stress (ER stress) markers expression was measured using by re-al-time quantitative polymerase chain reaction, Western blot analysis and immunofluorescence. TJ integrity and nasal epithelial barrier function were evaluated by tran-sepithelial electric resistance and paracellular flux. In ad-dition, the effects of N‐acetyl‐L‐cysteine (NAC) on UPM induced HNECs were investigated in vitro. Results: Ur-ban particulate matter significantly impaired the nasal epithelial barrier, as demonstrated by decreased mRNAs and protein expression of TJ markers in RPMI 2650 cells and cultures of human nasal epithelial cells. This was in parallel to reduced transepithelial electrical resistance and increased fluorescein isothiocyanate–dextran per-

April27(Sat)




alkalinization that profoundly affected eotaxin-3 gene expression and was significantly blocked by Fligotinib and AS1517499 (p<0.05). Conclusion: IL-13 potently stimulates eotaxin-3 production in airway epithelial cells and is strongly inhibited by JAK inhibitor and STAT6 inhibitor. Inhibition of IL-13-induced eotaxin-3 by JAK inhibitor and STAT6 inhibitor may provide therapeutic benefit in CRSwNP via a novel H/K-dependent mecha-nism.

» RHOP-52 11:40~11:50

» ExPRESSION AND ROLES OF RECEPTOR ACTIvATOR OF NUCLEAR FACTOR KAPPA-B LIgAND IN THE OSTEITIS OF CHRONIC RHI-NOSINUSITIS



SACRED HEART HOSPITAL, HALLYM UNIVERSITY

COLLEGE OF MEDICINE, ANYANG, KOREA1,


HEAD AND NECK SURGERY, NATIONAL MEDICAL

CENTER, SEOUL, KOREA2, DEPARTMENT OF


SURGERY, CHUNCHEON SACRED HEART

HOSPITAL, HALLYM UNIVERSITY COLLEGE OF

MEDICINE, CHUNCHEON, KOREA3, DEPARTMENT


SURGERY, BORAMAE MEDICAL CENTER, SEOUL


SEOUL, KOREA4

IL GYU KONG1,2, DONG-KYU KIM3, KYOUNG MI EUN4, SEUNG KOO YANG4,

DAE WOO KIM4

Objectives: Background: The evidence of osteitis are fre-quently observed in patients with chronic rhinosinusitis (CRS), especially in recalcitrant cases. However, the stud-ies focusing on biological markers of osteitis are limited, and it is still unclear whether the osteitis is differently associated with various phenotypes of CRS. This study aimed to analyze the expression and assess roles of recep-tor activator of nuclear factor kappa-B ligand (RANKL) in CRS with osteitis. Methods: Methods: Patients with CRS with nasal polyps (CRSwNP, n=63) or CRS with-out nasal polyps (CRSsNP, n=8) and control (n=12) were

tory epithelium. Conclusion: We have confirmed that the spheroids made in our culture system and they had similar features as nasal respiratory epithelium. Further studies are under investigation to reveal its gene profiles and functional similarity to in vivo characteristics.

» RHOP-51 11:30~11:40

» EFFECTS OF JAK INHIBITOR AND STAT6 IN-HIBITOR ON IL-13-INDUCED CHANgES IN AIR-WAY EPITHELIAL CELLS

1DEPARTMENT OF OTOLARYNGOLOGY-

HEAD AND NECK SURGERY, KYUNG HEE

UNIVERSITY SCHOOL OF MEDICINE, SEOUL,

KOREA, 2DEPARTMENT OF OTOLARYNGOLOGY,

NORTHWESTERN UNIVERSITY FEINBERG SCHOOL

OF MEDICINE, CHICAGO, ILL, USA, 3DIVISION OF

ALLERGY AND IMMUNOLOGY, DEPARTMENT

OF MEDICINE, NORTHWESTERN UNIVERSITY

FEINBERG SCHOOL OF MEDICINE, CHICAGO, ILL, USA

JYMIN1, SWKIM1, RCKERN2, RPSCHLEIMER3, BKTAN2

Objectives: Chronic rhinosinusitis with nasal polyps (CRSwNP) is a disease frequently characterized by mu-cosal eosinophilia likely influenced by elevated levels of type 2 cytokines, notably IL-13, and CCR3 ligands of the eotaxin family. The cytokine- activated Janus kinase (JAK)–signal transducer and activator of transcription (STAT) pathway has an important role in the control of immune responses. We aim to evaluate inhibitory ef-fects of JAK inhibitor and STAT6 inhibitor on IL-13-induced eotaxin-3 responses in airway epithelial cells (BEAS-2B and primary human sinonasal epithelial cells [SNEC]) and identify possible mechanisms of action in airway epithelium. Methods: BEAS-2B and SNEC from inferior turbinate (IT) scrapings from control and CRSwNP patients were cultured with IL-13 (5ng/ml) with or without Fligotinib, JAK inhibitor (10- 1000nM) and AS1517499, STAT6 inhibitor (10-1000nM) for 48 hours. The effects of those inhibitors on IL-13-induced effects were measured by ELISA, qRT-PCR, and pH imaging. Results: Fligotinib and AS1517499 dose-de-pendently suppressed IL-13-mediated eotaxin-3 mRNA expression and protein secretion from BEAS-2B cells and SNEC (p<0.05). In addition, using intracellular pH imaging, we found that IL-13 induced intracellular pH

April27(Sat)




process of the sinonasal mucosa. Cold temperature-re-lated exacerbation of chronic rhinosinusitis is often fol-lowed by a subsequent increase in bacterial and viral in-fections of the sinonasal mucosa. In this respect, CIRBP may participate in the pathogenesis of CRS. We analyzed the role of CIRBP in the pathogenesis of human sinona-sal mucosa. Methods: The expression levels of CIRBP in normal and inflammatory sinus mucosa were analyzed by real time PCR, western blot, and immunohistochemistry. The expression levels of CIRBP, transepithelial permea-bility and electrical resistance were measured in epithelial cells exposed to hypoxia and treated with Th1 and Th2 cytokines, in cells silenced with CIRBP specific siRNA. Furthermore, the expression and distribution pattern of tight junctional complex proteins were also evaluated in cells exposed to the hypoxia. Results: CIRBP was con-stitutively expressed in epithelial cells, and submucosal glands of sinonasal mucosa. Its levels is increased in in-flammatory mucosa of CRS patients with or without na-sal polyps and is up-regulated in epithelial cells treated with Th1 and Th2 cytokines. Increased epithelial a per-meability associated with decreased electrical resistance were found in cells with increased CIRBP where the ex-pression levels of ZO-1, occludin, and claudin-1 were de-creased. Conclusion: CIRBP is constitutively expressed in normal human sinonasal mucosa and is up-regulated in inflammatory mucosa, resulting in increased epithelial permeability.

» RHOP-54 12:00~12:10

» ENDOPLASMIC RETICULUM STRESS IN-DUCES MUC5AC ANDMUC5B ExPRESSION IN HUMAN NASAL AIRWAYEPITHELIAL CELLS



MEDICINE, YEUNGNAM UNIVERSITY1, REGIONAL

CENTER FOR RESPIRATORY DISEASES,

YEUNGNAM UNIVERSITY MEDICAL CENTER2

YOO SUN SONG1, TAE YEONG CHOI1, JOON-HEE KIM1, SOO YEON JO1,

CHANG HOON BAE1, YOON SEOK CHOI1, HYUNG GYUN NA1, SI-YOUN SONG1,

YONG-DAE KIM1,2

Objectives: Endoplasmic reticulum (ER) stress is known to be associated with inflammatory airway diseases, and

enrolled. Clinical information and CT scores, histolog-ic phenotypes were investigated. The clinical parameters (Global osteitis score) and molecular marker of bone re-modeling, RANKL were analyzed in each type of CRS. CRS mice model was tested using anti-RANKL. Results: Results: Global osteitis score (GOS) was significantly higher in all CRS compared to the control group. GOS in non-eosinophilic CRSwNP was higher compared to eosinophilic CRSwNP. Moreover, high GOS in non-eo-sinophilic CRSwNP was associated with poor disease control. Bone remodeling marker RANKL was upregu-lated whereas decoy receptor OPG was downregulated in CRS. RANKL at the level of mRNA and protein was pos-itively correlated with GOS of CT. Multiple inflammato-ry mediators were positively correlated with the protein level of RANKL in CRS tissues. In the mouse CRSwNP model, anti-RANKL treatment abrogated neutrophil recruitment in the nasal mucosa. Conclusion: Conclu-sion: Clinical osteitis is present in CRS, with more clin-ical significance in non-eosinophilic CRSwNP. RANKL is correlated with clinical osteitis and disease severity in CRSwNP. These findings shed light on the importance of RANKL as a potential biomarker of CRS and a key player in CRS pathogenesis.

» RHOP-53 11:50~12:00

» ROLE OF COLD-INDUCIBLE RNA BINDINg PROTEIN AS A NEW PATHOgENETIC FACTOR IN THE SINUS MUCOSA OF PATIENTS WITH CHRONIC RHINOSINUSITIS WITH OR WITH-OUT NASAL POLYPS

DEPT OF OTORHINOLARYNGOLOGY-HEAD AND


KOREA UNIVERSITY

SANG HAG LEE, JAE WOONG HWANG, KI JUNG LEE, TAE HOON KIM

Objectives: Cold-inducible RNA-binding protein (CIRBP) emerged as a new inflammatory mediator or damage-associated molecular pattern. CIRBP is induced in hypothermia and hypoxia, participating mucin secre-tion, epithelial mesenchymal transition, and cytokine se-cretion. Although the etiology and pathogenesis of CRS remain debatable, abnormal host response to infectious microorganisms such as virus and bacteria has been sug-gested to be responsible for the persistent inflammatory

April27(Sat)




CHANG-HOON KIM1,2,3,4, JOO-HEON YOON1,2,3, HYUNG-JU CHO1,2,3

Objectives: The epithelial sodium channel (short: ENaC, also: amiloride-sensitive sodium channel) is a mem-brane-bound ion channel that is selectively permeable to Na+ ions and that can be important role in upper airway disease. Hypoxia is an emerging important pathogenesis of upper airway disease such as sinusitis. Although the inhibition of ENaC subunits observed in cultured lower epithelial cells has been suggested, its pathophysiology in upper airway has not been elucidated. We investigated whether hypoxia induces ENaC, and the ENaC expres-sion can affected by the treatment with dexamethasone in human nasal epithelial (HNE) cells. Methods: Cul-tured primary human nasal epithelial (NHE) cells were used for the measurement of short-circuit current chang-es with the Ussing chamber. Membrane fractions were prepared from HNE cells exposed to hypoxia (3% O2) as well as normoxia. To evaluate the change of ENaC sub-units, RT-PCR, western blot, and immunofluorescence were performed. We additionally treated dexamethasone into hypoxia condition to evaluate the change of ENaC activity. Results: We determined the change of ENaC subunits under hypoxia compared to normoxia. ENaC-α, ENaC-β, ENaC-γ mRNA expression gradually increased in order and the peak level of expression was observed in ENaC-γ in hypoxia condition. The ENaC-γ expression significantly increased after 12 hours of hypoxic treat-ment which was decreased by the treatment with dexa-methasone. Conclusion: Hypoxia increased the ENaCγ expression in HNE cells. The overexpression of ENaCγ was significantly decreased by treatment with dexameth-asone. We suggest that the upper airway diseases such as sinusitis may be aggravated through the ENaCγ overex-pression by hypoxia, and this aggravation can be alleviat-ed by dexamethasone.

» RHOP-56 12:20~12:30

» EFFECTS OF POvIDONE IODINE (PvP-I) COMPOSITE ON ELIMINATION OF BACTERIAL BIOFILM


HEAD AND NECK SURGERY, RESEARCH

INSTITUTE FOR MEDICAL SCIENCE, CHUNGNAM

NATIONAL UNIVERSITY SCHOOL OF MEDICINE,

three major transmembrane receptors: double- stranded RNA- activated protein kinase-like ER kinase, inositol requiring enzyme 1, and activating transcription fac-tor 6 (ATF6) play important roles in ER stress- related proinflammatory signaling. However, the effects of ER stress and these three major signaling pathways on the regulation of the production of airway mucins in human nasal airway epithelial cells have not been elucidated. Methods: In primary human nasal epithelial cells, the effect of tunicamycin (an ER stress inducer) and 4-phen-ylbutyric acid(4-PBA, ER stress inhibitor) on the ex-pression of MUC5AC and MUC5B was investigated by reverse transcriptasepolymerase chain reaction, real-time polymerase chain reaction, enzyme immunoassay, and immunoblot analysis. Small interfering RNA (siRNA) transfection was used to identify the mechanisms in-volved. Results: Tunicamycin increased the expressions of MUC5AC and MUC5B and the mRNA expressions of ER stress-related signaling molecules, including spliced X-box binding protein 1 (XBP-1), transcription factor CCAAT-enhancer-binding protein homologous protein (CHOP), and ATF6. In addition, 4-PBA attenuated the tunicamycin-induced expressions of MUC5AC and MUC5B and the mRNA expressions of ER stress-related signaling molecules. Furthermore, siRNA knockdowns of XBP-1, CHOP, and ATF6 blocked the tunicamycin-in-duced mRNA expressions and glycoprotein productions of MUC5AC and MUC5B. Conclusion: These results demonstrate that ER stress plays an important role in the regulation of MUC5AC and MUC5B via the activations of XBP-1, CHOP, and ATF6 in human nasal airway ep-ithelial cells.

» RHOP-55 12:10~12:20

» HYPOxIA-INDUCED OvERExPRESSION OF EPITHELIAL SODIUM CHANNELS IN THE NA-SAL EPITHELIAL CELLS



THE AIRWAY MUCUS INSTITUTE, YONSEI

UNIVERSITY COLLEGE OF MEDICINE 2, KOREA

MOUSE SENSORY PHENOTYPING CENTER

(KMSPC), YONSEI UNIVERSITY COLLEGE OF

MEDICINE3, MEDICAL RESEARCH CENTER (MRC),


JONG-GYUN HA1, EUN JUNG LEE1, JAE SUNG NAM1, JUNG JIN PARK1,

April27(Sat)





Chair : SEUNG HEON SHIN, JEFFREY D. SUH

Allergy (Basic)

» RHOP-57 15:50~16:00

» INHALED DELIvERY OF TYPE III INTERFER-ONS RESTRICTS EPITHELIAL-DERIvED TH2 INFLAMMATION AND PATHOLOgIC RESPONS-ES IN ALLERgIC ASTHMA



COLLEGE OF MEDICINE

JINA WON, ARA JO, CHAN HEE CHIL, DONG-YOUNG KIM, CHAE-SEO RHEE,

HYUN JIK KIM

Objectives: Recent studies showed that interferon (IF-N)-λs can be induced rapidly in asthmatic mice after viral infection and this cytokine is important for restrict-ing Th2 cytokine secretion in asthmatic mice. These findings suggest the possibility that type III IFNs may modulate Th2-related immune responses and we sought to determine the in vivo contribution of type III IFNs on decrease of Th2 cytokines in vivo asthma. Methods: C57BL/6 mice were used for development of asthmatic mice with OVA. Asthmatic mice were exposed to whole body mainstream by the SCIREQ “InExpose” system and recombinant IFN-λ2/3 (IFN-λ2: 1 ug, IFN-λ3: 1 ug) was inoculated into asthmatic mice by intranasal deliv-ery. Results: Asthmatic mice were observed to have a sig-nificant increase in total lung resistance, the numbers of eosinophils and pathologic findings in their lung. ELISA showed that the mean protein levels of TSLP and IL-33 from BAL fluid of asthmatic mice were significantly high-er until 7 days. Following the collection of lung tissue of 20 asthmatic mice, TSLP and IL-33 gene expressions in-versely correlated with mRNA levels of IFN-λ2/3. Asth-matic mice were administered recombinant IFN-λs via the intranasal route and the mRNA levels of IFN-stim-ulated genes were elevated to an even greater extent than the mice without intranasal IFN-λ2/3. Asthmatic lung

DAEJEON, REPUBLIC OF KOREA

LEONITA PINTO JERONIMO

Objectives: Povidone Iodine (PVP-I) has been well known as antiseptic and has extensive activity against var-ious pathogens, including Gram-positive and Gram-neg-ative organisms, anaerobe, fungi and viruses. However, because of its unique unpleasant nature, such as irritating and disgusting smell and taste, it could not be used local-ly in order to inactivate various sinonasal pathogens. We have developed the PVP-I composite (Fludon®) which blocks unpleasant natures of PVP-I as using locally in si-nonasal cavity. The aims of the study were to develop in vitro and in vivo model of the biofilm formation and to evaluate the effect of Fludon® on biofilms formation and elimination. Methods: MTT(3-(-4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide) and LDH(Lactate dehydrogenase) Assay were performed to examine the cytotoxicity of the Fludon® on the primary nasal epithe-lial cells and RPMI 2650 cells. P.aeruginosa and S.aureus were cultured and Crystal Violet (CV) staining was per-formed to quantify adherent biofilm biomass. To devel-op the sinonasal biofilm model, S. aureus were instilled into the mice’s nose three times for seven days and un-derwent histologic examination (H&E stain) to confirm the biofilm formation. In addition, Fludon® was admin-istered into the nose to see this could eliminate biofilm from the nasal mucosa. Results: There was no significant toxicity of Fludon® treatment on primary nasal epithelial and RPMI 2650 cells at the given concentration. In ad-dition, Fludon® significantly decreased bacterial biofilm formation with dose dependent manner after 48 hours of incubation of P. aeruginosa and S. aureus. H&E stain revealed that bacterial biofilms on nasal mucosa of mice were significantly removed by Fludon® treatment com-pared with normal saline instillation. Conclusion: Flud-on® is effective for preventing and eliminating bacterial biofilm formation. Local treatment of Fludon® could be one of the therapeutic options for eliminating bacterial biofilms from the sinonasal cavity.

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caused by ROS expression and proinlfammatory cytokine induced by exposure to UPM.

» RHOP-59 16:10~16:20

» REgULATION OF TH2 IMMUNE RESPONSE BY CONTROLLINg BETA-2 ADRENERgIC RE-CEPTOR IN HUMAN DENDRITIC CELLS



KOREA UNIVERSITY, SEOUL, KOREA

JI WOO YEON, BYOUNGJAE KIM, JUNHYOUNG BYUN, KIJEONG LEE,

SANG HAG LEE, TAE HOON KIM

Objectives: The reduction of cyclic adenosine mono-phosphate (cAMP) concentration in dendritic cells (DCs) induces Th2 immune response and yields a prominent allergic phenotype in lower airway. G protein-coupled receptors (GPCRs) regulate the cAMP concentration through adenylyl cyclase (AC). In this study, we aimed to search a potential GPCR and evaluate Th responses by regulating it in human DCs. Methods: Human blood DCs from non-allergic controls and allergic rhinitis pa-tients were isolated with FACS sorting and analyzed by RNA-sequencing and immunoblotting. After THP-1 differentiated DCs were treated with ADRB2 agonist or antagonist, cAMP concentration in DCs were evaluated. Then, DCs were co-cultured with human CD4+ naïve T cell and cytokines were analyzed using ELISA. Results: In human allergic rhinitis patients, transcriptional level of beta-2 adrenergic receptor (ADRB2) in human blood DCs were statistically increased compared to non-allergic controls, which was validated by evaluating the protein expression of ADRB2. The level of cAMP in ADRB2 ag-onist treated DCs were increased but were decreased in ADRB2 antagonist treated DCs. When ADRB2 agonist treated DCs were co-cultured with naïve T cells, Th2 cy-tokines were decreased. Conclusion: The present study showed that the expression of ADRB2 were elevated in DCs from allergic rhinitis patients and its stimulation revealed elevated cAMP and decreased Th2 responses, indicating that ADRB2 is the AC stimulator and its el-evation in DCs is the effect of Th2 response. Thus, the stimulation of ADRB2 in DCs of nasal epithelium could be a therapeutic strategy for allergic rhinitis.

inflammation was significantly improved and total lung resistance was maintained within normal range in IFN-λ-treated asthmatic mice. Moreover, IFN-λ2/3-treated asthmatic mice exhibited significant decrease of secreted protein levels of TSLP and IL-33 in the BAL fluid until 7 days. Conclusion: The current data show that the com-pensation of type III IFNs can restrict the secretion of epithelial-derived Th2 cytokines, accompanied with lim-iting Th2-mediated responses in allergic asthma.

» RHOP-58 16:00~16:10

» PROTECTIvE EFFECTS OF CURCUMIN ON CULTURED HUMAN NASAL FIBROBLASTS Ex-POSED TO URBAN PARTICULATE MATTER



MEDICINE, THE CATHOLIC UNIVERSITY OF

KOREA1, CLINICAL RESERACH INSTITUTE,

DAEJEON ST MARYS HOSPITAL2

DONG CHANG LEE1, HYUNSU CHOI2, JEONG-MIN OH2, SUNG WON KIM1,

SOO WHAN KIM1, BYUNG GUK KIM1, JIN HEE CHO1, JOOHYUNG LEE1,2

Objectives: Exposure to urban particulate matter (UPM) has been studied as a cause of various health problems. We investigated the effects of UPM-induced reactive oxygen species (ROS)and inflammatory cytokine production on cultured human nasal fibroblasts, as well as the protective effects of curcumin on ROS and cytokine production. Methods: Human turbinate tissue specimens were col-lected from six patients. Then the effects of UPM on the viability of cultured nasal fibroblasts were determined. A fluorescent malondialdehyde assay was used to measure ROS levels. Real-time reverse transcription polymerase chain reaction was used to measure the mRNA levels of the proinflammatory cytokines (IL-6, IL-8) before and after curcumin treatment. Results: UPM reduced cell vi-ability and increased ROS expression and proinflamma-tory cytokine production in nasal fibroblasts. Curcumin treatment decreased ROS and proinflammatory cytokine production in UPM-exposed fibroblasts Conclusion: UPM exposure resulted in increased ROS and proinflam-matory cytokine production in nasal fibroblasts. Cur-cumin treatment inhibited this increase ,suggesting that curcumin may have a protective effect against rhinitis

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by TiO2. The IL-17 Ab decreased the degree of corneal damage due to micro-sized TiO2. In addition, IL-17A+ cells and neutrophil infiltration levels of micro-sized TiO2-enhanced conjunctival tissue were significantly de-creased in OVA/Poly(I:C) mice treated with IL-17 Ab. Conclusion: These results indicate that TiO2 increases IL-17-related inflammation in the eyes and nose of the OVA/Poly(I:C) mouse model and that IL-17 Ab can alle-viate inflammation in these TiO2-OVA/Poly(I:C) mice.

» RHOP-61 16:30~16:40

» PARADOxICAL RESPONSE TO COLD DRY AIR PROvOCATION ACCORDINg TO THE SEA-SON IN ALLERgIC RHINITIS PATIENTS


HEAD AND NECK SURGERY1, INHA INSTITUTE

OF AEROSPACE MEDICINE2, INHA UNIVERSITY

COLLEGE OF MEDICINE

KI-IK PARK1, TAE YOUNG JANG1, SUNG-HOON KIM1, KI-NAM KIM1,

YOUNG HYO KIM1,2

Objectives: We tried to investigate the seasonal variation of the nasal allergic response and nonspecific hyperreac-tivity by performing nasal provocation test (NPT) and cold dry air (CDA) provocation test in both the summer and winter periods in patients with rhinitis. Methods: We performed NPT or CDA provocation test in 57 pa-tients with allergic rhinitis (AR) or non-allergic rhinitis (NAR). Depending on the season and the type of rhi-nitis, we divided the patients into four groups (Summer AR group, n=17; Winter AR group, n=15; Summer NAR group, n=18 and Winter NAR group, n=7) and compared the changes in nasal symptoms, total nasal volume (TNV), and minimal cross-sectional area (MCA) measured by acoustic rhinometry after NPT or CDA provocation in each group. Results: Compared to NAR patients, patients with AR had significantly more aggra-vation of rhinorrhea, sneezing, and itching after NPT in summer (Summer AR versus Summer NAR, p<0.05). When the CDA provocation was performed for AR pa-tients in the summer, nasal symptoms improved slightly, which was significantly different from those in the winter (Summer AR versus Winter AR, p=0.012). In addition, there was a significant difference in symptom change be-tween AR and NAR patients in the summer (Summer AR

» RHOP-60 16:20~16:30

» ExPOSURE OF PARTICULATE MATTER MAY AggRAvATE IL-17 INFLAMMATION IN THE EYE AND NOSE OF THE OvA/POLY(IC) MOUSE MODEL



CHEONAN, KOREA1, BECKMAN LASER INSTITUTE

KOREA, DANKOOK UNIVERSITY, CHEONAN,

KOREA2, DEPARTMENT OF OPHTHALMOLOGY,


CHEONAN, KOREA3, DEPARTMENT OF PHYSICS,

COLLEGE OF NATURAL SCIENCES, DANKOOK

UNIVERSITY, CHEONAN, KOREA4

JUN-SANG BAE1,2, KYONG JIN CHO3, JEONGYUN KIM4, JI HYE KIM1,2, EUN-HEE KIM1,2,

SOO BIN OH3, JI-HUN MO1,2

Objectives: In this study, IL-17/neutrophil dominant OVA/Poly(I:C) mouse model was used to evaluate the effect of two different size of Titanium dioxide (TiO2) on mucosa of the nose and eyes. In addition, we evalu-ated whether treatment of IL-17 neutralization antibody (IL-17 Ab) could reverse the effect of TiO2 on nose and eyes. Methods: For 21 days, OVA and poly(I:C) were treated in the nasal cavity and conjunctival sac to induce inflammation of nose and eyes. Micro sized TiO2 was ex-posed using a floating device for 2 hours a day for 7 days during which OVA was challenged, and nano-sized TiO2 were treated with PBS in intranasal or conjunctival sac. After OVA challenge and TiO2 exposure, IL-17 Ab was injected intraperitoneally. Not only clinical parameters and but also inflammatory parameters were evaluated. Results: Airborne exposed micro-sized TiO2 significant-ly increased nasal symptom scores, IL-17A mRNA levels and IL-17A+ cells compared to OVA/Poly(I:C) group in nasal mucosa. In addition, the neutrophil infiltration of nasal tissue was also significantly increased in the mi-cro-sized TiO2 group. Increased expression levels of IL-17A mRNA, IL-17A+ cells and neutrophil infiltration, as well as nasal symptom scores with micro-sized TiO2, were significantly reduced by IL-17 Ab. In eyes, TiO2 groups showed a significant increase in clinical symp-tom scores and increased corneal damage compared with OVA/Poly(I:C) group. Neutrophil and goblet cells as well as IL-17A+ cells in conjunctival tissue were also increased

April27(Sat)




comes with SLIT.


Chair : YONG JIN PARK, WOO SUB SHIM

Olfaction

» RHOP-63 15:50~16:00

» THE ESTABLISHMENT OF OLFACTORY-EP-ITHELIUM-DERIvED ORgANOID IN A MURINE MODEL



KOREA1,THE AIRWAY MUCUS INSTITUTE, YONSEI

UNIVERSITY COLLEGE OF MEDICINE, KOREA2,

KOREA MOUSE SENSORY PHENOTYPING CENTER,


KOREA3, MEDICAL RESEARCH CENTER, YONSEI


BO-RA KIM4, JONG-GYUN HA1, HYUNG-JU CHO1,2,3, JOO-HEON YOON1,2,3,

CHANG-HOON KIM1,2,3,4*

Objectives: We aimed to set up the method of condi-tionally cultured olfactory-epithelium-(OE)-derived or-ganoids to study several olfactory signaling at the cellular level. Methods: We isolated the cells from main OE from the mouse and it was cultured on the 3D stem cell cul-ture gel with specialized medium including appropriate factors to induce differentiation of OE-derived organoid. Immunofluorescence staining was performed with anti- olfactory neural markers (OMP, Golf, GAP43, NeuroD1, Mash1) and non-neural markers (CK14, CK18) Abs to confirm the features of OE-derived organoids. Results: The isolated cells were formed as spherical shape on the culture gel. The size of the organoid was maintained at about 100~200 μm in diameter on the 6th day culture. In immunofluorescence staining, olfactory neural and non-neural proteins were observed to be expressed at specific sites on the organoid. The OE-derived organoid seemed to be composed of olfactory sensory neuron and

versus Summer NAR, p=0.033). There was no significant difference in TNV or MCA changes after NPT/CDA provocation depending on the type of rhinitis and season (p>0.05). Conclusion: When performing CDA provoca-tion in AR patients in summer, the examiner should pay attention to the possible paradoxical response.

» RHOP-62 16:40~16:50

» PREDICTIvE FACTORS FOR SATISFACTION IN PATIENTS TREATED WITH SUBLINgUAL IMMUNOTHERAPY


HEAD AND NECK SURGERY, SEOUL

NATIONAL UNIVERSITY COLLEGE

OF MEDICINE1,DEPARTMENT OF

OTORHINOLARYNGOLOGY, PUSAN NATIONAL

UNIVERSITY YANGSAN HOSPITAL, YANGSAN2

YOONJAE SONG1, JIN YOUP KIM1, SUE JEAN MUN2, TAE-BIN WON1,

DONG-YOUNG KIM1, CHUL HEE LEE1, CHAE-SEO RHEE1, DOO HEE HAN1

Objectives: To investigate predictive parameters at base-line and during early response to sublingual immuno-therapy (SLIT) for house dust mites in allergic rhinitis patients. Methods: Participants were treated with SLIT for at least 3 years, and serological tests were performed at baseline and 1-year follow-up to investigate predictive parameters. Satisfaction with SLIT, 4 nasal symptoms, and quality of life were evaluated before and after 3 years of SLIT. Sixty-one subjects were finally enrolled and di-vided into two groups depending on their satisfaction after 3 years of SLIT: 43 were satisfied (70.5%) and 18 were not (29.5%). Results: Immunological parameters at baseline did not differ significantly between the satisfac-tory and unsatisfactory groups. However, changes in both Dermatophagoides pteronyssinus (Dp)- and D. farinae (Df)-specific IgEs were significantly higher in the unsat-isfactory group than in the satisfactory group during early response to SLIT (p = 0.006 and p = 0.045, respectively). Conclusion: Lower changes in both Dp- and Df-specific IgE levels during early response were positive indicators for favorable long-term treatment outcomes with SLIT. Evaluation of immunological parameters during early treatment period may decrease the economic and phys-ical burden in patients expected to have unfavorable out-

April27(Sat)




function (n=51, 86%)' and were subsequently analyzed, however, there were no significant difference amongst the groups in the change of taste before and after follow up. Conclusion: According to our study improvement was detected in certain parts of tastes and portion of the tongue. These findings may provide preliminary values to healthcare providers who evaluate patients presenting with complaints of taste loss.

» RHOP-65 16:10~16:20

» EFFECT OF OLFACTORY BULB ATROPHY ON MRI AND OLD AgE ON THE SUCCESS OF OLFACTORY TRAININg




MEDICINE1, DEPARTMENT OF RADIOLOGY AND

RESEARCH INSTITUTE OF RADIOLOGY, ASAN



JA YOON KU1, MIN KYOUNG LEE2, WOO RI CHOI1, HYEON-YEONG JEONG1,

JEONG HYUN LEE2, JI HEUI KIM1

Objectives: Olfactory training is an attractive treatment modality for patients with olfactory loss. This study aimed to evaluate the olfactory bulb atrophy on MRI and patients’ characteristics on the success of olfactory train-ing in the patients with olfactory loss. Methods: Thir-ty-six patients who had olfactory loss between Sep 2016 and Sep 2018 were included. All patients underwent a nasal endoscopic examination and MRI before olfactory training. Korean Version of the Sniffin’ Sticks Test was performed before and after training. Success of olfacto-ry training was defined as improvement of more than 6 points in the TDI score. Results: The etiology of olfac-tory loss was respiratory viral infection in 16 (44.4%), idiopathic in 8 (22.2%) patients, chronic rhinosinusitis with/without nasal polyps in 6 (16.7%) patients, trau-ma in 4 (11.1%), transsphenoidal surgery in one (2.8%), and Parkinson’s disease in one (2.8%). 17 of 36 patients (47.2%) exhibited successful olfactory training. 19 pa-tients who failed in olfactory training showed bilateral olfactory bulb (OB) atrophy as well as older, and lower identification and TDI scores before olfactory training (P < 0.05). Bilateral OB atrophy and old age were indepen-

surrounding cells. Conclusion: We established the olfac-tory organoid from mouse and it would be physiological-ly relevant and amenable to molecular and cell biological analyses, holding great promise in both basic research and translational applications in the field of olfaction.

» RHOP-64 16:00~16:10

» CLINICAL INvESTIgATION ON PATIENTS WITH TASTE DISORDERS A RETROSPEC-TIvE STUDY ON 59 PATIENTS (PRELIMINARY DATA)


HEAD AND NECK SURGERY, KONKUK UNIVERSITY

SCHOOL OF MEDICINE, KONKUK UNIVERSITY

MEDICAL CENTER

KYUJIN HAN, HAEMIN NOH, BO YOON CHOI, JIN KOOK KIM

Objectives: The sense of taste is one of the most im-portant human senses. Taste disorders have not received sufficient attention by otolaryngologists and only a few studies have documented the clinical characteristics of taste disorders. We therefore analyzed the characteristics of patients with taste disorders who visited our Taste and Smell Clinic over a 4-year period. Methods: This study retrospectively examined records of 81 patients with taste disorders evaluated at Konkuk Univ. department of Oto-rhinolaryngology clinic from September 2015 to Febru-ary 2019. Because patients with follow-up tests at least 2 times were included, 59 patients with taste disorder were consequently investigated. Each subject was given a questionnaire for age, sex, duration and medication etc. Then, a whole mouth taste test was performed for the chemogustometer (CGM) with successive solutions of sucrose, sodium chloride, citric acid, and quinine hy-drochloride. The electrical taste thresholds were measured using an electrogustometer (EGM) for four different sites in the oral cavity, i.e., both sides of anterior and poste-rior tongue. Additionally, KVSS-II was performed for diagnosis for olfactory dysfunction. Results: A total of 59 patients had a subjective taste complaint and results from both gustatory and olfactory function tests. Patients showed significant improvement in sweet, bitter and sour taste in the CGM and anterior tongue when measured by EGM. Also the patients were grouped by 'taste only (n=8, 14%)' and patients 'accompanied by Olfactory dys-

Withdrawal

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the OND (p = 0.001) and CU groups (p = 0.013). The sensitivity and specificity of the CCI for AD diagnosis were 81.8% and 90.0%, respectively, at the cutoff point of 3.2% (area under the receiver operating characteristic curve = 0.900, 95% confidence interval = 0.769-1.000). Our results revealed that oligomeric Aβ42 levels in nasal secretions are increased in AD dementia. Conclusion: The CCI, which reflects the level of oligomeric Aβ42 in nasal secretions, is effective in the prediction of AD.

» RHOP-67 16:30~16:40

» THE DIFFERENCE BETWEEN A MECHANISM OF OLFACTORY TRAININg AND STEROID THERAPY


HEAD AND NECK SURGERY,UIJEONGBU ST

MARYS HOSPITAL, COLLEGE OF MEDICINE, THE


OF CLINICAL LABORATORY, UIJEONGBU ST




SURGERY, ST PAUL HOSPITAL,


UNIVERSITY OF KOREA3

BOO-YOUNG KIM, JUYEON PARK, EUIJIN KIM, BYUNGGUK KIM

Objectives: Approximately 5% of the general population are considered to be anosmic, and an additional 15% are considered to be hyposmic. To date, there is no validat-ed pharmacotherapy for olfactory dysfunction, although attempts have been made to establish treatment modali-ties through trials involving systemic and topical steroids. Furthermore, repeated short-term exposure to odorants so-called olfactory training appears to be effective in im-proving olfaction. Several studies have reported the ben-efits of olfactory training for patients with olfactory dys-function. However, the difference of steroid therapy and olfactory training is not clear fundamentally. So, the aim of this study was to evaluate the different mechanism of olfactory training and steroid therapy based on scientific study. Methods: Mice in each group were administered 300 mg of 3-methylindole per kg of mouse weight. The olfactory function was evaluated by a food-finding test

dent risk factors for the failure of olfactory training in patients with olfactory loss according to the multiple re-gression analysis. Conclusion: The patients with olfacto-ry loss who had bilateral OB atrophy or old age may not be able to improve their olfactory function after olfactory training.

» RHOP-66 16:20~16:30

» AMYLOID BETA IN NASAL SECRETIONS IS A POTENTIAL BIOMARKER OF ALzHEIMERS DISEASE


HEAD AND NECK SURGERY, INHA UNIVERSITY


CHEMICAL ENGINEERING, KANGWON NATIONAL

UNIVERSITY2, DEPARTMENT OF ELECTRONIC

ENGINEERING, GACHON UNIVERSITY3,

DEPARTMENT OF PHARMACOLOGY AND

MEDICINAL TOXICOLOGY RESEARCH CENTER,

INHA UNIVERSITY SCHOOL OF MEDICINE4,

DEPARTMENT OF NEUROLOGY, HALLYM

UNIVERSITY KANGNAM SACRED HEART


MEDICINE5, DEPARTMENT OF NEUROLOGY, INHA

UNIVERSITY, SCHOOL OF MEDICINE6

YOUNG HYO KIM1, SANG-MYUNG LEE2, SUNGBO CHO3, JU-HEE KANG4,

YANG-KI MINN5, SEONG HYE CHOI622

Objectives: We investigated the level of amyloid beta (Aβ) in nasal secretions of patients with Alzheimer’s dis-ease (AD) using interdigitated microelectrode (IME) bio-sensors and then determined the predictive value of Aβ in nasal secretions for AD diagnosis. Methods: Nasal secre-tions were obtained from 11 patients with AD dementia, 5 with cognitive decline associated with other neurolog-ical disorders (OND), and 10 cognitively unimpaired (CU) participants. Capacitance changes in IMEs were measured by capturing total Aβ (ΔCtAβ). After 4-(2-hy-droxyethyl)-1- piperazinepropanesulfonic acid was inject-ed, capacitance changes due to monomeric Aβ disassem-bled from oligomeric Aβ were determined (ΔCoAβ). The capacitance change index (CCI) was calculated by divid-ing the two values (ΔCoAβ x 100 / ΔCtAβ, %). Results: The CCI was higher in the AD dementia group than in

April27(Sat)




may complain of taste disorder after surgery. Thus, we aimed to prospectively compare the objective gustatory function with subjective symptoms before and after mid-dle ear surgery. In addition, in the patients with damaged nerve, the time required for recovery of taste was investi-gated. Methods: Ninety-one patients undergoing unilat-eral middle ear surgery were asked about taste symptoms before surgery and 10 days, 3 months, and 1 year after surgery. Their objective gustatory function was evaluated with thresholds of electrogustometry (EGM) as well as taste scores of paper taste strips with 4 concentrations of 5 tastes (sweet, sour, salty, bitter, and umami tastes) on both sides of the tongue at the same time points. The patients were divided into three groups depending on the degree of manipulation of chorda tympani nerve: no touched group, touched but not sectioned group, and completely sectioned group. Results: In sectioned group, 89.4% of the patients showed threshold elevation of EGM and sig-nificantly decrease of taste scores with subjective taste loss on the operated side. In 29.4% of the hypogeusia patients improved taste symptoms in 1 year after surgery. Interest-ingly, 80% of the recovered subjects had no complaints of taste despite no improvement of EGM thresholds or taste scores, whereas 16.6% of the non-recovered sub-jects still complained of hypogeusia although objective gustatory functions were ameliorated. Furthermore, in touched group, 46.8% of the patients complained of hy-pogeusia or numbness of tongue; 60% of them improved taste symptoms within 1 year after surgery. Conclusion: Depending on the amount of manipulation of chorda tympani nerve, gustatory functions decreased after sur-gery with possibility of recovery in long-term follow up. There might also be discrepancy between taste symptoms and objective gustatory function.

once a week. The olfactory neuroepithelium was har-vested for histologic examination and protein analysis. Subsequently, data analysis, gene ontology and pathway analysis, quantitative real-timepolymerase chain reaction of mRNA, and western blot analysis were conducted. Results: Mice were divided into four groups according to treatment.Control, anosmia, training, and steroid group mice resumed food finding. Olfactory Maker Pro-tein, Olfr1507,GNAL,S100, NGFR, NGFRAP1, IL10 mRNA expression were increased in training group than steroid group significantly. CCL22, TLR7, IL1r2 mRNA expression was higher in the olfactory neuroepithelium of steroid than training group mice Conclusion: olfac-tory training improved the olfactory recovery time to stimulate olfactory nerveregeneration. Olfactory training might initially stimulate the olfactory receptor, followed by neurogenesis. Steroid therapy and olfactory training operate under completely different mechanisms based on the protein and gene study.

» RHOP-68 16:40~16:50

» A PROSPECTIvE STUDY OF OBJECTIvE AND SUBJECTIvE gUSTATORY FUNCTION AFTER MIDDLE EAR SURgERY


HEAD AND NECK SURGERY, KANGNAM SACRED

HEART HOSPITAL, HALLYM UNIVERSITY COLLEGE

OF MEDICINE, KOREA1, DEPARTMENT OF

OTORHINOLARYNGOLOGY, YONSEI UNIVERSITY

COLLEGE OF MEDICINE, KOREA2, KOREA MOUSE

SENSORY PHENOTYPING CENTER, KOREA3,

THE AIRWAY MUCUS INSTITUTE, YONSEI

UNIVERSITY COLLEGE OF MEDICINE, KOREA4,

GLOBAL RESEARCH LABORATORY FOR ALLERGIC

AIRWAY DISEASES, KOREA5, MEDICAL RESEARCH

CENTER, YONSEI UNIVERSITY

COLLEGE OF MEDICINE, KOREA6

SANG CHUL PARK1,2, JONG-GYUN HA2, JINSEI JUNG2, IN SEOK MOON2,

HYUNG-JU CHO2,3,4, JOO-HEON YOON2,3,4,5, CHANG-HOON KIM2,3,4,6

Objectives: The chorda tympani nerve can be inevita-bly damaged or sacrificed during middle ear surgery to remove the pathological lesions. Consequently, patients

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difference in TNV or MCA changes after NPT/CDA provocation depending on the type of rhinitis and season (p>0.05). Conclusion: When performing CDA provoca-tion in AR patients in summer, the examiner should pay attention to the possible paradoxical response.

Resident Paper Award Room 3-2 (Emerald B)

Chair : SEUNG HEON SHIN, JEFFREY D. SUH

Resident Paper Award

» RHOP-61 16:30~16:40

» PARADOxICAL RESPONSE TO COLD DRY AIR PROvOCATION ACCORDINg TO THE SEA-SON IN ALLERgIC RHINITIS PATIENTS


HEAD AND NECK SURGERY1, INHA INSTITUTE

OF AEROSPACE MEDICINE2, INHA UNIVERSITY

COLLEGE OF MEDICINE

KI-IK PARK1, TAE YOUNG JANG1, SUNG-HOON KIM1, KI-NAM KIM1,

YOUNG HYO KIM1,2

Objectives: We tried to investigate the seasonal variation of the nasal allergic response and nonspecific hyperreac-tivity by performing nasal provocation test (NPT) and cold dry air (CDA) provocation test in both the summer and winter periods in patients with rhinitis. Methods: We performed NPT or CDA provocation test in 57 pa-tients with allergic rhinitis (AR) or non-allergic rhinitis (NAR). Depending on the season and the type of rhi-nitis, we divided the patients into four groups (Summer AR group, n=17; Winter AR group, n=15; Summer NAR group, n=18 and Winter NAR group, n=7) and compared the changes in nasal symptoms, total nasal volume (TNV), and minimal cross-sectional area (MCA) measured by acoustic rhinometry after NPT or CDA provocation in each group. Results: Compared to NAR patients, patients with AR had significantly more aggra-vation of rhinorrhea, sneezing, and itching after NPT in summer (Summer AR versus Summer NAR, p<0.05). When the CDA provocation was performed for AR pa-tients in the summer, nasal symptoms improved slightly, which was significantly different from those in the winter (Summer AR versus Winter AR, p=0.012). In addition, there was a significant difference in symptom change be-tween AR and NAR patients in the summer (Summer AR versus Summer NAR, p=0.033). There was no significant

April27(Sat)




HNOP-3Room 4-3 (Convention C)

Chair : JOON KYOO LEE, BUM JUNG PARK

Thyroid

» HNOP-11 08:00~08:10

» gASLESS TRANSORAL ROBOTIC THYROID-ECTOMY USINg DAvINCI SP SYSTEM FEASI-BILITY, SAFETY, AND OPERATIvE TECHNIQUE


YONSEI UNVERSITY COLLEGE OF MEDICINE,

SEOUL, KOREA

YOUNG MIN PARK, DA HEE KIM, MIN SEOK KANG, JAE YOL LIM, SE-HEON KIM,

EUN CHANG CHOI, YOON WOO KOH

Objectives: Transoral robotic thyroidectomy (TORT) is an ideal method for minimally invasive thyroidecto-my, as there is less flap dissection during the procedure and no postoperative scars, but it also has some technical problems of TORT with CO2 gas insufflation system to overcome. We investigated the feasibility and safety of gasless TORT using the latest version of DaVinci system (SP). Methods: From October 2018 to January 2019, we performed 6 cases of gasless TORT using DaVinci SP at Yonsei University Hospital. Results: Six cases (mean age 49.5 years; mean tumor size 1.5±0.9 cm) underwent unilateral thyroid lobectomies. Five cases were had papil-lary thyroid carcinomas and one was benign nodules. The mean surgical time was 312±31 min; the mean hospital stay was 4.1±0.5 days. There were no reports of transient or permanent vocal cord palsy, recurrence, or mortality during the follow-up period. Temporary hypesthesia of the lower lip and the chin due to mental nerve injury was observed in 3 of 6 patients, but it was recovered within 3months in all cases. Conclusion: Gasless TORT using DaVinci SP system is feasible and safe for selected pa-tients, and can be a potential alternative approach for scarless thyroid surgery.

» HNOP-12 08:10~08:20

» INCREASED MORBIDITY OF MAJOR DE-PRESSIvE DISORDER AFTER THYROIDEC-TOMY - A NATIONWIDE POPULATION-BASED STUDY IN SOUTH KOREA

DEPARTMENT OF PSYCHIATRY, DEPRESSION

CENTER, SAMSUNG MEDICAL CENTER,

SUNGKYUNKWAN UNIVERSITY SCHOOL OF

MEDICINE, SEOUL, KOREA1, DEPARTMENT OF

PSYCHIATRY, KOREA UNIVERSITY COLLEGE

OF MEDICINE, SEOUL, KOREA2, RESEARCH

INSTITUTE FOR FUTURE MEDICINE, SAMSUNG

MEDICAL CENTER, SEOUL, KOREA3, DEPARTMENT

OF SOCIAL AND PREVENTIVE MEDICINE,


MEDICINE SEOUL, SOUTH KOREA4, DEPRESSION

CLINICAL AND RESEARCH PROGRAM,

MASSACHUSETTS GENERAL HOSPITAL,

HARVARD MEDICAL SCHOOL, BOSTON, USA5,

KOREAN PSYCHOLOGICAL AUTOPSY CENTER

(KPAC)6,DIVISION OF ENDOCRINOLOGY

AND METABOLISM, DEPARTMENT OF

MEDICINE, SAMSUNG MEDICAL CENTER,


MEDICINE, SEOUL, KOREA7, DEPARTMENT OF


SURGERY, AND HEAD AND NECK CANCER

CENTER, SAMSUNG MEDICAL CENTER,


MEDICINE, SEOUL, KOREA8, DEPARTMENT

OF HEALTH SCIENCES & TECHNOLOGY,

DEPARTMENT OF MEDICAL DEVICE MANAGEMENT

& RESEARCH, AND DEPARTMENT OF CLINICAL

RESEARCH DESIGN & EVALUATION, SAMSUNG

ADVANCED INSTITUTE FOR HEALTH SCIENCES

& TECHNOLOGY (SAIHST), SUNGKYUNKWAN

UNIVERSITY, SEOUL, KOREA9

KWAN WOO CHOI1,2, YUWON KIM3,4, MAURIZIO FAVA5, DAVID MISCHOULON5,

EUN JIN NA1,6, SUN WOOK KIM7, MYUNG-HEE SHIN4, HONG JIN JEON1,6,9,

MAN KI CHUNG8


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is now an accepted alternative to immediate surgery, but experience with this approach outside of Japan is limited. The kinetics of tumor growth under active surveillance have not been well defined. Recently, several prospective studies for active surveillance of papillary thyroid cancer were published, and this study performed a systematic re-view and meta-analysis of available literature to evaluate the association of the growth of papillary thyroid can-cer and clinical parameters. Methods: Studies reporting the active surveillance of papillary thyroid cancer were systematically reviewed by searching the MEDLINE, PubMed, and Embase databases for studies published from database inception to Jan 2019. The selected articles included clinicopathological studies conducted with at least 50 subjects and at least 1 clinical parameter, includ-ing age, gender, and initial size of tumor. Results: A total of 2,232 individuals were indentified for analysis of seri-al change of tumor size. About 19% of patients showed increase of tumor size during the 5 year follow-up. Four studies involving a total of 2,273 individuals were iden-tified for the analysis of association between incrase of tumor size and clinical parameters. Younger age was a significant risk factor with a standardized median differ-ence of 0.38 (95% confidence interval (CI), 0.18-0.58). However, there was no significant correlation between in-crease of tumor size and initial size of tumor (p=0.920). In addition, there was no significant correlation increase of tumor size and gender (p=0.630). Conclusion: Active surveillance can be carefully applied for selected patients. Although it is not contraindicated, it should be applied more cautiously for younger patients.

» HNOP-14 08:30~08:40

» THYROID SURgERY UNDER LOCAL ANES-THESIA IN SELECTED gROUP OF PATIENT MY ExPERIENCE.


ABDUL MALEK UKIL MEDICAL COLLEGE

MD I SAFIULLAH

Objectives: Objective- To find out the safely and fusibil-ity of Thyroid surgery in selected group of patient under local anesthesia. Aim of study was to share our experience in case of haeme and total thyroidactomy in ENT foun-dation hospital and different clinics of Dhaka, Bangla-desh. Methods: Materials and Methods- All the patient was admitted in the hospital clinically significant goiter

Objectives: The number of thyroidectomies in South Ko-rea has been rapidly increasing due to extensive check-ups for thyroid cancer. However, few studies have examined associations between thyroidectomy and major depressive disorder (MDD). We aimed to investigate the association between thyroidectomy and the risk of MDD. Methods: A population-based, electronic medical records database from South Korea was used to identify 187,176 individ-uals who were treated with partial or total thyroidectomy between 2009 and 2016. A self-controlled case series de-sign and Cox regression analyses were used to identify risk factors for MDD. Results: Among 187,176 individuals who underwent thyroidectomy, 11,713 (6.26%) were di-agnosed with MDD during the observation period. Of these, 2,694 (23.0%) underwent partial thyroidectomy and 9,019 (77.0%) underwent total thyroidectomy. An elevated MDD risk was found during the one-year period before thyroidectomy, with incidence rate ratios (IRRs) of 1.36 (95% CI: 1.22–1.51, p < 0.001) for subjects with partial thyroidectomy and 1.32 (95% CI: 1.25–1.40, p < 0.001) for subjects with total thyroidectomy. The IRR increased during the first 30 days after total thyroidecto-my (IRR: 1.98; 95% CI: 1.71–2.29, p < 0.001) and re-mained elevated up to 450 days after total thyroidectomy, whereas the IRR increased during the first 30 days after partial thyroidectomy (IRR: 1.75; 95% CI: 1.32–2.31, p = 0.001) but returned to baseline levels after 360 days of partial thyroidectomy. In particular, total thyroidecto-my was associated with an increased risk of MDD (HR: 1.40; 95% CI: 1.06–1.85) in male subjects older than 50 years. Conclusion: The incidence of MDD was increased in the period immediately after thyroidectomy, for about 1-2 years. Subjects aged 50 years or older might be at especially high risks for MDD after total thyroidectomy.

» HNOP-13 08:20~08:30

» SYSTEMATIC REvIEW AND META-ANALYSIS OF ACTIvE SURvEILLANCE IN PAPILLARY THYROID CANCER



UNIVERSITY BORAMAE MEDICAL CENTER, SEOUL


SEUNG-HEON KANG, SUNGJUN HAN, TACK-KYUN KWON, DOH YOUNG LEE

Objectives: Active surveillance of papillary thyroid cancer

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two patients were withdrawn due to inability to locate the EBSLN intraoperatively. Pre-operative EMG studies were normal for each patient with no abnormality of in-sertional, spontaneous and voluntary activity identified. Of the patients studied no post-operative EMG abnor-mality was detected. Vibration, symmetry and vocal cord symmetry, closure, vibration and arytenoids position were normal on pre-operative videostroboscopy and no abnormality was identified following surgery. Results of the patient questionnaire showed a significant self-report-ed post-operative voice impairment. Conclusion: Our study demonstrated preservation of the electrophysiolog-ical and vocal cord function of the EBSLN post thyroid-ectomy. However, patient questionnaires demonstrate significant voice impairment post-operatively. This dis-parity of clinical and patient experience requires further investigation with larger prospective studies.

» HNOP-16 08:50~09:00

» INTRAOPERATIvE NEUROMONITORINg OF RECURRENT LARYNgEAL NERvE DURINg THYROIDECTOMY USINg ADHESIvE SKIN ELECTRODES



MEDICINE, BUSAN, SOUTH KOREA

HYOUNG SHIN LEE, JUNGHO OH, SUNG WON KIM, KANG DAE LEE

Objectives: Recording site error of Intraoperative neuro-monitoring (IONM) with malposition or displacement of the electromyogram (EMG) tube has been a barrier for the surgeons due to false positive outcomes. In this study, we used skin adhesive electrodes for IONM of recurrent laryngeal nerve (RLN) in patients who underwent thy-roidectomy and sought to evaluate the feasibility and ac-curacy of the monitoring technique. Methods: A total of 39 nerves at risk were prospectively enrolled in this study. The patients included 24 female and 6 male patients with a median age of 50 years. Twenty two patients with pap-illary thyroid carcinoma (PTC), 5 patients with follicular neoplasm, and 2 patients with Graves’ disease underwent thyroidectomy and one patient with parathyroid adeno-ma underwent parathyroidectomy. All patients were intu-bated with EMG tube (Medtronic Xomed, Jacksonville, FL, USA). Two disposable pre-gelled surface electrodes (DSE3125, Medtronic Xomed, Jacksonville, FL, USA)

selected for surgical treatment (2%) xylocane with adren-aline was used for infiltration anesthesia. Before the oper-ation patient had received 1 mg per kg body weight intra-venous pathedin slowly Diazepam 5mg iv. In case of need in selected group of patient iv ketorlac sometimes need. Results: Haeme thyroidactomy performs 42 patient and total thyroidactomy performs in 4 patient. There was no remarkable complication (Intra and post operative) Except 3 case (three patient postoperative scar two case Reactionary Haemorrhage. Mean duration of procedure about 90 minutes. Mean medical follow up was three days. all the patient were good general condition on the day of discharge from the hospital. Conclusion: Con-clusion- Surgery for thyroid swelling in selected group of patient may be alternative where General Anesthesia is not available and in patients contra indicated for medical reason.

» HNOP-15 08:40~08:50

» PERI-OPERATIvE FUNCTION OF THE Ex-TERNAL BRANCH OF THE SUPERIOR LA-RYNgEAL NERvE A PROSPECTIvE COHORT STUDY

DEP. ENDOCRINE SURGERY, MONASH HEALTH

FIONA PAVAN, CHERE MCCAMLEY, MALCOLM BAXTER, JANAKA SENVIRATNE,

DAVID MERENSTEIN

Objectives: Intraoperative iatrogenic nerve damage to the external branch of the superior laryngeal nerve (EB-SLN) is a recognised complication of thyroid surgery. In-jury may result in reduced voice projection, fatigue and failure to produce high-pitch phonation. The purpose of this study was to describe the effect of thyroid surgery on the function of the external branch of the superior laryn-geal nerve. A secondary aim was to assess the feasibility of a future randomised control trial. Methods: This cohort study prospectively studied the function of the EBLSN pre-operatively, intraoperatively and post-operatively for patients undergoing elective thyroid surgery at a tertiary public hospital between 2015 to 2017. EBSLN function was assessed by pre and post-operative electromyogra-phy (EMG), vocal cord movements (Videostroboscopy) and patient reported questionnaire (VoiSS). Intraopera-tively, anatomical location of the nerve and nerve mon-itoring was recorded. Results: A cohort of ten patients was included. Two patients were lost to follow-up and


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cells were investigated using RNA seq, cell viability assay, OCR/ECAR measurements and western blot analysis. The distinctive cellular and mitochondrial dysfunctions of two human thyroid cancer cell lines with BRAF muta-tion (BCPAP and 8505C) from human thyroid normal cell line (Nthy-ori3-1) were also studied by NTP treat-ment. Results: The cell number of thyroid cancer cells has been significantly reduced more than that of the thyroid normal cells. Transcriptomics analysis in thyroid cancer cells revealed the upregulation of mitochondrial stress re-sponse signaling and mitochondrial stress induced tran-scription factor after NTP therapy. Interestingly, NTP reduced mitochondrial function in thyroid cancer cells and increased the expression of EGR1, which was known as the tumor suppressor gene. Conclusion: These results suggest that NTP could be a potential therapy targeting mitochondrial stress response and mitochondrial func-tion for the treatment of thyroid cancer.

» HNOP-18 09:10~09:20

» FEASIBILITY AND EFFICACY OF INTRAOP-ERATIvE NEURAL MONITORINg USINg SUB-DERMAL NEEDLE ELECTRODE IN THYROID-ECTOMY



COLLEGE OF MEDICINE

SEON MIN JUNG1, DONG HWAN KIM2, KYUNG RAE KIM3, CHANG MYEON SONG4,

YONG BAE JI5, KYUNG TAE6

Objectives: All thyroid surgeon cannot be free from Re-current laryngeal nerve(RLN) palsy. Intraoperative neu-romonitoring(IONM) can be helpful in identification and confirm the integrity of the RLN. However, surface electrode around the endotracheal tube(ET) has some limitations. So, we performed this study to evaluate the efficacy of electromyography(EMG) recording system us-ing subdermal needle electrode through thyroid cartilage. Methods: We collected EMG data from IONM from 54 nerve at risk(NAR) in 38 patients during thyroid surgery. EMG reinforced ET was used for general anesthesia in all patients. After pyramidal lobe dissection, a pair of sub-dermal needle electrode was inserted through thyroid alar cartilage. EMG signal from both ET and thyroid carti-lage(TC) electrode were recorded simultaneously. We

sized 1.5 cm x 2.0 cm x 2.5 cm were attached to skin at both upper margins of thyroid cartilage. We followed the standard procedure of IONM from V1-R1-R2-V2 and the latency (msec) and amplitude (μV) of each signals were recorded prospectively. Results: Intraoperative neu-romonitoring using skin adhesive electrodes was success-ful in all nerves at risk. There were no complications or delay of surgery due to the application of skin adhesive electrodes or the IONM procedure. Amplitudes of the signals in IONM were significantly lower compared to those from EMG tube at each step of IONM, while no significant difference was identified in latency between two methods. Four nerves at risk (10.3%) showed loss of signal (< 100 μV) during the steps of IONM from EMG tube, while all nerves at risk from skin adhesive electrodes showed acceptable biphasic EMG signal. Conclusion: Adhesive skin electrodes may be applied to IONM during thyroidectomy as a reliable recording method.

» HNOP-17 09:00~09:10

» THE SPECIFIC CELL DEATH OF HUMAN THY-ROID CANCER BY NON-THERMAL PLASMA THROUgH MITOCHONDRIAL DYSFUNCTION


AND NECK SURGERY, RESEARCH INSTITUTE

FOR MEDICAL SCIENCE, CHUNGNAM NATIONAL

UNIVERSITY, COLLEGE OF MEDICINE,

DAEJEON, REPUBLIC OF KOREA1, DIVISION

OF ENDOCRINOLOGY AND METABOLISM,

DEPARTMENT OF INTERNAL MEDICINE,

CHUNGNAM NATIONAL UNIVERSITY, COLLEGE OF

MEDICINE, DAEJEON, REPUBLIC OF KOREA2

HO-RYUN WON1, YEA EUN KANG2, JAE WON CHANG1, MI AE LIM1,

SEUNG-NAM JUNG1, CHAN OH1, MINHO SHONG2, BON SEOK KOO1

Objectives: Non-thermal plasma (NTP) is generated by ionization of neutral gas molecules, which has led to its application in the treatment of various diseases, in-cluding cancer. However, the molecular mechanisms of NTP-induced cancer cell death are unclear. The purpose of this study was to evaluate the molecular mechanism of NTP in the regulation of tumor cell viability in thyroid cancer. Methods: The effects of NTP on thyroid cancer

April27(Sat)




mor progression, prognosis and assisting in targeted ther-apy. Various saliva-based biomarkers for diagnosis and therapeutic strategy of head and neck carcinoma (HNC) have been proposed. However, there has been little prog-ress in understanding saliva ctDNA biology in detail. In this proof-of- concept study, to determine that ctDNA in saliva has a role as a biomarker for HNC, we assessed ctDNA in saliva, as well as plasma, within orthotopic mouse model of metastatic HNC. Methods: To establish an animal model reflecting human metastatic HNC, we used athymic nude mouse and FaDu cell. We developed the cervical lymph node metastasis after tongue cancer resection in mouse model. We collected blood and saliva at each time point of baseline, 3, 7, 14 days post-tumor cell injection, post-operation, and metastasis establish-ment. We performed qPCR for quantifying human or-igin DNA in samples to assess the amount of ctDNA in saliva and plasma. Results: We developed an orthotopic HNC mouse model, in which nodal metastasis occurred within 18-76 days after surgical resection of the primary cancer. The amount of saliva ctDNA was associated with presence and size of tumor. As the cancer develops, the saliva ctDNA was increased and detected earlier than the plasma ctDNA. We found that concentration of saliva ctDNA and plasma ctDNA increased with disease pro-gression and decreased after surgery. A marked, transient spike in tumor origin DNA in saliva and plasma occurred immediately after cancer removal. The presence of nodal metastasis in the mouse was more related to ctDNA in plasma than saliva ctDNA. Conclusion: In our meta-static HNC mouse model, we could assess saliva ctDNA which reflects the tumor burden and metastasis. It allows for future studies focused on elucidating mechanisms of saliva ctDNA and establishing the salivary biomarker.

» HNOP-20 08:10~08:20

» PERIOSTIN ExPRESSION IN TONgUE CAN-CER ANALYSIS OF THE EFFECT ON RECUR-RENCE AND SURvIvAL


HEAD AND NECK SURGERY, GYEONGSANG



SURGERY, GYEONGSANG NATIONAL UNIVERSITY

CHANGWON HOSPITAL2

SEONGJUN WON1, JIN PYEONG KIM2, SEONG CHUL YEO1, JUNG-JE PARK1

compared characteristics of EMG signal and performance from both methods. Results: The mean EMG amplitudes from TC electrodes were significantly higher than ET elec-trode in all 4-step procedures (V1-R1-R2-V2)(p<0.001). EMG amplitude of V1>500μV could be achieved in 19 NAR of ET electrode and 47 NAR(p<0.001) of TC electrode. Loss of signal(LOS) occurred in 5 NAR using ET electrodes, but only 2 NAR showed LOS in TC elec-trode. The other 1 NAR showed significant decrease of TC EMG amplitude and 2 NAR did not show significant decrease of EMG amplitude. Postoperative laryngoscopy revealed that 2 NAR that showed LOS in both ET and TC electrode have RLN palsy but intact vocal cord move-ment in the other 3 NAR. So, sensitivity, specificity were 100%, 94% with ET electrode and 100% in all with TC electrode. 2 NAR showed significant decrease of EMG amplitude (>50%) from R1 in ET electrode but not in TC electrode. Conclusion: EMG recording method us-ing TC needle electrode is feasible, which enables higher amplitude of EMG. Moreover, stable amplitude of EMG could be obtained through TC needle electrode regard-less of position. It can be more accurate method than ET electrode to verify RLN integrity during thyroid surgery.

HNOP-4Room 2-3 (White Heron)

Chair : JUNG JE PARK, JONG LYEL ROH

Basic

» HNOP-19 08:00~08:10

» ASSESSMENT OF CIRCULATINg TUMOR DNA IN SALIvA IN METASTATIC HEAD AND NECK CANCER MOUSE MODEL



MEDICINE, KYUNG HEE UNIVERSITY1

YOUNG CHAN LEE1, YOU JIN YOON1, YOUNG-GYU EUN1

Objectives: Many studies suggested that detection and analysis of circulating tumor DNA (ctDNA) are capable of facilitating early-stage detection or determining the tu-


April27(Sat)



were investigated Knowing the effect of giving a carbo-platin chemotherapy regimen for 6 times chemotherapy (serial chemotherapy) on hearing function in patients with head and neck regional carcinoma. Methods: Thir-ty- NPC patients was treated with carboplatin chemo-therapy from 2015 to 2017 were analyzed. All patients received neoadjuvant, concurrent, or adjuvant use of car-boplatin. Pure tone audiometry and Distorsion Product of Otoacustic emission (DPOAE) was performed during the follow-up period with a median time of 36 months, ranging from 24 to 36 months. Correlation of SNHL at frequencies (pure tone average, 0.5-8 kHz) with a series of factors was analyzed. Results: Among 60 ears, 12.7% had low-frequency SNHL and 42.2% had high- frequen-cy (4-8 kHz) SNHL. Based on bivariate statistical analy-sis there was a significant relationship between the mean dose and the decrease in the hearing threshold. p = 0.00 (<0.01). Kidney clearance (CCT) and decreased hearing threshold have a significant relationship p = 0.00 <0.01. Age of respondents with a decrease in hearing threshold did not have a significant relationship p = 0.081 (> 0.01). Conclusion: For NPC patients treated with carboplatin chemotherapy, There was an effect of the administration of carboplatin chemotherapy regimen for 6 series che-motherapy (1 cycle) on hearing function in patients with head and neck regional.

» HNOP-22 08:30~08:40

» NOREPINEPHRINE-INDUCED CELL PROLIF-ERATION vIA Β2-ADRENERgIC RECEPTOR ACTIvATION IS INHIBITED BY Β-BLOCKER IN HEAD AND NECK CANCER


HEAD AND NECK SURGERY, BUNDANG

CHA MEDICAL CENTER, CHA UNIVERSITY1, 1DEPARTMENT OF OTORHINOLARYNGOLOGY-



MIN-SU KIM1, SOON YOUNG KWON2

Objectives: Some studies have shown that neurotransmit-ters are involved in the regulation of cancer cell invasion via Β2-adrenergic receptors. However, little is known re-garding the effect of neurotransmitters on head and neck cancer cells. The aim of this study was to examine the regulative effect of norepinephrine, which belongs to the

Objectives: The purpose of this study is to investigate the effect of periostin expression of cancer tissue on the survival of patients with oral tongue cancer. Methods: Tissues from a total of 97 patients with stage I-IV tongue cancer who have been diagnosed and underwent surgery with/without radiation and/or chemotherapy at Gyeo-ngsang National University Hospital from Jan 2001 to Dec 2010 were included. Medical records were reviewed for each patient including gender, age, tumor size, TNM staging, histopathologic result of primary tumor speci-mens, treatment modality, recurrence, and survival. Immunohistochemical analysis using monoclonal anti-bodywas carried out on all tissue samples. The correlation between data of patients and their periostin expression were analyzed using the paired t-test and χ2-test. Uni-variate and multivariate analyses with calculated hazard ratios (HRs) and 95% confidence intervals (CIs) were performed using Cox’s proportional hazards regression model.Kaplan–Meier method were used to show the dis-ease-free survival (DFS) and overall survival (OS), and these were compared using the log-rank test. Results: Patients with positive periostin expression had a signifi-cantly poorer prognosis for disease-free survival(p=0.035) than those with negative periostin expression. Although not statistically significant, similar results that periostin positive patients had poorer prognosis were found in overall survival.(p=0.056) The risk factors associated with recurrence were T status, cervical lymph node metastasis, advanced stage, and periostin positive. The risk factors associated with death were similar. Conclusion: In this study, we find that periostin expression on cancer tissue is associated with poor prognosis in oral tongue cancer.

» HNOP-21 08:20~08:30

» THE EFFECT OF CARBOPLATIN CHEMO-THERAPY REgULATION AgAINST HEARINg FUNCTIONS OF PATIENTS CARCINOMA HEAD AND NECK REgION

DEP. OF OTORHINOLARYNGOLOGY HEAD AND

NECK SURGEON FACULTY MEDICINE

SRIWIJAYA UNIVERSITY

ITA WAHYUNI

Objectives: The incidence of hearing loss after treatment with carboplatin- based chemotherapy in nasopharyngeal carcinoma (NPC) patients was evaluated, and relation-ships of loss with host factors, treatment- related factors

April27(Sat)




YOU-SOO PARK2, CHAE-SEO RHEE3

Objectives: To evaluate the efficacy of the combined treatment of anti-PD-1 Ab and dendritic cell immuno-therapy induced by radiation in head and neck cancer through animal experiments; not only primary tumor growth inhibition but also distant tumor growth in-hibition through the enhancement of abscopal effect. Methods: SCC7 cells were innoculated at 5~6 week-old mice; primary at thigh, distant at flanks. Six groups were divided; control, aPD-1, RT, aPD-1+RT, RT/iDC, aPD-1+RT/iDC. Intraperitoneal injection of antiPD-1 Ab and peritumoral injection of iDC were performed 24 hours after radiation. This treatment was repeated twice once a week. Immunologic parameters, tumor size and survival were analyzed. Results: IR upregulates PD-L1 expres-sion in SCC7 tumor cells and immature dendritic cells strongly express PD-L1. PD-1 blockade enhances the systemic antitumor effect of IR-based immunotherapy in a mouse model of head and neck cancer. PD-1 blockade significantly increases the effector T cells induced by IR/iDC but decreases the regulatory T cells. PD-1 blockade strongly increases the frequency of antigen-specific IFN-γ secreting T cells induced by IR/iDC. PD-1 blockade en-hances cytotoxic activity of IR-based immunotherapy against SCC7 tumor cells. Conclusion: Anti-PD-1 Ab improved the treatment efficacy of dendritic cell immu-notherapy induced by radiation in mouse head and neck cancer model. Distant tumor growth was also inhibited by enhancement of abscopal effect of radiation.

» HNOP-24 08:50~09:00

» ANTI-METASTATIC EFFECTS OF FUCOxAN-THIN IN HUMAN HEAD AND NECK CANCER CELLS


DONGNAM INSTITUTE OF RADIOLOGICAL &

MEDICAL SCIENCES

HEE YOUNG SON

Objectives: Fucoxanthin, an algae extract, among the various characteristics related to cancer treatment, the mechanism of inhibiting cancer metastasis and the com-bined use of anticancer drugs are examined and applied to an animal model of human head and neck cancer. Methods: The cytotoxicity and tumor suppression assay

group of classical neurotransmitters, on the proliferation of head and neck cancer cells and the therapeutic effect of the Β-blocker, propranolol, on them. Methods: Total 7 head and neck cancer cell lines (YD-9, 10, 38, SNU-46, 1041, 1066, 1076, and RPMI 2650) were selected for this study. Β2-adrenergic receptor expression was determined by RT-PCR and immunohistochemistry in head and neck cancer cell lines and specimens. Cell viability and proliferation assays were examined by use of b-adrenergic receptors agonists (norepinephrine) and antagonists (pro-pranolol). The viability of head and neck cancer cells was examined using the EZ-Cytox assay. The proliferation of head and neck cancer cells was examined using the BrdU assay. Results: Β2-adrenergic receptor was expressed on all head and neck cancer cell lines and specimens includ-ing oral, larynx, pharynx, and nasal cavity cancer. The viability of head and neck cancer cells pretreated with norepinephrine increased in a concentration-dependent manner. Propranolol reduced the viability of head and neck cancer cells of norepinephrine-stimulated. The pro-liferation of head and neck cancer cells pretreated with norepinephrine increased in a concentration-dependent manner. Propranolol reduced the proliferation of head and neck cancer cells of norepinephrine-stimulated. Conclusion: In conclusion, the proliferation of head and neck cancer is influenced by norepinephrine, which is one of the signal substances present in the tumor envi-ronment. This study also provides experimental evidence for the use of Β-blocker in the chemoprevention of head and neck cancer proliferation.

» HNOP-23 08:40~08:50

» THE ENHANCED EFFICACY OF PD-1 BLOCK-ADE COMBINED WITH IRRADIATION-BASED IMMUNOTHERAPY IN MOUSE HEAD AND NECK CANCER


HEAD AND NECK, DONGNAM INSTITUTE

OF RADIOLOGICAL & MEDICAL SCIENCES1,

DEPARTMENT OF RESEARCH CENTER,

DONGNAM INSTITUTE OF RADIOLOGICAL

& MEDICAL SCIENCES2, DEPARTMENT OF

OTORHINOLARYNGOLOGY-HEAD AND

NECK,SEOUL NATIONAL UNIVERSITY3

SOO-YOUN AN1, CHEOL-HUN SON2, HONG-RAE LEE2, EUN-KYOUNG KOH2,


April27(Sat)



SCHOOL OF MEDICINE

SUN WOO KIM, HYE SOO KIM, WOO JOO NAM, SUNG MIN JIN, SANG HYUK LEE

Objectives: Transoral laser microsurgery (TLM) is min-imally invasive and has become the standard approach for early and intermediate stage laryngeal cancers. Many studies show that the oncologic results of TLM are equiv-alent to those obtained by conventional conservative sur-gery and radiotherapy. The purposes of this study were to analyze, treatment outcome and predictors of local re-currence in glottic cancer patients who underwent TLM at the Kangbuk Samsung hospital. Methods: 65 patients who received TLM for glottis cancer between 2004 and 2018, were analyzed retrospectively. Patients were pre-dominantly male (98%), with a median age of 65 years (range 47 to 87 years). The types of TLM included 2 type I (3%), 11 type II (17%), 26 type III (40%), 9 type IV (13.8%), 17 type V (26.1%). The local recurrence rate was calculated with Fisher’s exact test and survival rate was calculated with Kaplan-Meier curve analysis. Addi-tionally, the logistic regression analysis was used for mul-tivariate analysis. Results: TLM alone was performed in 59 patients (90.7%) and TLM followed by adjuvant radiotherapy (RT) was done in 6 patients(9.3%). In Univariate analysis, significant factor of local recurrence were difficult laryngeal exposure, anterior commissure invasion, positive lymphovascular invasion and positive resection margin (P-value<0.05). In multivariate analy-sis, independent factor of local recurrence were anterior commissure invasion and positive resection margin. The 5-year overall survival, and disease-specific survival rates were 93.8%, and 97.3%, respectively. No major or le-thal complications were observed. Conclusion: TLM is a reliable modality to treat early and select cases of mod-erately advanced glottic cancer. Our study found that independent factors of local recurrence included anteri-or commissure invasion and positive resection margin. These findings may be useful to follow-up glottic cancer patients after TLM.

» HNOP-26 09:10~09:20

» LONg TERM OUTCOME OF SEvERE LATE DYSPHAgIA AFTER RADIATION FOR LARYNx/HYPOPHARYNx CANCER WITH OR WITHOUT SURgICAL TREATMENT


of the drug according to the treatment concentration of fucoxanthin using human squamous cell carcinoma (head & neck cancer) cell line (SNU 1076) was applied to an-imal models of nude mice. We compared the inhibitory effect of fucoxanthin on the inhibition of cisplatin treat-ment, which is the most commonly used anticancer drug for head and neck cancer, in cell and animal models. To establish lung metastasis model of head and neck cancer. Results: The viability of the human head and neck can-cer cell line (SNU1076, laryngeal cancer) was confirmed. There was a significant difference between migration and invasion according to the treatment and concentration of Fucoxanthin in vitro. The higher the concentration of fu-coxanthin, the less migration and invasion were observed. Cancer cells were injected into the thigh of BALB / C in immunosuppressed mice to construct a cancer mod-el. We investigated the size and tissue changes of cancer according to the presence of fucoxanthin and anticancer drugs. There was no statistically significant difference, but the cancer lesion size was relatively small in the combined treatment group. NSG mice were used to create a model of lung metastasis. Tail vein injection method was used, and the fucoxanthin and anticancer combination group showed a passive growth with a slightly smaller metastat-ic cancer lesion. Conclusion: Fucoxanthin induces a de-crease in MMP expression and EMT in head and neck cancer cells, thereby confirming the effect of inhibiting metastasis of head and neck cancer.


Chair : YOUNG HOON JOO, JEONG SOO WOO

Laryngohypopharyngeal Cancer

» HNOP-25 09:00~09:10

» ONCOLOgIC OUTCOME AND PREDICTOR OF LOCAL RECURRENCE IN PATIENTS WITH gLOTTIC CANCER TREATED WITH TRAN-SORAL LASER MICROSURgERY 15 YEARS ExPERIENCE IN A SINgLE INSTITUTION




April27(Sat)





ASAN MEDICAL CENTER

YEONJOO CHOI1, JONG-LYEL ROH1, KYUNG-JA CHO2, SEUNG-HO CHOI1,

SOON YUHL NAM1, SANG YOON KIM1

Objectives: Metastatic nodal burden becomes recognized as one of most important prognosticators in human solid cancers, which has been rarely examined in larynx and hypopharynx cancers (LHC). Therefore, we evaluated nodal factors for recurrence and survival in LHC patients with primary surgery. Methods: This study included 141 consecutive patients who underwent primary tumor ex-tirpation and neck dissection for previously untreated LHC, squamous cell carcinoma, at our tertiary referral center. Nodal factors included the presence of patholog-ical lymph node (LN) metastasis, number of metastatic LNs, LN ratio, and extranodal extension (ENE). Univar-iate and multivariate Cox proportional hazard regression analyses were used to define significant factors predictive of post-treatment disease-free survival (DFS) and over-all survival (OS). Results: Of 141 study patients, 75 (53.2%) had positive LNs and 27 (19.1%) had ENE. In multivariate analyses, the number of positive LNs and LN ratio were strongly associated with DFS and OS (P <0.001). Nodal classifications (AJCC 7th ed.) and ENE were also associated with poor DFS and OS outcomes (P <0.001). However, the c-index were higher in the num-ber of positive LNs and LN ratio than nodal classification or ENE. The number of positive LNs ≥ 4 and LN ratio ≥ 0.2 were associated with two-fold more increased overall mortality than the counterparts. Conclusion: Metastatic nodal burden, such as the number of positive LNs and LN ratio, may be considered as the important factor pre-dictive of recurrence and survival in the LHC patients.

» HNOP-28 09:30~09:40

» APPLICATION OF ROBOTIC SURgERY IN LA-RYNgEAL CANCER




GEUN-JEON KIM, DONG HYUN LEE, SANG YEON KIM, MIN-SIK KIM



HOSPITAL1

GENE HUH1, JUN-GIRL SUK1, WON SHIK KIM1, SEONG KEUN KWON1, SOON-HYUN AHN1

Objectives: To evaluate the long term occurrence of severe dysphagia after radiation therapy of hypophar-ynx and larynx cancer, and further compare the out-come of non-surgical treatment with surgical treatment. Methods: Patients diagnosed with hypopharynx or lar-ynx cancer (stage III-IVB) who had undergone radiation therapy at Seoul National University Hospital from Au-gust 1997 through September 2017 were enrolled. The patient profile, diagnosis, treatment modality (radiation dose, surgery, chemotherapy regimen etc.), outcome and dysphagia event were retrospectively analyzed. Results: Out of 225 patients reviewed, 54 patients were includ-ed in the present study. Out of 54 patients (median age, 62.6 years; range, 42.8 – 76.9 years), 16 (29.6%) were confirmed as stage III and 29 (53.8%) were confirmed as stage IV larynx/hypopharynx cancer. Severe late dys-phagia (SLD) occurred in 15 patients, and 9 in those had gone through surgical treatment and the other 6 patients conducted non-surgical treatment. Although the portion of patients whom experienced SLD are higher in surgical treatment compared to non-surgical treatment (37.5% vs 20%), surgical treatment is not in statistically-significant association with outcome of SLD (p=0.154). Smoking (p=0.042), advanced cancer of stage IV (p=0.019) and treatment without neck dissection (p=0.012) were sig-nificantly associated with increased SLD. Sex, age, subsite of tumor, TN staging, radiation dose and chemotherapy does not affect the occurrence of SLD. Conclusion: SLD may occur more after treatment of advance staged larynx/hypopharynx cancer, and to patients with heavier smok-ing history. Non-surgical treatment may have less effect on long term prognosis of dysphagia.

» HNOP-27 09:20~09:30

» NODAL FACTORS PREDICTIvE OF RECUR-RENCE AND SURvIvAL IN PATIENTS UNDER-gOINg PRIMARY SURgERY FOR LARYNx AND HYPOPHARYNx CANCER


HEAD AND NECK SURGERY1 AND PATHOLOGY2,


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experiences on successful application of the thyroid gland transpositional flap (TGTF) for the reconstruction fol-lowing partial or total laryngectomy and to highlight the utility of TGTF for pharyngeal reinforcemet in pre-viously irradiated laryngopharynx. Methods: A single institution database was reviewed to identify patients undergoing partial or total laryngectomy with TGTF from September 2017 to January 2019. Unilateral or bi-lateral hemithyroid gland flap which is pedicled by the superior thyroidal artery and vein was transpositioned into the pharyngeal suture-site, pexy-site or surgical de-fect after laryngectomy Results: In this study, 7 patients underwent salvage laryngectomy after definite radiation therapy or concurrent chemoradiation therapy ; 3 total laryngectomy (TL), 2 supracricoid partial laryngectomy (SCPL), and 2 vertical hemilayrngectomy (VHL). TGTF were used for pharyngeal suture-site reinforcement for TL to prevent pharyngeal fistula; cricohyoid pexy-site reinforcement for SCPL; neoglottis reconstruction for VHL. None of the TL patients developed pharyngocu-taneous fistula, and they started oral intake within 7 days after surgery. There was no pexy-disruption or separation in SCPL patients. Enough volume was maintained for the complete glottal closure on phonation in VHL pa-tients. Conclusion: The thyroid gland transpositional flap is easy to develop and it is useful for the reinforce-ment of pharyngeal suture site, crico-hyoid pexy site, or neoglottis reconstruction during salvage laryngectomy after radiation failure.`

» HNOP-30 09:50~10:00

» COMPARISON OF THE ONCOLOgICAL AND FUNCTIONAL OUTCOMES FOLLOWINg THE PRIMARY AND THE SALvAgE SUPRACRICOID PARTIAL LARYNgECTOMY





HOKYUNG JIN, WOORI PARK, NAYEON CHOI, YOUNG-IK SON

Objectives: Supracricoid partial laryngectomy (SCPL) is known as a reliable surgical option for the selected cases of laryngeal cancer. However, in patients who had radiation therapy previously, hospital courses are often

Objectives: Transoral robotic surgery (TORS) using the da Vinci system is described as a minimally inva-sive surgery for laryngeal cancer. We applied TORS to different subsites of the larynx. The aim of this study is to demonstrate our technique and analyzed surgical re-sults. Methods: Patients who underwent robotic surgery for laryngeal cancer from 2010 to 2018. We had applied robot assisted supraglottic partial laryngectomy(SGL) on nineteen supraglottic cancer patients and total laryngec-tomy(TL) on four patients(Two of them were advanced laryngeal cancer and the others were advanced thyroid cancer involving the larynx). The one patient applied robot assisted supracricoid partial laryngectomy(SCPL) on transglottic cancer. Results: In the nineteen SGL pa-tients, the mean hospitalization period was 31.8days. The mean oral diet start time and decannulation time were 19.4 days and 44.8 days. Two patients underwent total laryngectomy with recurrence at the primary site and distant metastasis was in 3 patients. Among the four TL patients, three patients were discharged within 20 days with normal diet. One of the patients who underwent a TL was not well-controlled pharyngocutaneous fistu-la due to systemic disease (chronic myeloid leukemia). All patients were in NED(no evidence of disease) state after surgery without further treatment modality. One patient who had SCLP was able to overnight-plugging after 15days, and regular diet was possible after 20days. Also, he was in NED state now. Conclusion: The robot assisted operation can be with smaller scar and surgical morbidity than the open total laryngectomy, it can be sig-nificant, particularly in those patients undergoing salvage surgery. In this sense, robots can be applied any-subsites successfully, and nowadays, it is possible to apply robots in SCPL, such as total laryngectomy.

» HNOP-29 09:40~09:50

» CLINICAL USEFULLNESS OF THE THYROID gLAND TRANSPOSITIONAL FLAP FOR SAL-vAgE LARYNgECTOMY AFTER RADIATION FAILURE





HEEJUNG KIM, WOORI PARK, YOUNG-IK SON

Objectives: The aim of the study was to report recent

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tial treatment modalities (CCRT, CTx vs. Surgery, RTx). Methods: The study was retrospectively reviewed the medical records of consecutive patients who were histo-logically confirmed hypopharyngeal cancer at Asan Med-ical Center from January 2012 to December 2013. The study was retrospectively reviewed the medical records of consecutive patients who were histologically confirmed hypopharyngeal cancer at Asan Medical Center from January 2012 to December 2013. Total 38 patients with hypopharyngeal cancer were analyzed. Piriform sinus was predominant subsite of hypopharygeal cancer (31 cases), and 7 cases were dominant in non-piriform sinus (lateral and posterior hypopharyngeal walls, postcricoid region). Survival of the each groups by initial treatment was com-pared using Kaplan-Meier survival analysis. Risk fac-tors were analyzed by Cox proportional hazards model. Results: Kaplan-Meier survival analysis and Cox propor-tional hazards model were applied in each group (priform sinus vs. non-priform sinus). In priform sinus dominant hypopharyngeal cancer, there was no significant difference in survival rates between the two initial treatment modal-ities (P=0.765) (by Kaplan-Meier survival analysis). Vari-ables such as age, sex, initial treatment were analyzed and there was no significant variables (P=0.0.974) (by Cox proportional hazards model). In non-priform sinus hypo-pharyngeal cancer, there was also no significant difference in survival rates between the two initial treatment mo-dalities (P=0.0.433) (by Kaplan-Meier survival analysis). Variables such as age, sex, initial treatment were analyzed and there was no significant variables (P=0.0.650) (by Cox proportional hazards model). Conclusion: In hypo-pharyngeal cancer, the subsite of cancer and initial treat-ment modalities (CCRT, CTx vs. Surgery, RTx) did not change the survival of patients

» HNOP-32 10:10~10:20

» FACTORS PREDICTIvE OF FEEDINg TUBE DEPENDENCY IN PATIENTS WITH TREAT-MENT FOR LARYNgOPHARYNgEAL CARCI-NOMA

DEPARTMENTS OF OTOLARYNGOLOGY1,

RADIATION ONCOLOGY2, AND INTERNAL

MEDICINE (ONCOLOGY)3, ASAN MEDICAL CENTER,


SEOUL, REPUBLIC OF KOREA, DEPARTMENT OF

OTOLARYNGOLOGY, KING FAISAL SPECIALIST

HOSPITAL AND RESEARCH CENTRE, RIYADH,

more complicated and unpredictable. This study aimed to compare the oncological and functional outcomes between the primary and the salvage SCPL after radia-tion failure. Methods: Medical records of the authors’ institution were reviewed to collect the cases of primary or salvage SCPL. Total 76 patients were enrolled in this study; 41 patients of primary SCPL and 35 of salvage SCPL. Oncological outcomes including overall survival (OS) and recurrence free survival (RFS) were compared between the two groups. Postoperative complications, hospital days, and time to per oral diet were compared. Risk factors of postoperative complication were evaluat-ed. Results: Oncological outcomes (OS and RFS) and functional outcomes (time to oral diet and hopital days) were not different between the two groups. Twenty-one patients (27.6%) experienced postoperative complica-tions; 7 patients in primary group (17.0%) and 14 in sal-vage group (40.0%). Most common complication (n=17, 80.9%) was wound infection with necrosis of the cricoid cartilage, which were managed by conservative dressing (n=10), sternocleidomastoid muscle flap (n=4), cricohy-oid-pexy repair (n=2) and full-thickness skin graft (n=1). Other complications included bleeding, stenosis of the neo-glottis, and aspiration penumonia. Conclusion: Functional and oncological outcomes of salvage SCPL after radiation failure were not different from those of primary SCPL. The incidence of postoperative complica-tions was significantly higher in the salvage group. Care-ful management of tracheostoma to prevent emphysema or ascending infection as well as preservation of blood supplies to strap muscles covering the cricoid cartilage would be helpful to reduce complications especially in salvage SCPL after radiation failure.

» HNOP-31 10:00~10:10

» ANALYzINg SURvIvAL OF HYPOPHARYN-gEAL CANCER BY THE SUBSITES OF CAN-CER AND INITIAL TREATMENT MODALITIES




IN SEONG JEONG, MANAL IBRAHIM BINMANIE, AH RA JUNG, JONG-LYEL ROH, SEUNG-HO CHOI,

SANG YOON KIM, SOON YUHL NAM

Objectives: This study aimed to evaluate survival rate of hypopharyngeal cancer by the subsites of cancer and ini-


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Chair : HAN SU KIM, JIN CHOON LEE

Thyroid

» HNOP-33 11:10~11:20

» SURgICAL RESECTION OF THYROID ANA-PLASTIC CARCINOMA A SINgLE INSTITUTION ExPERIENCES

CENTER FOR HEAD AND NECK THYROID

SURGERY, KUSATSU GENERAL HOSP

SUEYOSHI MORITANI

Objectives: Anaplastic thyroid carcinoma (ATC) is rare disease, accounting for 1 to 2% of all thyroid carcinomas. However, ATC presents with a rapid and lethal clinical course, and the mean survival time after diagnosis was reported approximately 4 months. Locoregional disease control is absolutely required for improvement of the prognosis of the patients with ATC. We investigated sur-vival rate and locogerional recurrence in patients with ATC. Methods: The data of ATC patient who under-went surgery at our institution between 2006 and 2016 were retrospectively reviewed, and 16 patients were en-rolled. Curative resection was performed for all patients. Results: Of the 16 patients, 10 were initial cases, whereas 6 were diagnosed with ATC during cancer relapse. The mean age at time of ATC surgery was 70.5 years (range, 50-85 years). All patients excluding 1 case had surround-ing organs invasion by ATC great vessels in 4, trachea or larynx in 8, esophagus or pharynx in 8, recurrent laryn-geal nerve or vagal nerve in 9, other organs in 11. The 5 years disease-specific survival rate and 5 years locoregion-al control rate were 31.3% and 65% respectively. Twelve patients died the cause of death was distant metastasis in 8 patients, and locoregional and distant metastasis in 4. Four patients are alive without cancer relapse. Among the cases with locoregional recurrence within the dissection area, the lesion was located on the carotid artery after ca-rotid artery resection and reconstruction in 1 patient, lar-ynx after paritial laryngectomy in 1, deep fascia in 1, and mediastimun in 1. Conclusion: ATC presents as the rap-id growth associated with surrounding organ invasion in

SAUDI ARABIA4

MANAL IBRAHIM1,4, YEONJOO CHOI1, JONG-LYEL ROH1, SANGWOOK LEE2,

SUNG-BAE KIM3, SEUNG-HO CHOI1, SOON YUHL NAM1, SANG YOON KIM1

Objectives: Dysphagia and tube feeding dependency are commonly involved in patients with larynx and hy-popharynx cancers (LHC) during and after treatment, which might cause poor functional outcomes. Therefore, we examined the factors related to feeding tube depen-dency in LHC patients. Methods: This study included 303 consecutive patients who underwent definitive sur-gery or radiation therapy for previously untreated LHC, squamous cell carcinoma, at our tertiary referral cen-ter. Feeding tube dependency was defined as one year or more after treatment completion. Linear regression analyses were used to determine the factors predictive of feeding tube dependency. Cox proportional hazard re-gression analyses were used to determine the association between tube feeding dependency and overall survival (OS). Results: None of study patients had prophylatic feeding tube but 62 (20.4%) had reactive feeding tube. A total of 25 (8.3%) had feeding tube dependency. Univar-iate analyses showed that comorbidity, pretreatment hy-poalbuminemia, hypopharyngeal tumor site, advanced T classification, nodal positivity, tracheostomy, pharyngec-tomy, and postoperative radiotherapy were significantly associated with feeding tube dependency (all P <0.05). In multivariate analyses, hypopharyngeal tumor site and postoperative radiotherapy remained the independent factors of feeding tube dependency (all P < 0.05). Feed-ing tube dependency was not a factor associated with poor OS outcomes (P >0.05). Conclusion: Tube feeding dependency might be predicted in the LHC patients with clinical factors, such as hypopharyngeal tumor site and postoperative radiotherapy.

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Hashimoto’s thyroiditis (p=0.05). Several immune relat-ed canonical pathways were upregulated and several path-ways associated with tumor aggressiveness were downreg-ulated inBRAFV600E PTCs with Hashimoto’s thyroid-itis. Conclusion: BRAFV600E PTCs with Hashimoto’s thyroiditis showed better OS but worse RFS when com-pared to BRAFV600E PTCs without Hashimoto’s thy-roiditis. We could explain this survival difference by ge-nomic analysis using gene expression profile and altered pathway analysis.

» HNOP-35 11:30~11:40

» THYROID HORMONE SUPPLEMENTATION FOLLOWINg HEMITHYROIDECTOMY INCI-DENCE, RISK FACTORS, AND CHARACTERIS-TICS


AND NECK SURGERY, SCHOOL OF MEDICINE,

KYUNGPOOK NATIONAL UNIVERSITY

DONGBIN AHN, GIL JOON LEE, JIN HO SOHN

Objectives: The aim of the present study was to de-termine the true incidence, predictive risk factors, and clinical characteristics of thyroid hormone supplementa-tion (THS) after hemithyroidectomy by using our stan-dardized follow-up protocol in order to provide better preoperative counseling regarding postoperative THS. Methods: From 2008 to 2015, we included 535 patients who underwent hemithyroidectomy and were followed for ≥12 months with regular postoperative thyroid func-tion follow-up. THS was initiated based on 3 major cri-teria including development of overt hypothyroidism, subclinical hypothyroidism with TSH >10 mIU/L, and subclinical hypothyroidism with TSH 4.5–10 mIU/L but associated with signs/symptoms. Results: Overall inci-dence of THS following hemithyroidectomy was 26.4% (141/535) in our cohort. Their mean maintenance dose of levothyroxine of was 1.34μg/kg (range, 0.5–2.8μg/kg). The mean interval between the surgery and initiation of THR was 24.5 months (range, 1–116 months). For a total of 535 patients, 1-year, 3-year, 5-year, and 7-year THR-free survival rate obtained using the Kaplan–Meier method were 88.6%, 80.2%, 73.8%, and 69.1%, respec-tively. Risk analysis for THS following hemithyroidec-tomy demonstrated that preoperative TSH level >2.12 mIU/L (OR 2.857; 95% CI, 1.895–4.305; p<0.001) and coexistence of Hashimoto’s thyroiditis were inde-

the locoregional area, also associated with high frequency of distant metastasis. Without distant metastasis, locore-gional disease control by complete resection is absolutely required for improvement of the prognosis of the patients with ATC.

» HNOP-34 11:20~11:30

» EFFECT OF HASHIMOTOS THYROIDITIS TO BRAFv600E PAPILLARY THYROID CARCINO-MA THE PERSPECTIvE FROM A gENOMIC ANALYSIS


AND NECK SURGERY, KANGNAM SACRED HEART


MEDICINE, SEOUL, SOUTH KOREA

DONG JIN LEE, JI HOON PARK, BUM SANG LEE, JONG KYU LEE,

SOO KYUNG JANG, KYU YOUNG CHOI, JIN HWAN KIM

Objectives: The association between Hashimoto’s thy-roiditis and BRAFV600E positive papillary thyroid car-cinoma (PTC) remains controversial. The aim of this study is to evaluate the effect of Hashimoto’s thyroiditis to survival result of BRAFV600E PTCs using the Can-cer Genome Atlas (TCGA) data. Methods: Statistical analysis and genomic analysis were done using gene ex-pression data and clinical data of PTCs in The Cancer Genome Atlas data portal (https://tcga-data.nci.nih.gov) and cancer browser (https://genome-cancer.ucsc.edu). We compared overall survival (OS) and recur-rence-free survival (RFS) between BRAFV600E PTCs with Hashimoto’s thyroiditis and BRAFV600E PTCs without Hashimoto’s thyroiditis. Also, using differently expressed genes(DEG) between two groups, we tried to find altered canonical pathways which could explain the effect of Hashimoto’s thyroiditis to BRAFV600Epositive PTCs. Results: When we compared OS and RFS using Kaplan Meier survival curve, BRAFV600E PTCs with Hashimoto’s thyroiditis showed better OS but worse RFS than those of BRAFV600E PTCs without Hashimoto’s thyroiditis (p=0.19 and p=0.05, respectively). As for inci-dence, BRAFV600Emutation and Hashimoto’s thyroid-itis didn’t show any association each other. BRAFV600E PTCs with Hashimoto’s thyroiditis showed lower TNM stage when compared with BRAFV600E PTCs without


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showed significant recovery (p < 0.01) in the experimen-tal group. These results indicate that local adhesion after thyroidectomy might affect general movement of the lar-ynx and that wound massage could help patients recover normal general movement of the larynx. Conclusion: Neck discomfort and voice change after thyroidectomy are related to local wound adhesion, possibly associated with impairment of laryngeal vertical movement. Release of wound adhesion could help patients recover from neck discomfort and voice changes after thyroidectomy.

» HNOP-37 11:50~12:00

» EFFICACY OF RADIOFREQUENCY ABLA-TION FOR THYROID gOITER PATIENTS WITH PREvIOUS UNILATERAL LOBECTOMY A PRO-SPECTIvE CLINICAL STUDY




SEUNG-WON LEE, HYO-JUN KIM, KI-NAM PARK, JAE-HONG PARK, MYUNG-JIN BAN, JAE-WOOK KIM

Objectives: We evaluated the efficacy of ultrasonography (USG) guided radiofrequency ablation (RFA) in patients with benign thyroid goiters who had previously under-gone unilateral lobectomy. Methods: This prospective clinical study (SCHBC_IRB_2011-21) ran from Febru-ary 2013 to December 2018. A total of 160 consecutive RFAs were performed on patients with solid or predomi-nantly solid, benign thyroid nodules that were of cosmet-ic problem. Of these, 14 patients had only one function-ing thyroid gland because they had previously undergone unilateral lobectomy. All RFAs were performed under local anesthesia by a single surgeon (SW Lee) using the moving shot technique. All patients underwent ultraso-nographic evaluation prior to RFA, and 6 and 12 months thereafter; we calculated nodule volumes, cosmetic and symptom scores, Wong/Baker FACES Pain Rating Scale scores, and any related complications. Results: The nod-ule volume significantly reduced from 4.5 ± 0.9 mL pre-RFA to 1.3 ± 0.5 mL at post RFA 6 months and to 0.6 ± 0.5 mL at post RFA 12 months (P<0.05). The mean volume reduction rate was 79.4% ± 17.6% at post RFA 6 months and 81.2% ± 10.5% at post RFA 12 months, re-spectively. The cosmetic scores improved significantly at

pendent risk factor for THR. Conclusion: Result of the present study can be used for comprehensive preoperative counseling in patients who are adapted to hemithyroid-ectomy. After the surgery, meticulous follow-up protocol with regular thyroid function measurement is needed to provide appropriate long-term postoperative care in these patients.

» HNOP-36 11:40~11:50

» EFFECT OF WOUND MASSAgE ON NECK DISCOMFORT AND vOICE CHANgES AFTER THYROIDECTOMY

1DEPARTMENT OF OTOLARYNGOLOGY,

GYEONGSANG NATIONAL UNIVERSITY, JINJU,

KOREA, 3HEAD AND NECK ONCOLOGY CLINIC,

NATIONAL CANCER CENTER, ILSAN, SOUTH

KOREA, 4DEPARTMENT OF OTOLARYNGOLOGY-



CHANAN, KOREA

JAE SEOK LEE1, JIN PYEONG KIM1,2, JUN SUN RYU3, SEUNG HOON WOO1,2,4

Objectives: Neck discomfort and voice change are fre-quent complications following thyroidectomy. These symptoms might be due to damaged laryngeal nerves, intrinsic structures, or extra-laryngeal muscles. They can also occur without injury to any structure as with wound adhesion after thyroidectomy. The objective of this study was to determine causes of neck discomfort and voice change after thyroidectomy and to evaluate the effect of wound massage on symptom relief. Methods: Forty-five female patients who underwent total thyroidectomy were included (21 in the experimental group and 24 in control group). Wound massage was used as an interven-tion to release surgical adhesion. After wound massage education, subjects in the experimental group received wound massage from 4 to 12 weeks after thyroidecto-my. Analysis was performed for both groups. Results: No laryngeal pathology was found after thyroidectomy. The experimental group showed significantly better recovery from surgical adhesion and subjective visual analogue scale (VAS), Voice impairment score (VIS) and swallow-ing impairment score (SIS) (all p < 0.01) compared to the control group. Voice analysis results associated with laryngeal movement (SF0, VRPmax, VRPrange) also

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were NED state now. Conclusion: VHLP is one of the good surgical procedure to preserve the laryngeal func-tion in the surgical treatment of locally advanced head and neck cancer especially deeply invading into the lar-ynx. The SCM muscle flap method is a good substitute to solve this problem especially mid size tracheal invasion cases.

» HNOP-39 12:10~12:20

» ANATOMICAL STUDY OF gASLESS TRAN-SORAL THYROIDECTOMY AND CLINICAL AP-PLICATION

1DEPARTMENT OF ANATOMY, YONSEI UNIVERSITY

COLLEGE OF MEDICINE, 2DEPARTMENT OF

ANATOMY AND CELL BIOLOGY, DONG-A

UNIVERSITY COLLEGE OF MEDICINE, BUSAN, 3DEPARTMENT OF SURGERY, 4DEPARTMENT OF



CHANAN, KOREA

HUN-MU YANG1, KANG-JAE SHIN2, JUNWON MIN3, SEUNG HOON WOO4

Objectives: Transoral thyroidectomy is becoming a pre-ferred technique because it has the advantage of not leav-ing a scar after surgery. However, it’s not yet standard be-cause of the anatomic nerve complexity of this oral cavity and difficulty of approach. The aim of this study was to determine the safety zone of a gasless transoral thyroid-ectomy approach using an anatomical study and to eval-uate the efficacy of this approach on clinical application. Methods: Phase 1, twenty unilateral specimens from fresh cadavers underwent staining by the modified Sihler’s method to identify nerves around the oral vestibules. Then, the safety zone of the transoral thyroidectomy ap-proach was proposed. Phase 2, a comparative analysis of the clinical outcomes of gasless transoral thyroidectomy through the safety zone versus transcutaneous thyroid-ectomy approach. Results: In phase 1, numerous infe-rior labial branches diverged from the mental nerve and were distributed across the lower lip. In most cases, the most lateral branch reached almost to the corner of the mouth, whereas a nerve-free area was present at the me-dial region of the lower lip. The suggested safety zone was presented as a trapezoid shape. In phase 2, there were no significant differences in age, mass size, or complications

post RFA 6 and 12 months (P<0.05). One patient (7.1%, 1/14) developed vocal-fold paresis but recovered spon-taneously during follow-up. Conclusion: USG guided RFA effectively reduced thyroid goiter volume and sig-nificantly improved the cosmetic score of patients who had undergone prior thyroid lobectomy; no additional surgery was necessary

» HNOP-38 12:00~12:10

» SURgICAL MANAgEMENT OF AIRWAY IN LOCALLY ADvANCED THYROID CANCER




GEUN-JEON KIM, DONG HYUN LEE, SANG-YEON KIM, MIN-SIK KIM

Objectives: Surgery remains the main treatment for locally advanced thyroid cancer invading the upper air-way. We attempted to preserve the laryngeal skeleton by performing vertical hemilarygopharyngectomy (VHLP) in patients requiring total laryngectomy and sternoclei-domastoid(SCM) muscle flap for reconstruction defect in thyroid cancer involving the trachea cases. Methods: From January, 2005 to December, 2016, thyroid can-cer patients hospitalized in Seoul St. Mary Hospital in-volved in this study. We have applied VHLP in locally advanced thyroid cancer with laryngeal invasion in three cases which are needs to take a total laryngectomy, and describe eight cases of thyroid cancer involving the tra-chea reconstructed with SCM muscle flap. We evaluate oncological and functional results from medical record retrospectively. Results: Three patients had advanced thyroid cancer with laryngeal skeleton invasion and eight patients had trachea invasion . The first case was laryngeal invasion by spindle cell carcinoma of thyroid with para-glottic space invasion, the second casebys papillary carci-noma with paraglottic space invasion, and the third case by anaplastic carcinoma with pyriform sinus invasion. In the case of anaplastic carcinoma, the cancer was recurred locally and the patient died 6 months after surgery and other two cases were NED(no evidence of disease) state with 5 – 10 years follow-up. The five of the SCM muscle flap cases were recurred tumor with tracheal wall inva-sion after total thyroidectomy. Other three cases were the primary cases. One patient recurred and operation again using the opposite site of SCM muscle flap. All patients


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>5 involved LNs were significantly associated with poor RFS outcomes (all P <0.05). When adjusted with clinical and pathological factors, >5 involved LNs remained the significant factors predictive of RFS outcomes (P <0.01). Conclusion: Intermediate-risk PTC is associated with fairly good survival outcomes. Of risk factors, only >5 involved LNs may predict the post-treatment recurrence of intermediate-risk PTC.

» HNOP-41 12:30~12:40

» PROgNOSTIC vALUE OF TUMOR SIzE AND ExTRATHYROIDAL ExTENSION IN PATIENTS WITH PAPILLARY THYROID CARCINOMA AF-TER PRIMARY SURgERY

DEPARTMENTS OF OTOLARYNGOLOGY

AND PATHOLOGY, ASAN MEDICAL CENTER,

UNIVERSITY OF ULSAN COLLEGE OF MEDICINE

CHOL HO SHIN, JONG-LYEL ROH, GYUNGYUP GONG, KYUNG-JA CHO, SEUNG-HO CHOI, SOON YUHL NAM,

SANG YOON KIM

Objectives: Previous studies have shown different prog-nostic impacts of tumor size and minimal extrathyroidal extension (ETE) in patients with papillary thyroid carci-noma (PTC). Therefore, we examined the prognostic val-ue of tumor size and ETE on recurrence in pathological T1 to T3 PTC patients. Methods: This study involved 2916 consecutive patients who underwent thyroidecto-my for previously untreated PTC at our tertiary referral center. Tumor size was determined on pathological ex-aminations and minimal or macroscopic ETE were iden-tified by operative and pathological findings. Univariate and multivariate Cox proportional hazard regression analyses were used to determine significant factors pre-dictive of post-treatment recurrence-free survival (RFS). Results: Minimal and macroscopic ETE were found in 1334 (45.7%) and 331 (11.4%) patients, respectively. Tumor size and ETE were significantly associated with pathological lymph node metastasis (all P <0.01) and post-treatment recurrence (all P <0.01). Tumor size did not differ or modify its impact on post-treatment recur-rence along different age (P >0.05). Minimal ETE as well as macroscopic ETE were significantly associated with RFS (P <0.01). However, in multivariate analysis, no minimal but macroscopic ETE was the independent

between the two groups. However, the operation time in the transoral thyroidectomy group was longer than in the transcutaneous group (p = 0.001). Conclusion: Based on the anatomical study, we suggested a safety zone for the gasless transoral thyroidectomy. On application of this safety zone, gasless transoral thyroidectomy is a safe and feasible procedure.

» HNOP-40 12:20~12:30

» CLINICAL OUTCOMES AND RISK FACTORS FOR RECURRENCE IN PATIENTS WITH INTER-MEDIATE-RISK PAPILLARY THYROID CARCI-NOMA

DEPARTMENTS OF 1OTOLARYNGOLOGY

AND 2PATHOLOGY, ASAN MEDICAL CENTER,



YONG HAN KIM1, JONG-LYEL ROH1*, GYUNGYUP GONG2, KYUNG-JA CHO2, SEUNG-HO CHOI1, SOON YUHL NAM1,

SANG YOON KIM1

Objectives: American Thyroid Association (ATA) prac-tice guideline defines the intermediate-risk of papillary thyroid carcinoma (PTC) according to several patholog-ical findings, of which prognostic impact has not been clearly determined. Therefore, we evaluated the clinical outcomes of intermediate- risk PTC and find risk fac-tors of post-treatment outcomes. Methods: This study examined patients who underwent primary thyroidec-tomy and neck dissection for previously untreated PTC between 2006 and 2015 at our tertiary referral center. In-termediate-risk PTC was defined as having one or more of aggressive pathology, minor extrathyroid extension, lymphovascular invasion, or >5 involved lymph nodes (LNs) of 0.2 to 3 cm size according to the ATA guideline. Tumor multifocality and radioactive iodine avid neck lesions were also identified. Univariate and multivariate Cox proportional hazard regression analyses were used to define significant factors predictive of recurrent-free survival (RFS). Results: : A total of 1191 patients were classified as intermediate-risk group. Patients with inter-mediate-risk PTC were related to fairly good survival out-comes showing as much as the 5-year overall survival rate of 99.9% and the 5-year RFS rate of 97.5%. Of risk fac-tors, tumor multifocality, extrathyroidal extension, and

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ing status, alcohol intake, exercise, body mass index, and diabetes. Participants who had HBP without medication was at risk of incidence of oral cancer (HR: 1.149; 95% CI: 1.048–1.259), laryngeal cancer (HR: 1.252; 95% CI: 1.089–1.439), and esophageal cancer (HR: 1.474; 95% CI: 1.330–1.634) after adjusting for confounders. Participants with both HBP and diabetes had also the highest HR of having oral cancer (HR, 1.215; 95% CI, 1.109–1.332), laryngeal cancer (HR, 1.464; 95% CI, 1.219–1.659), and esophageal cancer (HR, 1.438; 95% CI, 1.308–1.581). Conclusion: HBP may be associated with oral, laryngeal, and esophageal cancer. The data have implications for etiological investigations and prevention strategies.

» HNOP-43 15:30~15:40

» PSYCHIATRIC PROBLEMS OF PATIENTS AF-TER SURgICAL TREATMENT FOR HEAD AND NECK CANCER - PILOT STUDY



COLLEGE OF MEDICINE

JAE-WOO JOO, YONG JUN JEONG , KYUNG-HO OH, JAE-GU CHO,

JEONG-SOO WOO, SEUNG-KUK BAEK, KWANG-YOON JUNG, SOON-YOUNG KWON

Objectives: Surgical treatment for head and neck can-cer has played a pivotal role in otorhinolaryngology area. Various complications can be induced due to the surgical treatment. Psychological problems are one of the most at-tracting attention and researches have been actively con-ducted recently. The purpose of this study is to evaluate mental problems objectively after operation for head and neck cancer. Methods: From January 2016 to September 2018, we reviewed the patients who had been diagnosed with head and neck cancer and who underwent surgery in Korea University Ansan Hospital, Department of Oto-rhinolaryngology. The patient's psychiatric morbidities were assessed using the Athens insomnia scale (AIS), the Hospital anxiety and depression scale (HADS) as an in-dicator of anxiety and depression, the Suicide behaviors questionnaire-revised (SBQ- R) were used. All patients completed the preoperative questionnaire and completed one or more questionnaires after the operation. Results: Most psychiatric morbidities did not deteriorate after

factor of RFS (P <0.05). Conclusion: No minimal but macroscopic ETE impacts on RFS after thyroidectomy in patients with T1 to T3 PTC.

HNOP-7Room 3-3 (Diamond)

Chair : JEONG PYO BONG, DONG JIN LEE

Other Head & Neck Disease

» HNOP-42 15:20~15:30

» ASSOCIATION BETWEEN HYPERTENSION AND THE INCIDENCE OF ORAL, LARYNgEAL, AND ESOPHAgEAL CANCER A NATIONWIDE POPULATION-BASED STUDY




SEOUL, KOREA

HO-YOUNG YOON, JAE-HYUN SEO, YOUNG-HOON JOO

Objectives: The presence of metabolic syndrome, includ-ing high blood pressure (HBP) is the risk factor for the development of cancer. The aim of this study was to ana-lyze the risk of developing oral, laryngeal, and esophageal cancer according to baseline HBP. Methods: Baseline enrollment was conducted for participants who under-went a national health screening examination within the enrollment period between January 1 and December 31, 2009 (n=9,746,606). The development of oral, laryngeal, or esophageal cancer was investigated until 2016, with the time point of diagnosis using the claims records of the Korean Health Insurance claims database during the study period. Results: During the seven-year follow-up period, 6,062, 2,658, and 4,752 subjects were newly di-agnosed with oral, laryngeal, and esophageal cancer, re-spectively. HBP was remarkable risk factor for each can-cer [hazard ratio (HR): 1.105; 95% and 95% confidence interval (CI): 1.044-1.169 in oral cancer), (HR: 1.226; 95% CI: 1.129-1.331 in laryngeal cancer), (HR: 1.253; 95% CI: 1.178-1.332 in esophageal cancer)] after adjust-ing for age and other variables including gender, smok-


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-9.71 and -11.75, respectively. Univariable analyses re-sulted that Group, SMM, SMI and LBM were indepen-dent predictive of RFS and OS (all P <0.05). Multivari-able analyses showed that all factors did not predictive of RFS and OS outcomes (all P >0.05). Conclusion: Preoperative body composition may predict survival and recurrence of elderly HNSCC patients.

» HNOP-45 15:50~16:00

» OPERATIvE PLANNINg FOR vELOPHARYN-gEAL INCOMPETENCY: INTERRATER AND INTRARATER RELIABILITY IN LATERAL vID-EOFLUOROSCOPY ASSESSMENT

UNIVERSITY OF NEW SOUTH WALES

DOMINIC KU, OLIVER CHOW, VICKY SEWANI, MARYAM SEYEDABADI

Objectives: Videofluoroscopy and videonasendoscopy are essential in the pre-operative assessment of velopharyn-geal incompetency (VPI). In the 1990s, Golding-Kush-ner et al introduced a standardised scale in assessing VPI (1) and recent studies have demonstrated that this scale can be used reliably (2). However, no study as yet has ex-amined the correlation between the clinical assessment of VPI and the eventual operative strategy. This study aims to investigate the reliability of the surgeons rating of VP function from lateral view videofluoroscopy and its rela-tionship with the recommended operative strategy. We predict that although the clinicians may agree on their assessment of VPI, they disagree on their preferred opera-tive strategies. Methods: A total of 36 lateral view record-ings from 12 patients were presented to 5 palatal- recon-structive plastic surgeons from three paediatric hospitals in Australia. All patients were assessed with lateral view videofluoroscopies with/without contrast. The surgeons rated velar displacement, location of maximum displace-ment relative to the palatal plane and provided treatment recommendation for each recording. Results: The cor-relation between each pair of surgeons assessment of velar displacement, location of maximum displacement rela-tive to the palatal plane and degree of work for VP closure were analysed. There were strong correlations among the surgeons assessment of velar displacement and degree of work for VP closure. The treatment recommendations had a chi-squared value of 378.56 (p=0.382). Ergo, weak correlations were observed among the surgeons recom-mendations. Conclusion: This study demonstrated high

surgery, unlike previously known. In addition, the de-pression, suicidal tendency, and insomnia of the patients immediately after the operation did not show significant change with time. Conclusion: Preoperative mental sta-tus of the patients with head and neck cancer itself is an unchanging important factor that may affect post-oper-ation care and further studies with a large number of pa-tients are needed.

» HNOP-44 15:40~15:50

» ASSOCIATION OF BODY COMPOSITION WITH CLINICAL IMPLICATIONS OF PRIMARY SURgERY-TREATED ELDERLY HNSCC PA-TIENTS

DEPARTMENT OF 1OTOLARYNGOLOGY AND 2NUCLEAR MEDICINE, ASAN MEDICAL CENTER,



AH RA JUNG, JONG-LYEL ROH, JAE SEUNG KIM, SEUNG-HO CHOI,

SOON YUHL NAM, SANG YOON KIM

Objectives: Primary surgery-treated elderly head and neck cancer squamous cell carcinoma (HNSCC) patients is usually associated with unbalanced body composition, related to poor clinical outcomes. Methods: We analyzed 88 primary surgery-treated elderly HNSCC patients who were prospectively enrolled between September 2010 and December 2015. Sarcopenia was defined by computed tomography (CT) at the levels of the third lumbar ver-tebra (L3) as skeletal muscle index (SMI) < 52.4 cm2/m2 for man and SMI <38.5 cm2/m2 for woman. Pri-mary outcomes were recurrence-free survival (RFS) and overall survival (OS). All comorbidity was recorded pro-spectively, including Charlson comorbidity index (CCI), Karnofsky performance status (KPS), ASA, and Frailty. Univariate, multivariate, and Cox proportional hazards regression analysis was performed. Results: Sarcopenia and normal were found in 24 (27.2%) and 64 (72.7%) of 88 elderly patients, respectively. Sarcopenia were poor recurrence-free (P <0.05) and overall survival (P <0.05) after surgery than normal. Two group were significantly difference with SMM at L3 and the levels of the third cer-vical vertebra, total fat tissue area at L3, lean body mass, and fat mass. (all P <0.05). Sarcopenia and normal were change of SMM at L3 before and after surgery found in

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DEP. OF SURGERY MONASH UNIVERSITY

FIONA PAVAN, PEDRO GUIO-AGUILAR, TANIA GREEN, JAMES LEE, JAMES LEONG

Objectives: The ageing population has seen a rise in the number of elderly patients diagnosed with head and neck cancers (HNC) that require microsurgical recon-struction. The effects on aesthetics, function and patient wellbeing after this surgery can often be detrimental. This study aims to determine if patients aged 75 years or older report poorer quality of life after microsurgery for head and neck cancers. Methods: In this cross-sectional study, the University of Washington Quality of Life (QOL) Questionnaire was used to assess patients following their reconstructive surgery in psychosocial, physical and func-tional categories. Patients responses were compared be-tween those less than 75 years (control group) and those 75 years and over (study group). Results: Of the 100 pa-tients invited, the response rate was 71% with 46 patients in the control group and 25 in the study group. Patients 75 years and older scored worse in overall QOL when compared to the control group, and a higher proportion felt their overall QOL was very poor however these re-sults were not statistically significant (p=0.34 and p=0.71 respectively). Reduced activity was identified as a signif-icant issue by patients over 75 years (p= 0.01) and they scored worse for all of the functional category outcomes. Conclusion: This study demonstrates some differences in quality of life score between the study groups however statistical significance was only demonstrated in specif-ic QOL aspects for patients over 75 years compared to those under 75 years. Surgical planning for HNC surgery and reconstruction in patients over 75 years should bal-ance the medical impact of prolonged surgery and risks of surgical complication with the presumed functional benefits. By using the best available research evidence combined with clinical expertise and patient values, an optimal patient-centred surgical plan that maximizes health-related quality of life can be achieved.

intra- and inter-surgeon reliability in the assessment of VPI from lateral videofluoroscopy. However, the sur-geons assessments did not appear to correlate with their recommended operative strategies. Further analysis of the factors influencing the treatment of VPI is warranted.

» HNOP-46 16:00~16:10

» THE vALIDITY OF NARROW-BAND IMAgINg NASOENDOSCOPY (NBI) ON POST- THERAPY NASOPHARYNgEAL CARCINOMA


HEAD AND NECK SURGERY ISLAMIC

UNIVERSITY OF INDONESIA 1 / DEPARTMENT OF

OTORHINOLARYNGOLOGY, HEAD AND NECK

SURGERY FACULTY OF MEDICINE,

PUBLIC HEALTH, AND NURSE UNIVERSITAS

GADJAH MADA2

VEBY NOVRI YENDRI1, CAMELIA HERDINI2

Objectives: This study aimed to determine the validity of NBI nasoendoscopic examination on post-therapy nasopharyngeal carcinoma. Methods: This study was a cross-sectional design for all post-therapy of nasopha-ryngeal carcinoma patients who will be conducted a re-sponse assessment at the ENT-HNS Clinic Dr. Sardjito as many as 40 subjects during May-June 2018 period that conducted sequentially. Biopsy examination was carried out with nasoendoscopy NBI guidance, and the results of biopsy were performed histopathological examination. Results: Fourty research subjects showed the results of NBI nasoendoscopy validity on NPC after therapy, in-cluded sensitivity (85.7%), specificity (87.8%), positive predictive value (60%), negative predictive value (96.6 %), positive trend ratio (7.07), negative trend ratio (0.16), and accuracy (87.5%). The features of NBI naso-endoscopy appear homogeneous (75%), inhomogenous (25%). Conclusion: Validity of Narrow Band imaging nasoendoscopic on post-therapy nasopharyngeal carcino-ma is good (87.5%)

» HNOP-47 16:10~16:20

» PATIENT REPORTED OUTCOMES OF MI-CROSURgICAL HEAD AND NECK RECON-STRUCTION IN THE ELDERLY POPULATION

April27(Sat)



April 27(Sat) ORLOP

Korean Session ORLOP Audiologist

Room 2-1 (Flamingo)Chair : SEOK MIN HONG, SUNG HEON KIM

Audiologist Oral Presentation

» Audiologist-01 13:30~13:40

» vIDEO HEAD IMPULSE TEST gAINS FROM RIgHT vS. LEFT OR OUTWARD vS. INWARD HEAD IMPULSES IN PATIENTS WITH vESTIB-ULAR DISORDERS





EUN HYE CHA, YEHREE KIM, MIN YOUNG KWAK, JI WON SEO,

JUN WOO PARK, BYUNG CHUL KANG, HONG JU PARK

Objectives: The right/left and outward/inward vHIT gain differences have been reported in normal subjects when using a vHIT system which records the right eye movements. We aimed to investigate the presence of those differences in patients with vestibular disorders. Methods: The outward/inward vHIT gain difference was evaluated by comparing outward/inward vHIT gains in 34 patients with unilateral vestibular impairment based on vHIT findings. The right/left vHIT gain difference was evaluated by comparing the incidence of abnor-mal vHIT gains in 51 patients with right/left vestibular neuritis (VN) which was confirmed by caloric results. Results: In patients with unilateral vestibular impair-ment, outward vHIT gains (0.48±0.17) when stimulat-ing the lesioned LSCC were not significantly different from those (0.49±0.18) by inward head impulses. The outward vHIT gains (0.91±0.08) when stimulating the contralateral intact LSCC were also not significantly dif-ferent from those (0.90±0.09) by inward head impulses. In patients with VN, the degrees (44±19%) of canal pa-resis of the VN ears with normal vHIT gains were signifi-cantly lower than those (78±21%) of the VN ears with abnormal vHIT gains. The incidence (9 of 24, 38%) of

normal vHIT gain in right VN was higher than left VN (5 of 27, 19%, p=0.21). This difference was significant (8 of 10, 80% in right VN vs. 4 of 14, 29% in left VN) when considering VN patients with canal paresis < 70%. Conclusion: The outward/inward vHIT gain difference was not observed in patients with vestibular disorders, suggesting that neural integrator is functionally leaky and vHIT can be performed either outward or inward in pa-tient with vestibular disorders. The right/left vHIT gain difference was still observed in patients with vestibular disorders and right vestibular dysfunction was less detect-ed by the vHIT gain criteria.

» Audiologist-02 13:40~13:50

» AUDITORY PERFORMANCE OF ADULTS WITH SEQUENTIAL BILATERAL COCHLEAR IMPLANTS WITH LONg IMPLANTATION INTER-vALS: A CASE REPORT

SPEECH-LANGUAGE PATHOLOGIST, KYUNGPOOK

NATIONAL UNIVERSITY HOSPITAL⒥,



MEDICINE, KYUNGPOOK NATIONAL UNIVERSITY2

MYUNG-JIN LEE⒥, SEUNG-EUN LEE⒥, KYU-YUP LEE2

Objectives: As the effectiveness of bilateral cochlear im-plant has been proven, sequential or simultaneous bilat-eral cochlear implant are increasing. Recent studies have shown that adults tend to receive cochlear implant on their side, whereas young children and adolescents tend to implant cochlear implant on both sides. However, the number of adults who consider bilateral cochlear implant is increasing due to problems such as poor speech rec-ognition in noise, which affects their occupational and social relationship. Therefore, in this study, we tried to investigate the auditory performance of adults with long implantation intervals of sequential bilateral cochlear implant. Methods: One adult with sequential bilateral cochlear implant, five adults with unilateral cochlear im-plant, and five adults with normal hearing participated in this study. We measured the change in speech recog-nition of the second cochlear implant in the sequential bilateral cochlear implant. In addition, we investigated speech recognition in noise of bilateral cochlear implant. Speech recognition test was performed in a quiet and

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and variables related to the frequency (frequency table allocation, channel gain). Results: In this study, the CI performance in the patients with inner ear anomalies was significantly worse than control group. However, after one year of mapping process, the patients with inner ear anomalies showed significant improvement of CI perfor-mance. In the mapping characteristics, it was found that C level, T level, pulse width, and input dynamic range were set significantly higher in the patients with inner ear anomalies than control group. The frequency related vari-ables showed no significant difference. Conclusion: We estimated that continuous mapping process can improve the CI performance and mapping characteristics between the two groups were difference in some variables. Thus, different mapping strategies should be needed in the CI patients with inner ear anomalies.

» Audiologist-04 14:00~14:10

» RELIABILITY AND vALIDITY OF SPEECH AU-DIOMETRIC TEST RESULTS AS CRITERIA FOR HEARINg DISABILITY DETERMINATION


HEAD AND NECK SURGERY, THE CATHOLIC

UNIVERSITY OF KOREA

IL-GYE IM, HYUN-HO LEE, HA-RAM KANG, JEONG-HOON OH

Objectives: Speech audiometry (SA) is an important part of hearing evaluation as it provides information about how well an individual perceives and understand speech, also can be used to validate pure-tone audiometry(PTA) thresholds. However, intrasubject variability of speech audiometry remains a valid concern, and its reliability of this test has been argued for a long time. The Kore-an government- issued criteria for verification of hearing mpairment is based on PTA, SA and auditory brainstem response(ABR) thresholds to offer supportive services to the people who have hearing disability.The aim of the study was to investigate the reliability and validity of speech audiometric test results as criteria for hearing dis-ability determination. Methods: The medical records of the 220 patients who underwent PTA, SA and ABR at our hospital were reviewed and divided to two groups: patients presenting with hearing loss, and those applying for the hearing disability certificate. Each group is subdi-vided into 10dB range in PTA thresholds. The difference between the speech reception threshold and pure tone

noise environment (SNRs: 0, +10, + 20) using monosyl-labic words, and the result was calculated as a percentage of phonemes. Speech recognition in noise was compared with unilateral cochlear implant group and normal hear-ing group. Results: Speech recognition of the second cochlear implant was dramatically improved at 2 years and 6 months after implantation, similar to that of the first cochlear implant. Speech recognition in noise was higher than unilateral cochlear implant group but lower than normal hearing group. Conclusion: Although the implantation intervals of both sides was long, good re-sults were obtained in speech recognition. It may be re-ported as an example when consulting adults considering sequential bilateral cochlear implant.

» Audiologist-03 13:50~14:00

» ANALYSIS OF MAPPINg CHARACTERISTICS OF COCHLEAR IMPLANT PATIENTS WITH IN-NER EAR ANOMALIES



COLLEGE OF MEDICINE

EUYHYUN PARK, PYUNG GON THAK, YOON CHAN RAH, JUNE CHOI, HAK HYUN JUNG, GI JUNG IM

Objectives: In the past, cochlear implant (CI) was con-traindicated in patients with inner ear anomalies. How-ever, as the results of CI in patients with inner ear anom-alies has been reported, currently almost patients with inner ear anomalies are undergoing CI. There have been many reports of results after CI in patients with inner ear anomalies, but there has been no reports on the CI mapping characteristics of patients with inner ear anom-alies. Therefore, in this study, we aimed to analysis of CI mapping characteristics of patients with inner ear anomalies from compared to control group. Methods: We retrospectively reviewed the recent 1 year mapping process and CI performance of 10 patients with inner ear anomalies and 10 patients without inner ear anomalies (control group). All patients were pre-lingual hearing im-paired CI users who were implanted with a Cochlear Nu-cleus. The CI performance was analyzed by Ling 6, CAP, speech perception test and standardized articulation test named U-TAP. The mapping characteristics were focused on variables related to the stimulus intensity (C level, T level, dynamic range, pulse width, input dynamic range)

April27(Sat)



April 27(Sat) ORLOP

contemporaneous bilateral CIs, 5 exhibited ASSRs at all frequencies and the other 5 showed no response at ≥1 frequency. The latter patients had higher CAP scores at the postoperative 1-year speech evaluation (P=0.018). Conclusion: Residual hearing at 2 kHz ASSR correlat-ed positively with the post-CI T-level. Weak associations were apparent between the ASSR threshold and the post-operative 1-year T- and C-levels. Of patients undergo-ing contemporaneous bilateral CIs, those with ASSRs at all frequencies had significantly lower CAP scores at the postoperative 1year speech evaluation, which may reflect the fact that they were older at the time of operation than other children. CI should not be delayed if marginal re-sidual hearing is evident in ASSR tests.

Korean Session ORLOP SLP

Room 2-3 (White Heron)Chair : SANG HYUK LEE

Oral Presentation

» SLP-01 13:30~13:40

» EFFECTS OF vOICE THERAPY PROgRAM USINg INHALATION PHONATION TECHNIQUE FOR PATIENTS WITH MUSCLE TENSION DYS-PHONIA


HEAD AND NECK SURGERY COLLEGE OF

MEDICINE, THE CHATHOLIC UNIVERSITY OF

KOREA⒥

MI-RAN SHIM⒥, SLP, YEON-SHIN HWANG⒥, SLP, SANG-YEON KIM⒥, MIN-SIK KIM⒥,

DONG-IL SUN⒥

Objectives: MTD는 후두내근과 외근의 지나친 긴장에 기인하여 발생한 음성장애로 초기 치료로 약물치료와 함께 호흡 훈련, 후두 위치 교정, 후두 마사지, 한숨하품기법, 성대기능 강화 훈련 등의 음성치료가 선행된다. 그러나 임상에서 남성 MTD 환자의 경우, 치료에 대한 동기가 부족하고 치료 효과에 대한 기대 수준이 낮으며, 실제 이들에 대한 치료 효과가 낮은 경우가 빈번하다. 이에 이들에 대한 치료 반응도를 높일 수 방법을 고민하게 되었고 이에 직접적

threshold in each test between two groups were analyzed, and mean SRT and speech discrimination score(SDS) in each subsets in both groups were compared. Results: The differences of average SDS between two groups were 9.93 % in the range of PTA threshold less than 50 dB, 6.00 % in the range of 50-59 dB PTA threshold, 14.12 % in the range of 60-69 dB PTA threshold and 1.53% % in the range of 70-79 dB PTA threshold, respectively. In the dis-ability certificate group, 37% of the patients showed a dif-ference more than 12 % between speech discrimination score results. Conclusion: The significant difference of average SDS between two groups shows that SDS alone would be insufficient to confirm degree of hearing dis-ability, and that the reliability of SDS should be verified with objective audiometric test results.

» Audiologist-05 14:10~14:20

» EFFECTS OF RESIDUAL HEARINg IN CHIL-DREN ON THE ASSR AFTER CI



YOUNG SEOK KIM, SANG-YOUP LEE, JUN HO LEE, SEUNG HA OH, MOO KYUN PARK

Objectives: ASSR can be employed for monitoring of re-sidual hearing at various frequencies. We used the ASSR to explore the effects of residual hearing on CI outcomes in children lacking ABR. Methods: We retrospectively reviewed the relationship between the preoperative ASSR and the post-CI outcomes of children lacking ABRs. All ears were divided into two groups: with residual hearing and without hearing. The T- and C-levels and the EDR of postoperative 3-month and 1-year mappings were com-pared between the two groups. To evaluate speech per-ception, patients who received contemporaneous bilater-al CIs were divided into two groups: group 1 exhibited responses at all frequencies in both ears; in group 2, at least one ear evidenced no response. The CAP and IT-MAIS scores at postoperative 3-month and 1-year were compared between the groups. Results: We enrolled 16 patients (30 ears). At 2 kHz, the postoperative 3-month and 1-year T-levels of patients with residual hearing were lower than those of patients without hearing (P=0.001, P=0.035). In residual hearing group, the ASSR threshold correlated positively (but weakly) with the postoperative 1-year T-level (P=0.012, r2=0.276) and 1-year C- level (P=0.002, r2=0.374). Of 10 patients who underwent

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fore, we sought to investigate voice outcomes after Po-tassium-Titanyl-Phosphate (KTP)-assisted glottoplasty in vocal fold scarring. Methods: A total of nine patients with vocal fold scarring (three males and six females, age = 47.0 ± 9.7 yrs) who underwent KTP-glottoplasty were retrospectively enrolled. Clinical records were reviewed and pre- and post-operative multi-dimensional voice assessment were performed, including acoustic, electro-glottographic, auditory-perceptual, aerodynamic, and psychometric assessment. Patients had follow-up for 4.8 ± 4.6 months after surgery. Results: The most common cause of the scar formation was previous surgery (77.8%). Post-operative voice results showed that perceived breath-iness (B of the GRBAS scale) decreased after surgery (p = .034), while the cepstral peak prominence derived from both vowel phonation (p = .021) and passage-reading tasks (p = .021) increased significantly. In addition, de-creased standard deviation of the speaking F0 measured by EGG (p = .011) and mean airflow rate measured by the PAS (p = .011) were observed. Lastly, decreased to-tal score of the K-VAPP (p = .021), Activity Limitation Score (p = .038), and Participation Restriction Score (p = .035) were noted. Conclusion: The current data showed that breathiness decreased, and several related parameters were also improved after surgery. These findings suggest that KTP-laser assisted glottoplasty might be a potential candidate for treatment of vocal fold scarring. Further re-search is needed to assess long-term voice outcomes with a bigger sample size.

» SLP-03 13:50~14:00

» THE USEFULNESS OF AUDITORY PERCEP-TUAL ASSESSMENT AND ACOUSTIC ANAL-YSIS AS A SCREENINg TEST FOR vOICE PROBLEMS



RESEARCH INSTITUTE, PUSAN NATIONAL

UNIVERSITY HOSPITAL1, 5DEPTARTMENT OF

HUMANITIES, LANGUAGE AND INFORMATION,

PUSAN NATIONAL UNIVERSITY2

YEONWOO LEE1, GEUNHYO KIM2, BYUNGJOO LEE3, WONJAE CHA4,

SOOGEUN WANG5, SOONBOK KWON6

Objectives: The aims of this study were to (1) to deter-

이고 즉각적인 음성 개선에 대한 피드백을 줄 수 있는 흡기발성을 이용한 음성치료 효과를 확인해 보고자 하였다. 흡기발성을 이용한 MTD 치료 연구는 거의 보고된 바 없으며 이에 본 연구에서는, MTD 환자에게 흡기발성을 적용하여 즉각적인 피드백을 주어 치료 전후 효과를 비교하여 그 효과를 확인하고자 하였다. Methods: 18년 6월부터 12월까지 음성 장애 환자 중 MTD(II,III,IV포함) 환자 38명을 대상으로 다른 후두 질환이 있는 secondary MTD는 제외 하였으며 이들에게 ‘흡기발성을 이용한 음성치료 프로그램’을 1회 적용하였다. 후두미세진동 검사를 통해 자연스러운 발성 /i/와 흡기 발성 이후 성대 진동 및 접촉 양상을 비교하였고, 치료 전과 치료 사이, 그리고 치료 후 EGG를 이용하여 CQ값의 변화를 알아보았으며, Real time pitch, MDVP를 이용하여 GRBAS F0, Jitter, Shimmer, NHR 값의 청지각적, 음향학적 수치를 비교해 보았다. Results: 음향학적, 청지각적 평가 결과 shimmer, G, S, B 수치가 통계적(P <.05)으로 유의하게 낮아져 음질 개선을 보였으며, CQ값의 경우 흡기 전보다 흡기 발성 연습 중 높아졌다가 흡기 연습 이후 다시 낮아지는 경향을 보였다. 후두미세진동 검사 결과 흡기 전과 흡기 후 환자마자 차이는 있었지만 근육의 긴장 정도가 감소되고 성대 접촉 수준이 높아지는 경향을 보였다. Conclusion: MTD 환자에게 치료 초기에 direct therapy 방법으로 흡기발성은 비교적 쉽게 적용할 수 있고 짧은 시간에 즉각적인 음성치료 효과를 줄 수 있어, 치료에 대한 동기를 부여할 수 있고 치료 효과에 대한 만족도를 높일 수 있어, 음성치료 효율성을 높일 수 있을 것으로 여겨진다. 다만 그 음성 개선 및 성대 접촉 수준 향상의 지속 정도는 치료 후 몇 개월에 걸쳐 연구해야 할 것으로 여겨지며 이는 추후 연구를 진행할 예정이다.

» SLP-02 13:40~13:50

» vOICE OUTCOMES AFTER KTP-ASSISTED gLOTTOPLASTY IN vOCAL FOLD SCARRINg: PRELIMINARY FINDINgS

DEPARTMENT OF OTORHINOLARYNGOLOGY THE

INSTITUTE OF LOGOPEDICS & PHONIATRICS,

YONSEI UNIVERSITY COLLEGE OF MEDICINE⒥

SEUNG JIN LEE⒥, JAE-YOL LIM⒥, HONG-SHIK CHOI⒥

Objectives: The scarring of the vocal folds can be in-duced by trauma, surgery, drugs, or radiation, resulting in severe vocal vibratory dysfunction. Recently, angiolytic lasers have been shown to have favorable results for var-ious vocal fold lesions, although little studies have been conducted in terms of multi-dimensional voice outcomes after angiolytic laser surgery in vocal fold scarring. There-

April27(Sat)



April 27(Sat) ORLOP

neurologic cause, Neurological voice disorder, Voice dis-order secondary to gastroesophageal reflux, Patient with thyroid disease, Patient with functional voice disorder) by an otolaryngologist. Each subject checked for the frequency and severity of VTD. Results: First, the fre-quency of symptoms of incomplete glottal closure with-out organic or neurologic cause was 7.25, lesions in the membranous portion of vocal fold was 5.79, neurological voice disorder was 5.60, voice disorder secondary to gas-troesophageal reflux was 5.5, laryngeal disease excluding vocal cord lesion was 4.80, fuctional voice diorder was 4.67, thyroid disease was 2.89. There was a significant dif-ference between the groups(P <0.01). Second, there was no significant difference in severity of discomfort accord-ing to laryngeal disease. Third, symptoms of major vocal discomfort according to disease were as follows. laryngeal disease excluding vocal cord lesion, functional voice dis-order, lesions in the membranous portion of vocal fold reported burning, tightness. Incomplete glottal closure without organic or neurologic cause reported burning, tightness, dry, aching, tickling, sore. Neurological voice disorder reported dry, irritable. Thyroid disease reported tightness, tickling. Conclusion: There was a significant difference in the frequency of symptoms of vocal discom-fort according to laryngeal disease. However, there was no significant difference in severity of discomfort according to laryngeal disease.Further studies are needed to evaluate the VTD of more laryngeal disease. We hope that this a study on the correlation of VTD and voice evaluation.

» SLP-05 14:10~14:20

» EFFECTS OF RESONANCE vOICE THERAPY APPLYINg SELF-REgULATION STRATEgY


DONGNAM INSTITUTE OF RADIOLOGICAL &

MEDICAL SCIENCES

CHANG YOON LEE⒥, SOO YOUN AN2, HEE YOUNG SON⒧

Objectives: The goal of this study is to apply the self – regulation(SR) strategy to resonance voice therapy, one of the physiological therapies. To do this, we introduce the concepts applicable to voice therapy among self-reg-ulation principles, and explain it as concrete voice thera-py method based on it. Methods: Twenty patients with vocal cord nodules were enrolled in this study. The reso-nance voice therapy used in this study consisted of 3 steps

mine the cutoff values of parameters related to auditory perceptual assessment (VAS) and acoustic analysis (CPP, L/H ratio, CPP SD, L/H ratio SD, AVQI, and CSID) for predicting the voice problems within a Korean pop-ulation; and (2) to verify the discriminative power of these cutoff values. Methods: 1,113 voice samples were analyzed in this study. Auditory perceptual assessments were performed by five speech-language pathologists. The acoustic analysis of cepstral parameters, CSID, and AVQI were calculated using the CSL and Praat software. The cutoff values of parameters predicting the voice prob-lems were obtained using receiver operating characteris-tic (ROC) analysis. Through this analysis, the sensitivity, specificity, and area under the receiver operating charac-teristic curve (AUC) were measured. Results: High inter- and intra-rater reliabilities were found for the auditory- perceptual assessment. The cutoff values of parameters predicting voice problems had high sensitivity, specificity, and AUC. Of these, the CSID was the parameter with the highest values of AUC. Conclusion: The cutoff val-ues of parameters predicting the voice problems demon-strated a high power to discriminate for classifying the presence or absence of voice problems within a Korean population. The results of this study could be used as an objective criterion for screen the voice problems.

» SLP-04 14:00~14:10

» CHARACTERISTICS OF vOCAL TRACK DIS-COMFORT SCALE ACCORDINg TO LARYNgE-AL DISEASE

⒥DEPARTMENT OF OTOLARYNGOLOGY-HEAD

AND NECK SURGERY, CHOSUN UNIVERSITY

SCHOOL OF MEDICINE, 2DEPARTMENT OF

SPEECH LANGUAGE PATHOLOGY,

HONAM UNIVERSITY

HA-NA LEE⒥, JI-HYE HAN⒥, DO-YOON JEONG⒥, JAE-YEON YOO2,

JUN-HEE PARK⒥

Objectives: The purpose of this study was to investigate the characteristics of Vocal Track Discomfort Scale(VTD) according to laryngeal disease. Methods: The subjects were 100(45 males, 55 females) who were classified into seven laryngeal disease areas(Laryngeal disease excluding vocal cord lesion,Lesions in the membranous portion of vocal fold, Incomplete glottal closure without organic or

April27(Sat)




in total. The first stage was forethought and skills acquisi-tion, the second stage was performance control and habit formation, and the last stage was self reflection and habit change. The main goal of the SR voice therapy strategy was to minimize or restore SR depletion. This strategy includes SR depletion recovery strategies, such as period-ic rest and relaxation, positive emotional induction, and strategies to minimize SR depletion, such as goal imple-mentation intentions. Results: All subjects who received voice therapy had a significant effect on the acoustic anal-ysis. The subjects set goals for each step with the clini-cian considering the individual situation and condition. Two months after the end of voice therapy, improved status was maintained in the generalization confirmation phase. Conclusion: Understanding SR is important in voice therapy, where the main goal is to alter inappropri-ate speech behavior. The most common consideration is SR depletion. SR depletion has a significant impact on achieving the goals of voice therapy, as the ability to con-trol subsequent tasks is reduced. The strategies associated with SR depletion used in this study focused on identify-ing and effectively controlling the problems that arise in the process of achieving the patient's goals. Future studies will need to support SR efforts and develop better ways to prevent or recover from depletion.

April27(Sat)




RHPX


Poster Exhibition

» RHPX-01

» A CASE OF SECONDARY TRIgEMINAL NEU-RALgIA AFTER ENDOSCOPIC SINUS SURgERY


NATIONAL POLICE HOSPITAL1, DEPARTMENT

OF OTOLARYNGOLOGY, KANGWON NATIONAL


JUNHO HWANG1, WOO HYUN LEE2

Trigeminal neuralgia (TN) is a distinctive facial pain syn-drome that is characterized by unilateral pain following the sensory distribution of cranial nerve V, the etiology of which remains idiopathic in the majority of cases. We present a case of an elderly woman who experienced unilateral neuralgic pain after undergoing endoscopic si-nus surgery. Following endoscopic sinus surgery of the left sphenoid sinus to remove putative fungus balls, the patient complained of intermittent facial pain that was localized in the left periorbital and left forehead area. The pain disappeared completely after a five-week medical therapy including gabapentin and zaltoprofen. Although rare in the literature, this case demonstrates that second-ary TN can be considered in the differential diagnosis of patients presenting with unilateral facial pain after endo-scopic sinus surgery.

» RHPX-02

» HUgE CHOLESTEROL gRANULOMA OF THE MAxILLARY SINUS CONFUSED WITH ODOTO-gENIC KERATOCYST

1DEPARTMENT OF OTORHINOLARYNGOLOGY ,

PUSAN NATIONAL UNIVERSITY HOSPITAL

DONG-JO KIM, KEUN-IK YI1, SUNG-DONG KIM1, KYU-SUP CHO1

Cholesterol granuloma (CG) is a foreign body reaction to the deposition of cholesterol crystals, usually found in association to chronic middle ear diseases, being highly uncommon in the paranasal sinuses. This article reports a case of huge CG in the maxillary sinus of a 85-year-old woman, manifesting as a swelling on the right maxilla associated with pain and nasal obstruction. Computed tomography of the paranasal sinuses showed a low-den-sity huge mass in the left maxillary sinus destroying the inferior and posterior wall of maxillary sinus, which was confused with expansile odontogenic keratocyst. En-donasal endoscopic approach was performed and a his-tologic examination revealed a cholesterol granuloma. Endoscopic examinations and CT performed 6 months postoperatively showed no evidence of recurrence.

» RHPX-03

» ENDOSCOPIC ENDONASAL TRANSPTERY-gOID APPROACH OF PETROUS APEx CHO-LESTEROL gRANULOMA A CARE REPORT


AND NECK SURGERY, ST PAULS HOSPITAL,


UNIVERSITY OF KOREA, SEOUL, REPUBLIC OF

KOREA1,DEPARTMENT OF OTOLARYNGOLOGY-

HEAD AND NECK SURGERY, INCHEON ST

MARYS HOSPITAL, COLLEGE OF MEDICINE,

THE CATHOLIC UNIVERSITY OF KOREA, SEOUL,

REPUBLIC OF KOREA2,DEPARTMENT OF

NEUROSURGERY, INCHEON ST MARYS HOSPITAL,


UNIVERSITY OF KOREA,

SEOUL, REPUBLIC OF KOREA3

JI-SUN KIM1, DONG-HYUN KIM2, WAN-SOO YOON3, YEONJI KIM2

With the development of minimally invasive endoscopic surgery and image guided navigation system, endoscopic endonasal approach to petrous apex lesions has become more favorable. In this case, petrous apex cholesterol granuloma was successfully removed with endoscopic endonasal transpterygoid approach. The navigation sys-tem was used, and the contralateral nasoseptal flap and silicone tube stent were used to maintain the cholesterol granuloma drainage pathway. We describe the endoscop-

April27(Sat)




the direction of the gun could not remember by him. There is history of nose bleed and no vision disturbance. We performed a CT Scan Paranasal Sinus and we found hipoechoid imaging in the agger nasi, and an ethmoid anterior sinuses sheathed. we underwent to endoscopic approach and we found a single bullet in the roof of eth-moid near to AEA. CT shown the foreign body in the agger nasi but doing surgery the foreign body position in the roof of ethmoid. After removed the bullets, we evalu-ated shrapnel in the sinus. There is no injury of AEA and CSF leak.

» RHPX-06

» ANATOMICAL EvALUATION OF THE EUSTA-CHIAN TUBE USINg OPTICAL COHERENCE TOMOgRAPHY(OCT)


KOSIN UNIVERSITY COLLEGE OF MEDICINE

YEONG-WOOK JEONG, JOO-YEON KIM, JAE-HWAN KWON

Objectives: Optical coherence tomography(OCT) is a good diagnostic imaging modality that shows cross-sec-tional images of living tissues by analyzing the coherence pattern of the reflected light. The exact anatomy and function of Eustachian tube have not been evaluated even development of diagnostic instruments, yet. Using this technology, we have imaged the full length of hu-man Eustachian tube and figured out. Methods: 5 adult patients (5 Eustachian tube) with chronic otitis media were examined using OCT during surgery. The OCT probe was inserted from middle ear to nasopharynx and the scan system was introduced backward to obtain the entire morphology of E-tube. Results: Entire imaging of the Eustachian tube was obtained with a characteriza-tion of the 2 different portions: an osseous posterolateral portion and a fibrocartilaginous anteromedial portion. Also, the total length of the Eustachian tube was mea-sured as the length of the adult eustachian tube is known to be 31 to 44 mm in adults. The length of the osseous part was about 14mm, accounting for about one-third of the total length. The length of the fibrocartilaginous part was about 31mm, accounting for about two-thirds of the total length. In addition, these two portions were overlapped by about 6mm for the cartilage extends into the roof of the osseous part. Conclusion: The anatomical structures such as the length, portion of the Eustachian

ic endonasal transpterygoid approach of petrous apex cholesterol granuloma with literature review.

» RHPX-04

» A NOvEL TECHNIQUE FOR CORRECTINg HIgH SEPTAL DEvIATION - HIgH SEPTAL AN-CHORINg SUTURE TECHNIQUE


NATIONAL MEDICAL CENTER

KYUNG WON KWON, JIN SEOK OH, JAE-GOO KANG, SUNG HEE KIM

Correcting deviations of the high septum can be chal-lenging because of cartilage memory, the need to provide adequate dorsal septal support, and the long-term effects of healing. The authors describe a high septal anchoring suture technique to the correction of high septal devia-tion. The procedure involves a hemitransfixion incision, mucoperichondrial flap elevation, and wedge resection of excessive septal cartilage. For correcting the high septal deviation, two suture holes were made at the contralateral nasal bone above the keystone area after minimal skin in-cision (about 2mm) and then deviated high septal carti-lage was gently repositioned to the midline by anchoring it to the contralateral nasal bone.

» RHPX-05

» FOREIgN BODY BULLETS OF AIR RIFFLE IN THE ROOF OF ETHMOID SINUS

FACULTY OF MEDICINE UNIVERSITY

MUHAMADIYAH OF SUMATERA UTARA

SITI MASLIANA SIREGAR

Foreign body in the etmoid sinus presents in a challenges, it is related to the sinus anatomy complex paranasal and adjacent to important structures, such as the eyes, lamina cribrosa, dura, arteries and nerves. Other difficulties in cases of bullet trauma or explosion, which causes destruc-tion of soft tissue and bone, resulting in local anatomical distortion. Endoscopy surgery become the best approach. We reported a Male, 25 years old, with the main com-plaint was pain in the top of the nose near to the right eye. The history of being shot by air rifles was found, and

April27(Sat)




Inferior turbinate pneumatization is a rare cause of infe-rior turbinate enlargement. Suspected cases need careful examination and evaluation using Computed Tomogra-phy (CT) scan of paranasal sinuses followed by a tailored management plan. Here we are reporting three cases of inferior turbinate pneumatization including their clinical assessment and CT scan of paranasal sinuses along with their surgical management. The case series is followed by literature review of this entity and its management.

» RHPX-09

» TWO CASES OF RHINOPLASTY OF CLEFT LIP NOSE DEFORMITY


NECK SURGERY, CHOSUN UNIVERSITY COLLEGE

OF MEDICINE,

DO YOON JEONG, JI YOON CHOI, JI HYE HAN

Reconstruction of the cleft lip nasal deformity remains an ongoing challenge for the facial plastic surgeon. The deformity is a complex, three-dimensional alteration in nasal anatomy with defects in all tissue layers: skin, car-tilage, vestibular lining, and bone. The asymmetric nasal tip results from the irregularly formed lower lateral carti-lage on the cleft side. Although not ubiquitously accept-ed, the length of the lower lateral cartilage on the cleft side is considered equal to the noncleft side, primarily differing in shape and position. On the cleft side, the me-dial crus is shorter and the lateral crus longer, with a less defined and wider dome. This results in a poorly defined nasal tip with less projection. These procedures essential-ly involve a dissection of the alar cartilages, with suture suspension of the cleft side alar cartilage to reposition it into a more normal position. Although these techniques have certainly improved the results of the nasal deformity and overall symmetry, rhinoplasty may still be necessary as the child grows. We experienced two cases of the pa-tients with unilateral cleft nasal deformity. In this study, we performed rhinoplasty of cleft lip nose deformity.

» RHPX-10

» SECONDARY AUgMENTATION RHINOPLAS-TY WITH DERMOFAT gRAFT IN PATIENT WITH THE MASS OF NASAL DORSUM

tube examined using OCT showed similar results to the well-known statistical value. This study has great signifi-cance in that it is the first study to demonstrate the full length of E-tube using the OCT.

» RHPX-07

» PALATAL FISTULA IN A PATIENT WITH NOR-MAL PALATE AS A RARE COMPLICATION AF-TER SEPTOPLASTY


AND NECK SURGERY,


JI-HYEON SHIN

Septoplasty is a commonly used procedure for correcting septal deformities. Many complications such as hemor-rhage, abscesses, adhesions, and septal perforation are often seen after the operation of the septoplasty. Palatal fistula has been reported very rarely in the literature, es-pecially in patients with normal palate. A 20-year- old female patient was admitted to correct nasal septal de-viation. There was no feature in her history and also no sign other than nasal septal deviation on physical ex-amination. After septoplasty, she was doing well except mild nasal obstruction. However, about one month lat-er, she complained of nasal regurgitation during eating and drinking. Small perforation in the junction of hard palate and soft palate was observed. Palatal perforation was repaired with advancement flap. Patient follow-up 2 months after oronasal closure revealed complete healing of the hard palate without the presence of fistula.

» RHPX-08

» PNEUMATIzED INFERIOR TURBINATE_ RE-PORT OF THREE CASES


HEAD & NECK SURGERY, KING FAHD MILITARY

MEDICAL COMPLEX, DHAHRAN, SAUDI ARABIA1,



KYUNG HEE UNIVERSITY, SEOUL, KOREA2

KHALID AL-DILAIJAN1,2, MAI AL-MASOUD1, JIN-YOUNG MIN2, SUNG WAN KIM2

April27(Sat)




SAL vESTIBULAR STENOSIS


GYEONGSANG NATIONAL UNIVERSITY HOSPITAL1,



CHANGWON HOSPITAL2

YOUNG CHUL KIM1, YUNG JIN JEON1, YEON-HEE JOO2, HYUN-JIN CHO1

Nasal vestibular stenosis is an uncommon cause of nasal obstruction. There are various causes of the narrowing of vestibule including previous trauma, surgery, infection, and iatrogenic injury. The disease is characterized by cir-cumferential scar retraction in inlet of nasal cavities that caused by secondary proliferation of granulation and fi-brous tissue. A number of studies were reported about surgical correction of vestibular stenosis, but no single technique had been widely accepted due to wide spec-trum of the disease extent and various deformity of relat-ed anatomy. Here we present a case of vestibular steno-sis caused by trauma. A 52-year- old woman visited the clinic with complaint of left-sided nasal obstruction cause by circumferential scarring of soft tissue in her left nasal vestibule. She had a history of nasal blunt trauma in her childhood, after then simple, augmentation rhinoplasty had been performed in her 3rd decade. The lesion was successfully corrected using incision and bi-directional flap surgery with anterior base. As the stenotic portion is confined in skin and soft tissue, both subjective symptom and endoscopic finding were improved over follow-up periods.

» RHPX-13

» APPROACH AND CONSIDERATIONS IN PAE-DIATRIC SOFT TISSUE CHEEK TRAUMA. A CASE REPORT

DEP. OF PLASTICS AND RECONSTRUCTIVE

SURGERY, WOMEN'S AND CHILDREN'S HOSPITAL

HSU PHIE CHONG, PUVESH PUNJ

Paediatric soft tissue facial injuries is both traumatising and challenging in plastic surgery. Animal bites, in partic-ular dog bites, are common. In Australia, it has been esti-mated that approximately 2% of the population is bitten




JI HYE HAN, JI YUN CHOI, DO YOON JEONG

Autologous materials remain the preferred graft material for use in rhinoplasty, owing to their high biocompati-bility and low risk of infection and extrusion. The only complication encountered was infection, which resolved with antibiotic therapy without graft extrusion. Dermo-fat was an autogenous material that could be as effectively used in nose dorsum. Its clinical record of survival and contouring in the author's practice has been excellent. In this study, We experienced a case of secondary rhinoplas-ty using dermofat graft in a 60 year male complaining of nasal dorsum mass. Through the open rhinoplasty inci-sion, granuloma was removed under direct vision. Saline irrigation and meticulous hemostasis were performed. Simultaneously, the secondary depressed nasal deformity was corrected with autogenous dermofat graft harvested from inferior gluteal fold.

» RHPX-11

» ENDOSCOPIC REPAIR OF THE FRONTAL BONE FRACTURE - REPAIRINg WITHOUT SCARS ON THE FACE



MEDICINE, THE CATHOLIC UNIVERSITY OF KOREA

DO-HEE LEE, HO-JOON JIN, YUPYO HONG, DONG-CHANG LEE, JOOHYUNG LEE

Frontal bone fractures frequently require an open ap-proach. It usually remains the stigmata of surgery on the face, although not evident. We presented the 23-year-old young man, who was hit by the ball in the baseball game and got the medial side of the frontal bone fractured and depressed medial brow. He underwent the operation via the endoscopic endonasal approach, followed by balloon supporting. Also, the advantages of this approach and limits and pitfalls are discussed with the literature review.

» RHPX-12

» A CASE OF SURgICAL CORRECTION OF NA-

April27(Sat)







YEON-SEOK YOU1, JONG-SEUNG KIM2, SAM-HYUN KWON3

Fungal pathogens are well known to cause severe and fatal opportunistic infections in immuno-compromised pa-tients. Among fungal pathogens, invasive Aspergillosis is especially a leading cause of death, due to its rapid infec-tion progress and intracranial spread. Invasive aspergillus infection may occur through various sites such as the re-spiratory tract, broken skin barrier, cornea and the ear. In this paper, the infection site of interest is the respiratory tract, especially the sinuses. Invasive Aspergillosis infec-tion of the sinuses is extremely rare. Yet the consequences of fungal infection of the sinuses may be fatal if not diag-nosed properly at an early stage. We discuss three cases of Aspergillosis sphenoid sinusitis that were misdiagnosed, and led to unfavorable consequences.

» RHPX-16

» OPTHALMOPLEgIA DUE TO SINUSITIS: 3 CASES REPORT




JEONJU, KOREA

SU GEUN KIM1, JONG HWAN LEE2, CHA DONG YEO3, JONG SEUNG KIM4,

SAM-HYUN KWON5

The orbital apex refers to the posterior confluence of the orbit at the craniofacial junction, where nerves and vessels are transmitted from the intracranial compart-ment into the orbit via several bony apertures. An or-bital apex syndrome is a syndrome involving damage to the oculomotor nerve, trochlear nerve, abducens nerve, and ophthalmic branch of the trigeminal nerve (V1) in association with optic nerve dysfunction. Infection, in-flammation, and neoplastic conditions, and vascular causes may cause orbital apex syndrome. The optic canal lies near inferior root of the lesser wing of the sphenoid. Therefore, sphenoid sinusitis can cause orbital apex syn-drome. Usually, visual loss, ophthalmoplegia and dip-

by a dog annually. Disfigurement following trauma, be-comes a social stigma and has the gross detrimental effect on the personality and future of the victim. Children are more vulnerable to injuries in the craniofacial region due their low stature, propensity to crawl/play on the ground and exploratory behavior. We present a case of complex soft tissue facial laceration sustained from a dogbite. We discuss the treatment options and special considerations in management of cases in this age group.

» RHPX-14

» TWO CASES OF ACUTE ISOLATED SPHENOID SINUSITIS IN CHILDREN


GYEONGSANG NATIONAL UNIVERSITY HOSPITAL1,



CHANGWON HOSPITAL2

SOMI RYU1, YEON-HEE JOO2, HYUN-JIN CHO1, SANG-WOOK KIM1, YUNG JIN JEON1

Acute isolated sphenoid sinusitis is a rare disease, espe-cially in young children. Delayed diagnosis usually occur in many cases and it is difficult to recognize its atypical presentation on history and examination alone. We re-port two cases of previously healthy 6 year old girl and 13 year old boy, whose symptoms at presentation were uncontrolled headache and high fever over 40℃. Physi-cal examination and initial laboratory investigations were normal. Diagnosis was made after brain MRI revealed bilateral sphenoid sinusitis. The one girl was treated with 3rd generation cephalosporin. Although under medical treatment, the other boy manifested eyeball swelling and underwent endoscopic sinus surgery in an emergency. Both cases had good outcomes, without neurological se-quelae or other complications. Optimal antibiotic ther-apy is essential and immediate surgical drainage can be required in the cases of persistence or manifestation of orbital or intracranial complications.

» RHPX-15

» INvASIvE FUNgAL SINUSITIS OF SPHENOID SINUS IN IMMUNO-COMPROMISED PATIENTS REPORT OF THREE CASES

April27(Sat)




which is usually asymptomatic but can be implicated in the cause of the inflammatory sinus disease and of nasal obstruction. In this report, we present a unique anatomi-cal variant of the middle turbinate, a concha bullosa con-taining another concha bullsa.

» RHPX-19

» SUBgALEAL ABSCESS DUE TO ODONTOgENIC INFECTION A CASE REPORT


AND NECK SURGERY SANGGYE PAIK HOSPITAL,

COLLEGE OF MEDICINE, INJE UNIVERSITY

SEUNG HO KIM1, KI JIN LEE2, KYOUNG RAI CHOI

In this report, we describe a case of Subgaleal abscess due to odontogenic infection. A 66-year-old male who had been suffering from headache and left frontal area swelling for 3 days visited the Department of Otorhino-laryngology-Head and Neck Surgery at the Sanggye Paik Hospital(Seoul, Korea). Clinical examination, contrast enhanced CT concluded to a Subgaleal abscess due to odontogenic infection

» RHPX-20

» A CASE OF NODULAR FASCIITIS AT PERINA-SAL REgION

MARYKNOLL MEDICAL CENTER

GYO HAN BAE, JUNG SUK KIM, TAE YOUNG JUNG, TAE JUNG PARK

Nodular fasciitis is a rare benign tumor-like fibroblas-tic proliferation of unknown etiology, most commonly located in the extremities and trunks in young to mid-dle-aged adults. Due to its rarity and more sinister disease entity mimicry like a sarcoma they can pose a challenge to surgeons. Herein, we present a case of 68-year-old pa-tient who presented with a perinasal painful swelling for a month, that was proven to be nodular fasciitis on his-topathology.

lopia are the initial clinical manifestations of an orbital apex syndrome. However, recently, we experienced three cases of ophthalmoplegia with sinusitis in a sinus other than the sphenoid sinus. 2 of 3 patients had oculomotor nerve palsy and 1 of 3 patients had abducens nerve palsy. They went through surgical treatment, and subsequently improved opthalmoplegia. So we report this case with a review of the literature.

» RHPX-17

» HEMOPTYSIS AS A UNIQUE SYMPTOM PRE-SENTINg FUNgUS BALL LOCALIzED IN POS-TERIOR ETHMOID SINUS


WONKWANG UNIVERSITY SCHOOL OF MEDICINE

MYEONG SIN KANG, DONG HWAN OH, DONG HYUN KIM, JAE HOON LEE

Hemoptysis is defined as the expectoration of blood, alone or mixed with mucus, from lung parenchyma or respiratory tract. Bronchitis, pneumonia, bonchietasis, asthma, chronic obstructive pulmonary disease, and ma-lignancy are the common causes of hemoptysis. So, the initial step in the evaluation is determining the origin of hemoptysis. A woman with chronic hemoptysis as her only complaint had the examinations such as bronchos-copy, chest CT and did not find out the cause. CT of the paranasal sinuses identified a localized lesion in posterior ethmoid sinus which, on surgical exploration, was found to be the result of a fungus.

» RHPX-18

» ANOTHER CONCHA BULLOSA INSIDE THE CONCHA BULLOSA


WONKWANG UNIVERSITY SCHOOL OF MEDICINE

MYEONG SIN KANG, DONG HWAN OH, DONG HYUN KIM, JAE HOON LEE

Different types of the middle turbinates including penu-matized, paradoxically curved, lateralized, hypertrophic or hypoplastic ones have been reported. Concha bullosa of the middle turbinate is frequent anatomical variant,

April27(Sat)




removal of the lesion from the inner surface of frontal sinus. The patient made an uncomplicated recovery, there was no recurrence at two years follow-up. Mini osteoplas-tic flap combined endoscopic approach provides advan-tages in overcoming the difficulty of insufficient exposure of defects during trans-nasal endoscopic procedure but also improving the success rate of operation.

» RHPX-23

» CHOLESTEROL gRANULOMA OF THE MAx-ILLARY SINUS PRESENTINg AS ANTROCHO-ANAL POLYP



MEDICINE, WONJU, SOUTH KOREA

SEUNG WON PAIK, YOUNG SUB LEE, CHI SANG HWANG

Cholesterol granuloma is a granulomatous reaction to cholesterol crystal precipitated in the tissue, common-ly found in the mastoid cavity or middle ear. Since it is rarely found in sinonasal region, with the etiology nor the clinical manifestations not yet known. Here we re-port a 47-year-old man with complaints of nasal obstruc-tion and hyposmia since several years. Nasal endoscopic examination revealed a nasal polyp in the left middle meatus, and computed tomography scans showed total opacity of left maxillary sinus and a thin rimmed expan-sile lesion within antrum. During the endoscopic sinus surgery, fibrous granulation tissues were observed around the antrochoanal polyp, which was found to be cholester-ol granuloma in the histopathological examination. After discharge and a 10-month follow-up period, examina-tions found no recurrence or complications.

» RHPX-24

» MELANOTIC ONCOCYTIC METAPLASIA OF THE NASOPHRYNx FOUND IN A 56-YEAR-OLD FEMALE WITH SUSPICIOUS HEMOPTYSIS


HEAD AND NECK SURGERY, INJE UNIVERSITY

COLLEGE OF MEDICINE, ILSAN PAIK HOSPITAL

TAEK-YOON CHEONG, ICK-SOO CHOI

» RHPX-21

» OPTIC NEUROPATHY CAUSED BY ISOLAT-ED ETHMOID SINUS MUCOCELE


HEAD AND NECK SURGERY, EWHA WOMANS


JU HYUN YUN, SU JIN KIM, JUNG HO BAE, SO JEONG KIM

An Onodi cell is the most posterior ethmoid cell that pneumatizes laterally and superiorly to the sphenoid si-nus and is closely associated with the optic nerve. Given the proximity of the adjacent optic nerve, lesions of the Onodi cell may present with vision changes as the pro-cess extends beyond the borders of the cell or expands the osseous margins. An isolated mucocele of an Onodi cell causing optic neuropathy has been reported rarely. We present a rare case of compressive optic neuropathy in a 35-year-old woman secondary to an Onodi cell mu-cocele, which is likely to misdiagnose to optic neuritis. The mucocele was managed successfully by endoscopic marsupialization, but the vision was not improved after 10 weeks after the surgery. A lesion in an Onodi cell may be associated with ocular symptoms even if the lesion is isolated or small. Imaging studies should be considered for the differential diagnosis because early diagnosis and prompt surgical treatment for mucocele are needed for recovery of visual function.

» RHPX-22

» MINI-OSTEOPLASTIC FLAP THROUgH SUPRA EYEBROW INCISION FOR PRIMARY FRONTAL SINUS SQUAMOUS CELL CARCINOMA



UNIVERSITY HOSPITAL

YU-MI LEE, KEUN-IK YI, SUNG-DONG KIM, KYU-SUP CHO

A 53-year-old man presented with primary frontal si-nus squamous cell carcinoma. The frontal sinus was ap-proached via a mini osteoplastic flap through an extended Lynch incision. A rigid endoscope was used to visualize

April27(Sat)




requires further investigation.

» RHPX-26

» COExISTENCE OF ANTROCHOANAL POLYP AND FIBROUS DYSPLASIA IN THE MAxILLA



UNIVERSITY MEDICAL SCHOOL, HWASUN HOSPITAL

DONG HOON LEE, BONG MIN SHIN, KYUNG SEOK PARK, JAE GU KIM,

SUNG MIN JIN, SUNG HOON KANG, TAE MI YOON, JOON KYOO LEE,

SANG CHUL LIM

We report an unusual case of coexistence of antrochoanal polyp (ACP) and fibrous dysplasia (FD) in the maxilla. To the best of our knowledge, this condition has never been reported in the literature. The complete removal of the ACP through endoscopic sinus surgery was attained and FD was ultimately diagnosed by histopathological exam-ination. It is hypothesized that chronic inflammation or ir-ritation due to FD has an effect on the occurrence of ACP.

» RHPX-27

» A CASE OF ATYPICAL CARCINOID TUMOR OF THE NASAL CAvITY


GANGNEUNG ASAN HOSPITAL, UNIVERSITY OF

ULSAN COLLEGE OF MEDICINE

MIN JUN SHIN, HYUN GI SOHN, SEUNG JIN PARK, NAM-KYOUNG YEO

Neuroendocrine tumors are uncommon in the nasal cav-ity. They can be classified into typical carcinoid, atypi-cal carcinoid, small cell carcinoma, and neuroendocrine type. Among them, atypical carcinoid tumor of the nasal cavity was extremely rare, so the treatment has not been established. The tumor histology correlates closely with patient prognosis. We report a case of atypical carcinoid tumor of the nasal cavity in a 46-year-old man who treat-ed by conservative surgery using sinus endoscopy. To the best of our knowledge this is the first report on an atypi-cal carcinoid in the nasal cavity.

Melanotic oncocytic metaplasia(MOM) of the nasopha-ryngeal space is an extremely rare lesion. Only 25 cases were reported in English literature before, and most pa-tients were East Asian male between age of 60 to 70. MOM presents brown or black colored lesion with a slight eleva-tion of mucosa. They are benign lesions, defined as cellular enlargement with eosinophilic granular melanin-pigment-ed cytoplasm caused by mitochondrial accumulation, but may lead physicians to misjudge it as other malignant le-sions. Recently, We've experienced a case of MOM of the nasopharynx. 58-year-old woman was admitted to internal medicine department presenting small volume hemopty-sis, and consulted to ENT department for evaluation. She was a regular smoker without any medical history. Sinus endoscopy showed black pigmented lesion on both torus tubaris and left posterior tonsillar pillar, but bleeding from the lesion was unlikely. Excisional biopsy of the lesion was performed, and oncocytic metaplasia was confirmed pathologically. So, melanotic oncocytic metaplasia in the nasopharynx should be clinically recognized, as it may be misdiagnosed as a malignancy like melanoma.

» RHPX-25

» A CASE OF CONCURRENT NON-INTESTINAL TYPE ADENOCARCINOMA AND INvERTED PAPILLOMA IN A MAxILLARY SINUS


HEAD AND NECK SURGERY, DONGGUK

UNIVERSITY COLLEGE OF MEDICINE, ILSAN

HOSPITAL, GOYANG, KOREA

YOUN WOO KIM, JUNG WOO SHIN, SANG WOO KIM, SEOK-WON PARK

Inverted papilloma is a benign epithelial tumor that arises from the sinonasal epithelium and occurs in 0.5%-4% of all sinonasal tumors. Inverted papilloma is a benign tumor, it is associated with malignant transformation in 2%-27%, and the most commonly accompanying malig-nant tumor is squamous cell carcinoma. Malignant trans-formation into adenocarcinoma is extremely rare, with two cases reported worldwide to date. Here, along with a literature review, we report a recent case of 53-year-old man with non-intestinal type adenocarcinoma associated with a sinonasal inverted papilloma. This case shows the possibility of a malignant transformation of inverted pap-illoma into non-intestinal type adenocarcinoma, which may be associated with human papilloma virus and thus




Program at a GlanceApril 28(Sun)



7:00

7:30

8:00

8:30

임상특강 IKorean9:00

연구 활성화 심포지움

Korean

개회식 & 축사

9:30 전체특강 IKorean

10:00 임상특강 IIKorean

10:30 전체 특강 IIKorean

Coffee Break11:00

필수특강

*필수평점 강의Korean

11:30

12:00

정책특강Korean

12:30

Luncheon SymposiumLuncheon

13:00

13:30

[교양세미나] 와인, 자동차

Korean

[임상세미나 I] 청력검사법 비디오강의

Korean

윤리특강

*필수평점 강의Korean

14:00

14:30

[임상세미나 II] 소아이비인후과

Korean

[임상세미나 III] 비부비동염

Korean15:00

15:30 Coffee Break

[심포지움 I] LPR/geRD

Korean

[심포지움 II] 알레르기 면역치료

패널토의Korean

16:00

16:30

17:00

Closing Ceremony17:30

18:00






7:00Poster exhibition

7:30

8:00

감정서 작성요령

Korean

Poster exhibition

8:30

9:00

OT-SP 6Recent advances in Otology (asian-

Oceanian association of Otolaryngology-

Head and neck Surgery Symposium)

OT-SP 7(Basic Research in

Hearing Loss)

RH-gD 1(How to Diagnose and Treat Pediatric

Rhinosinusitis)

HnOP 8 (Basic)

RH-SP 6(What’s new in

Obstructive Sleep apnea Management)

Hn-gD2(Korean guideline for the Management of unilateral Vocal Fold

Paralysis)

9:30

10:00

10:30

11:00

OT-SP 8(Vestibular

Rehabilitation)

OT-SP 9(How to Maximize Convenience and

Satisfaction of Hearing aids users?)

RH-SP 7(unique Role of Immune Cells in airway Mucosal

Diseases)

HnOP 9(Larynx & Voice)

RH-SP 8(RH-aSean Symposium)

Hn-SP 9(aSHnO Symposium:

update on the Management of nPC)

Poster exhibition

11:30

12:00

12:30

Luncheon Luncheon13:00

13:30

언론에 비친 이비인후과

KoreanOT-SP 10

(Cochlear Implantation in Challenging Cases)

Hn-SP 10(Recent updates :

Immunooncolgy in Head and neck Cancer)

HnOP 10(endoscopic & Robotic

Surgery)

Hn-SP 11(TSOHnS)

14:00

14:30

HnOP 11(neck)15:00

기자간담회

Korean15:30Coffee Break Coffee Break

16:00

OTOP 13(Best Oral Presentation)

RHOP 12(Best Oral Presentation)

Korean Society of Thyroid-Head and neck

Surgery endoscopic & Robotic Surgery

Committee: update of Transoral

Thyroidectomy

Korean

HnOP 12(Other Head & neck

Disease)

HnOP 13(Best Oral Presentation)

Poster exhibition

16:30

17:00

17:30

18:00

April28(Sun)




OT-SP 6Room 2-1 (Flamingo)

Moderator : SHENG-PO HAO, SEUNG-HA OH

Recent Advances in Otology (Asian-Oceanian Association of Otolaryngology-Head and Neck

Surgery Symposium)

» 09:00~09:20

» EARLY HEARINg LOSS DETECTION AND IN-TERvENTION


MOO KYUN PARK

Hearing loss is the most common developmental disorder identifiable at birth and its prevalence increases through-out school‐age due to the additions of late‐onset, late identified and acquired hearing loss. Results of several studies show that early screening and detection of hearing disorders, and timely intervention prevents delayed lan-guage development and improves general developmental outcome. Under identification and lack of appropriate management of hearing loss in children has broad eco-nomic effects as well as a potential impact on individual child educational, cognitive and social development. Uni-versal newborn hearing screening (UNHS) has extended and now cover more than 95 % of newborn in Korea. The most widely used audiometric test is aABR or OEA. The government started to finance the whole Universal newborn hearing screening (UNHS) from 2018. Howev-er, further quality control should be followed to improve the detection rate. It is estimated that 9‐10 per 1000 chil-dren will have identifiable hearing loss in one or both ears by school‐age. The presumption of hearing based on a child’s behavior in everyday situations has been shown to be faulty by several studies documenting outcomes from the use of parent questionnaires. Pure tone audiometry (PTA) seems to be the best choice for the screening test for it. However, preschool hearing screening program us-ing PTA is not implemented yet in Korea. Benefit of early hearing loss detection and intervention will be handled in terms of cost-effectiveness.

» 09:20~09:40

» IMPLANTABLE HEARINg DEvICE UPDATE

SINGAPORE GENERAL HOSPITAL. SINGAPORE

BARRIE TAN YAU BOON

TBD

» 09:40~10:00

» ENDOSCOPIC STAPES SURgERY -IS IT COMPARABLE WITH MICROSCOPIC SUR-gERY


SHIN-KONG WU-HO-SU MEMORIAL HOSPITAL

HSINGMEI WU

Stapes surgery is mainly done using the time-tested oper-ating microscopes. Recently the number of reports about endoscopic ear surgery has been increasing. The surgical technique is suitable for chronic otitis media, malforma-tions of the auditory ossicles, traumatic damage to the ossicles, some limited cholesteatoma disease and other disease. Among the indications, otosclerosis is considered a suitable but challenging disease for endoscopic ear sur-gery. Otosclerosis is not a common neither rare disease in Asian. We will discuss endoscopic stapes surgeries in treating patients with otosclerosis, and analyze the po-tential advantages, disadvantages, and hearing outcomes, compare the results with microscopic surgery.Also, we will share some tips about endoscopic stapes surgery.

» 10:00~10:20

» COCHLEAR IMPLANT IN ASEAN COUNTRIES AN OvERvIEW

KPJ HEALTHCARE UNIVERSITY COLLEGE

LOKMAN BIN SAIM

Cochlear implant has been accepted as the standard treat-ment for individuals with severe to profound hearing loss. In the more advanced countries, cochlear implant programs are readily available and accessible to most chil-dren and individuals who require cochlear implantation. The incidence of hearing loss from congenital or acquired causes such as ear infections, in the ASEAN countries is relatively high. However, the availability of cochlear im-plant programs is very much dependent upon the eco-

April28(Sun)


April 28(Sun) Otology


was decreased except ETD . ETD caused by post-radiat-ed NPC was varied. At first 10 years, ET was obstructed by inflammatory process and myodysfunction. After 10 years, many of the ETs became patulous. We will show our preliminary results for ET tuboplasty for this group of patients.

OT-SP 7Room 2-2 (Skylark)

Chair : NORIO YAMAMOTO, SEUNG GEUN YEO

Basic Research in Hearing Loss

» 09:00-09:20

» A CURRENT PERSPECTIvE HEARINg PRES-ERvATION BY INSULIN-LIKE gROWTH FAC-TOR 1

KYOTO UNIV. GRADUATE SCHOOL OF MEDICINE,

DEP. OTOLARYNGOLOGY, HEAD AND NECK

SURGERY

NORIO YAMAMOTO

Sensorineural hearing loss is considered an intracta-ble disease, given that hair and supporting cells of the postnatal mammalian cochlea are unable to regenerate. However, several innovative approaches for achieving regeneration or protection of inner ear hair and sup-porting cells have become available. These methods in-clude stem cell transplantation, overexpression of specific genes, and treatment with growth factors. Among several kinds of growth factors, we have investigated the role of insulin-like growth factor-1 (IGF1) in cochlear hair cell protection. In in vivo experiments, we showed that IGF1 protected mammalian cochlear hair cells from noise ex-posure or ischemic stress. Using the cochlear explant cul-ture system, we elucidated that IGF1 protects hair cells through activation of two major pathways downstream of IGF1 receptor signaling. Promotion of the cell-cycle in supporting cells as well as inhibition of hair cell apop-tosis was observed in the IGF1-treated group. Two im-portant observations were obtained through clinical trials performed for the treatment of idiopathic sudden sen-sorineural hearing loss cases. One observation was that

nomic standings and healthcare standards in the ASEAN countries. Malaysia and Singapore were the first countries to start cochlear implant programs in 1995. This was fol-lowed by Thailand and Philippines in 1996. Indonesia es-tablished its program in 2002, together with Brunei and Vietnam. Myanmar started cochlear implant program in 2011 and more recently, cochlear implant programs have also started in Cambodia. The author has no informa-tion from Laos and Timor Leste. With limited funding from the government, the high cost of cochlear implant is one of the major factor that makes this technology not made available to the majority of individuals who require cochlear implant. However this is not the only limiting factor. ASEAN countries also need to step up its effort in training a bigger pool of healthcare professionals to deal with the overall management of children with hearing loss. There is a dire need to train more ENT surgeons in otology, and to establish educational programs that train audiologists and speech- language pathologists profes-sionally. Programs for early detection of hearing loss in children, prevention of acquired hearing loss and prop-er hearing and speech rehabilitation can be enhanced in ASEAN countries when more of these professionals are available.

» 10:20~10:40

» EUSTACHIAN TUBOPLASTY FOR POST RA-DIATED NASOPHARYNgEAL CARCINOMA AND TINNITUS PATIENTS

CHANG GUNG MEMORIAL HOSPITAL, KEELUNG,

CHANG GUNG UNIVERSITY, TAIWAN

WEI-CHIEH CHAO

Eustachian Tube Dysfunction (ETD) is a condition in which this function is compromised, either due to ob-struction or abnormal patency. Obstructive ETD is esti-mated to occur as a chronic condition in approximately 4% of adults worldwide, but it is an intermittent problem in an unknown higher percentage. In recent years, trans-nasal endoscopic Eustachian tuboplssty made changes in ETDs. Balloon was applied for obstructive ETD and Different procedures (shim insertion, obliteration of ET, and augmentation injection) aided by angle endoscopic equipment have been used for repair of patulous ET. The developments of Radiotherapy techniques have raised sur-vival of nasopharyngeal carcinoma, with précised image guide radiotherapy , many post radiation complication

April28(Sun)




Sensory nervous system, especially central nervous sys-tem (CNS) is developed after birth and it is continued to adulthood. Neural plasticity is a broad range of phenom-ena. Plasticity means that the change of the neural system after some impacts including injury, learning, experience, and recovery. Auditory neural plasticity was defined as alterations in structure, connection or function that oc-cur in response of hearing loss, injury or overstimulation. After hearing loss, central auditory system has several changes to adapt or to compensate for hearing loss. Neu-ral system consists of several neural components such as neurons, glial supporting cells and perineural network. After hearing loss, so many neuronal changes have been reported according to substructures. Axon is a long pro-jection of a neuron and it transmit the neuronal infor-mation as an electrical form to other neurons. Axon con-tains many microtubules and neurofilaments and these are known as cytoskeleton of axon. In some conditions of CNS such as multiple sclerosis, a functional change of neurofilament was reported. Phosphorylated neurofila-ment was stable and functioned as a cytoskeleton, howev-er, in the pathologic state, it turned to non-phosphorylat-ed and became unstable. After hearing loss, some changes of neurofilament also observed in the rat experiment. In the inferior colliculus and auditory cortex, some portion of neurofilament heavy chain were changed to non-phos-phorylated state from phosphorylated state. It could be an evidence of axonal plasticity and rewiring of neuronal connection after hearing loss.

» 10:00-10:20

» INNER EAR ORgANOID, READY?



DANKOOK UNIVERSITY

MIN YOUNG LEE

Introduction “Organoid” is multicellular three-dimen-sional in-vitro structure which resembles in vivo organs. They can be generated from one or few cells. These cells can be from a tissue and external source, and respectively called induced pluripotent stem cells and embryonic stem cells. Technique to culture and grow organoid is now enhancing rapidly since 2010 and 2013 it was desig-nated as “Big Advances in Science” along with CRIPR/cas9 by the journal “The Scientist”. To generate the or-ganoid, pluripotent cells are cultivated in 3D medium

the proportion of patients showing hearing improvement was significantly higher in the IGF1-treatment group at 24 weeks after treatment than in the hyperbaric ox-ygen-treatment group. The other was that the change in pure-tone average hearing thresholds over time in the IGF1 treated group was significantly better than those in the intra-tympanic corticosteroid treatment group. As another application of IGF1 to the hearing preservation, the effects of IGF1 on hearing preservation were exam-ined after cochlear implantation to a normal-hearing guinea pig model. IGF1 attenuates loss of low-frequen-cy hearing after cochlear implantation, suggesting its possible clinical use in soft surgeries involving cochlear implants with electric-acoustic stimulation for hearing preservation.

» 09:20-09:40

» INNER EAR CHANgES AFTER COCHLEOS-TOMY – AN ANIMAL STUDY AND CLINICAL IM-PLICATIONS




YONG-HO PARK

In this session, we describe the results of various animal experiments and the clinical significance of changes in cochlea after cochlear implants. We will discuss the func-tional and histological changes of cochlea after cochleos-tomy, the mechanism of dizziness after cochlear implan-tation, and the clinical implications of dexamethasone for hearing preservation.

» 09:40-10:00

» NEURAL PLASTICITY IN THE CENTRAL AU-DITORY SYSTEM



MEDICINE, SMG-SNU BORAMAE MEDICAL

CENTER, SEOUL NATIONAL UNIVERSITY,

SEOUL, KOREA

MIN-HYUN PARK

April28(Sun)




advances of adopting photobiomodultion (PBM) for the stem cell therapy showed that stem cells and progenitor cells have favorable responses to light. PBM has been shown to stimulate different types stem cells to migrate, proliferate and differentiate in vitro [23-25] and in vivo [26]. Meanwhile, very little is known about the effect of PBM on the differentiation of embryonic stem (ES) cells towards the otic lineage. In this study, we determined the optimal condition to differentiate the stem cell into the otic organoid. Different culture techniques and cell den-sity has been tested and effect of photobiomodulation was analyzed. A mouse embryonic stem cell with GFP was used. Embryoid-body (EB) formation was obtained by two methods (monolayer culture and hanging drop technique). For the differentiation of inner ear like organ-oid, on the second day of differentiation, BMP4 and SB431542 were treated for Non- neural ectoderm induc-tion and FGF2 and LDN193189 were treated for Pre- placodal ectoderm induction on the third day of differen-tiation to induce into ectoderm. They were cultured until differentiation Day 6 and were observed until day 18. LEDs (470 nm, 630 nm and 740 nm) were used in mat-uration phase (Day 6 to 8). The cells were directly irradi-ated at an intensity of 40 mW for 750 s per day. Epifluo-rescence (MyosinVIIa, ROS & intracellular calcium lev-el), RT-qPCR and RNA-Seq were analyzed. EB formed by hanging drop was much larger than monolayer cul-ture. The diameter of EBs statistically increased with the increase of cellular density but the largest number of or-ganoids was observed at the density of 4. 0 x 105. It was observed the formation of organoid like structure over time. MyosinVIIa positive cells inside the organoid was observed and confirmed by RT-qPCR. 630 and 740 nm of LED irradiation except 470 nm were increased the or-ganoid formation rate. ROS levels in EB were significant-ly increased at 630 nm, and calcium levels in EB were significantly increased at 740 nm. With the RNA seq analysis among the biological process, nervous system de-velopment-related processes are enriched with only down-regulated genes in PBM groups. Among the down regulated genes Hes5 which inhibits the hair cell transdif-ferentiation process are negatively down-regulated in PBM group. EB formation was generated by hanging drop technique, and differentiation of EBs into inner ear hair cell-like cells were enhanced by PBM with LED. In-vestigation on gene expression showed the factors that are responsible for the therapeutic effect of PBM in the for-mation of otic organoids. Co-culture system for organoid formation HEI-OC1 expresses specific markers of co-chlear hair cells (HCs) and supporting cells which could represent a common progenitor for sensory and support-

which can be generated using and extracellular matrix hydrogel Matrigel. Then these cells aggregate together and usually forms embryoid bodies [1]. Starting this time point, these embryoid bodies are treated with different pharmacologic agent and patterning factors to lead the differentiation process into target organ. Organoids have been created from adult stem cells [2] and cancer cells [3] to achieve the proposed effect. There are multiple uses of organoid both in basic research and for clinic. Organoids are an excellent tool to review target biologic processes. Cellular interactions and their interaction with environ-ment can be easily observed using this technique. Exper-iments using organ culture only evaluates the characteris-tics of the organ, on the contrary experiments using or-ganoid can evaluate the interaction with the other organs. Disease modeling including genetic disease and cancer is another future role of organoid. Drugs to treat certain disease can be used to these organoid model instead using animal models which still has difference of species. So far organoids that has been established are cerebral organoid [4], gut organoid [5], lingual organoid [6], etc. Organoid for other organs are also reported [7-16], ready to be used for different experimental trials. Development of inner ear organoid Inner ear organoid development has been dominantly performed by a research group in Indianapo-lis, Indiana, US. According to their methodology after formation of embryoid body, this stem cell complexes should be led to differentiated into the ectodermal lin-eage, and then neural differentiation should be inhibited to transform the structures into organoids that contains inner ear hair cell like cell [17, 18]. This method uses BMP4 and FGF2, and in some cases Wnt agonist [19-21]. Both mouse [17] and human embryonic stem cell [20] has been successful source of inner ear organoid, af-ter the full differentiation hair cell like cell has observed with proper mechano-electric transduction function [17, 18, 20]. Still, there are no obvious evidence that these structures resembles the cochlear hair cell which transfers sound energy to central nervous system, in fact some of later reports are suggesting that hair cells in this organoid are more close to vestibular hair cell which is the source for balance function rather than cochlear hair cell [22]. Clearly the cochlear structures are more complex and fragile to toxic exposure and tend to be harder to regener-ate, and it seems to be similar in case of organoid differ-entiation. Still, enhancing the effectiveness and further forwarding the differentiation into the cochlear hair cell seems to be necessary at current time point, and author like to introduce couple methods to enhance or ease the differentiation process of inner ear organoid differentia-tion. Differentiation enhancement by light energy Recent

April28(Sun)




death in auditory-brain. Materials and Methods: HEI-OC1 has been used as an auditory cell line. The cell via-bility was determined by cell viability assays. Si-RNA was transfected into cells by lipofection. Western blot analysis was performed to detect molecular signaling pathways. Results: The cell viability after direct exposure of miR-NA let-7b or TLR7 agonist was decreased in time-de-pendent manner, while the number of apoptotic cells were significantly increased. The expression of TLR7 and TRPA1, cleaved-caspase-3 (apoptosis induction maker), LC3-II, Atg-7 and Beclin-1 (autophagy induction mak-er) and p-ERK (cell excitation maker) were increased in miRNA let-7b-exposured cells. Interestingly, the cell viability wasn’t decreased, and the number of apoptotic cells wasn’t increased in miRNA let-7b-exposured TLR7 knock down (KD) cells. TRPA1 agonist increased the ex-pression of TRPA1 and p-ERK. The expression of p-ERK wasn’t induced in miRNA let-7b-exposured TRPA1 KD cells. The expression of TLR7 was decreased in TRPA1 KD cells, correlating with TRPA1. These results indicate that TRL7 and TRPA1 form a complex, enhanced in response to miRNA let-7b. The biochemical interaction between TLR7 and TRPA1 might function as a gatekeep-er of auditory cell excitation. These results indicate that endosomal miRNA let-7b acts as potentially novel TLR7 endogenous ligands, and induced TLR7- mediated cell death and the hyperexcitability via TLR7/TRPA1 bind-ing in auditory cell. Namely, the biochemical interaction of TLR7/TRPA1 was enhanced in response to exosomal miRNA let-7b in auditory cells. Conclusion: Our results reveal that exosomal miRNA let-7b modulates the inter-action between TLR7 and TRPA1, and induce hyperex-citability-induced cell death in auditory cell, serving as a novel biomarker of the hyperexcitability of auditory cell.


Chair : TOSHIAKI YAMANAKA, SUNG-WON CHAE

Vestibular Rehabilitation

» 11:00~11:20

» CONvENTIONAL PERSONALIzED vESTIBU-LAR REHABILITATION FOR PERIPHERAL vES-TIBULOPATHY-OPTIMAL TREATMENT PERIOD

ing cells of the organ of Corti. Several studies have pro-vided evidence of damaging effects of archetypal ototoxic drugs to HEI-OC1 as well as the therapeutic effects of stem cells on them. However, it is unknown if HEI-OC1 cells can promote the differentiation of embryonic stem (ES) cells. The objective of this study is to determine whether the endogenous inductive factors from HEI-OC1 cells can induce the differentiation of ES cells into HC phenotype through co-culture. Embryonic bodies (EBs) were formed using ES cells via hanging drop tech-nique. EBs and dissociated ES cells were co-cultured with a conditioned and inactivated layer of HEI-OC1 cells for 14 days. Differentiated cells were immune-stained for oct4, sox2 and myosinVIIa and quantified for gene ex-pression using PCR and western blotting. The dissociated ESCs coalesced into an EB like form yet smaller than the actual co-cultured EBs. Furthermore, both the co-cul-tured forms of ESCs expressed Myosin7a and only in the periphery showed Sox2 expression. Co- cultured EBs de-veloped organoid outgrowths with Myo7a and Sox2-pos-itive cells after 14 days of contact co-culture with HEI-OC1 cells. Dissociated ESCs form dense EB-like aggre-gates and expressed Myo7a while Sox2- positive cells are only found around the periphery after 14 days of co- cul-ture. ESCs and EBs were also cultured in conditioned medium (CM) from HEI-OC1 cells suspecting soluble factors alone could have a similar effect. However, the ESCs did not form into aggregates yet still showed to be Myo7a positive while the EBs degenerated. The present study suggests that cellular interaction between ES cells and HEI-OC1 cells may stimulate the differentiation of ES cells towards a HC- like cells. However, further work is needed to determine the viability of the differentiated cells to further develop in vivo.

» 10:20-10:40

» TLR7-TRPA1 INTERACTION DRIvES HYPER-ExCITABILITY CELL DEATH MODULATED BY MIRNA LET-7B IN AUDITORY CELLS

KAMIO MEMORIAL HOSP., DEP. OF

OTORHINOLARYNGOLOGY

KEN HAYASHI

Objective: MiRNA let-7b play a major role to regulate cell death through the interaction with TLR7 and control the cell excitation through TRPA1. Our objective is to clarify the mechanism of hyperexcitability-induced cell

April28(Sun)




ST. MARY’S HOSPITAL, DEPARTMENT OF

OTOLARYNGOLOGY-HNS

EUN-JU JEON

Vestibular rehabilitation is one of the essential parts in the treatment of dizziness. Customized vestibular exercise had been approved for new health technology in 2017, and it has been possible to treat dizziness in a comprehen-sive manner. Customized method is considered unsettled and hard to approach since it varies on the individual patient’s functional status and therapist’s knowledge and experience. Since the Customized vestibular exercise was initiated in our hospital in April, 2017, 89 patients were undergone the exercise treatment for control of dizziness and unsteadiness. Vestibular neuritis was the most com-mon etiology. Unilateral vestibular hypofunction, acous-tic neuroma, BPPV, Meniere’s disease, etc. followed as common etiology for CVE treatment. The formal CVE schedule was consisted of 4 sessions of 30 minute of su-pervised exercise at weekly base. After supervised exercise for 30 minutes in the clinic, home exercise 3 times/day was prescribed. 14.1% of patients discontinued the treat-ment after one session. 45.1% of patients completed the whole 4 sessions of CVE. We tried to find what factors determine the compliance to the CVE. The correlation between the number of treatments and the rate of im-provement of dizziness was investigated also.

» 11:40~12:00

» vESTIBULAR PROSTHESIS



COLLEGE OF MEDICINE

SEOK MIN HONG

The vestibular system is a sensory system that is critical-ly important in humans and patients with chronic pro-found bilateral loss of vestibular sensation (also called BVD) were disabling and suffer from oscillopsia, chronic disequilibrium and poor postural control. But, no medi-cal treatment to restore lost vestibular function exists and physical therapy is only mildly effective in BVD patients. Along with the development of cochlear implant technol-ogy, there has been a development of artificial vestibular implant or prosthesis that can help patients with chronic bilateral vestibulopathy for the past 10 years. The vestib-

OF TRAININg PROgRAM-

DEPT OF OTOLARYNGOLOGY-HEAD AND NECK

SURGERY, NARA MEDICAL UNIV

TOSHIAKI YAMANAKA

Background and Aim: Vestibular balance rehabilitation therapy (VBRT) is effective for the treatment of balance problems and increases safety and independence in such patients with chronic balance disorders after a unilateral vestibular loss. However it is unclear when to quit the VBRT program for favorable treatment outcomes. In this study, VBRT was performed for a long term to deter-mine optimal period of training program in patients with intractable chronic balance dysfunction due to vestibu-lar balance deficit. Methods: 44 subjects with persisted chronic dizziness and postural imbalance due to unilat-eral vestibular loss determined by significant unilateral caloric canal paresis received VBRT. Our VBRT consists of vestibular/visual-ocular motor related training and vestibular spinal related training to promote vestibular adaptation and improve the laterality of the vestibular system. All of the subjects completed for training sessions 2-3 times per day for total of 12 months. Subjects were regarded as improvement when both of Dizziness Hand-icap Inventory (DHI) and Functional Gait Assessment (FGA) score used to evaluate the severity of the subjects’ balance problems and dynamic stability/ gait function showed normal level. Results: VBRT produced marked improvements in the balance ability of subjects with in-tractable chronic balance dysfunctions due to vestibular deficits and also increased their ability to perform daily activities after 1-month period. Although about 10 % im-provement was assessed between 3 months and 6 months from the starting point, no more improvement was seen in patients at 9 and 12 months from 6 month-treatment. Conclusion: We suggest that the training for conven-tional vestibular balance rehabilitation on peripheral ves-tibulopathy would continue at least from 3 months to 6 months to exhibit a favorable effect.

» 11:20~11:40

» PILOT RESULT AND THE FACTORS OF THE COMPLIANCE TO THE CUSTOMIzED vESTIB-ULAR ExERCISE

THE CATHOLIC UNIVERSITY OF KOREA, INCHEON

April28(Sun)




tractive components of virtual reality may contribute to successful outcomes. Moreover, when we focus on the theoretical background that virtual reality enables visu-al-vestibular interactions by abundant visual stimuli, vir-tual reality likely provides an optimized environment for VR exercises. However, findings on the clinical efficacy of virtual reality for VR are inconsistent. In particular, de-spite growing interest in head-mounted display (HMD) as a popular virtual reality platform for VR, the conflict between the nature of a VR program requiring repeated performance of a task over time with intervention by a supervisor and the difficulty of this type of intervention within the fully immersive environment of HMD could be main adverse effect for VR. Augmented reality can be an alternative in that the device provides a real-world en-vironment to communicate outside. However, the clini-cal optimization for dizzy patients is still in its beginning stages. The issues regarding vestibular rehabilitation using mixed reality (virtual reality or augmented reality) will be addressed in this lecture

OT-SP 9Room 2-2 (Skylark)

Chair : JUN HO LEE, CHANG HYUN CHO

How to Maximize Convenience and Satisfaction of Hearing Aids Users?

» 11:00-11:25

» SELECTINg OPTIMAL HEARINg AIDS AND RELATED OPTIONS SUITABLE TO INDIvIDU-ALS



GI JUNG IM

Hearing aids improve hearing by amplifying soft sounds, helping people communicate with each other. Hearing aids vary in price, size, special features, and placement type in the ear. Hearing aid companies keep making smaller hearing aids to meet the demand of each individ-uals. for a hearing aid that is not very noticeable. A com-pletely-in-the-canal hearing aid is molded to fit inside the ear canal, and is the smallest and the least visible hearing

ular prosthesis consists of a head worn unit containing a gyroscope that senses the three-dimensional rotational angular velocity of the head, three electrodes for stimulat-ing the semicircular canals, and a power and control unit that receives information about the head movement from the gyroscope, processes and modulate the electrical stim-ulation in pulse-frequency way. During the development of the vestibular prosthesis, current spread that stimulates the unwanted nerves around the target nerve in the elec-trical stimulation, and asymmetry of the vestibular reflex that caused by inadequate suppression of the vestibular organ have been raised. However, but researchers are solv-ing these problems in a various way. In this symposium, we will review the outline of the vestibular prosthesis, the development process, and introduce human studies that challenge well-established clinical concepts.

» 12:00~12:20

» IS BENIgN PAROxYSMAL POSITIONAL vER-TIgO TREATED SUCCESSFULLY WITH THE TRv REPOSITION CHAIR?

DENMARK

DAN DUPONT HOUGAARD

TBD

» 12:20~12:40

» AR & vR IN vESTIBULAR REHABILITATION



HALLYM UNIVERSITY COLLEGE OF MEDICINE

SUNG KWANG HONG

Vestibular rehabilitation (VR) is known to be a safe and effective treatment modality for patients with dizziness. Earlier works have demonstrated that patients who are referred to VR programs earlier show less disability and better performance after vestibular deafferentation. How-ever, a few significant concerns have been raised that VR is tedious and requires active effort from patients to achieve better performance. Recently, virtual reality and augmented reality has been highlighted as a supple-mental platform for overcoming these serious concerns. Numerous previous studies have suggested that the at-

April28(Sun)




IOT TECHNOLOgY



UNIVERSITY COLLEGE OF MEDICINE, SEOUL,

KOREA

EUN JIN SON

Today’s rapid advancement of technology is evident in various aspects of our daily lives. The Internet of Things (IoT) is essentially a system of interrelated computing devices, mechanical and digital machines, objects, ani-mals, and it provides the method to transfer data over a network without requiring human-to-human or hu-man-to-computer interaction. The IoT is changing the environment of hearing aid users. Wireless connectivity of newer hearing aids to smartphones and internet can offer methods to better hearing aid performance. Wire-less transmission of sound data between two hearing aids offers opportunities to provide better sound quality, im-proved localization, and convenience. Also IoT connec-tion of the hearing aids can be used to optimize adaptive programs, and set an alert system to send automated au-dio message to the hearing aid user when the doorbell rings. The new concept of connectivity to IoT is expected for further innovation of hearing aid performance and also their interaction with other people and environment.

» 12:15-12:40

» AURAL REHABILITATION

DIVISION OF SPEECH PATHOLOGY AND

AUDIOLOGY, HALLYM UNIVERSITY COLLEGE OF

NATURAL SCIENCES

JIN-SOOK KIM

Hearing loss can have a serious impact on quality of life. For children, while the most obvious impact of childhood hearing loss is on language acquisition, the condition also has consequences for overall literacy, the development of social skills and attitudes, including self-esteem. For adults, the hearing loss can impact primarily with deficits in the activities of speech perception and communication and the limitations imposed by these deficits on partici-pation in social interactions, in employment, in leisure pursuits, and in the enjoyment of sound. The goal of

aid in the ear. However, smaller aids may not have the power to give the patients improved hearing they may expect. The receiver-in-canal (RIC) and open-fit hearing aid are similar to a behind-the-ear hearing aid with the speaker or receiver in the ear canal. A tiny wire, rather than tubing, connects the pieces. Open-fit style keeps the ear canal very open, allowing for low-frequency sounds to enter the ear naturally and for high-frequency sounds to be amplified through the hearing aid. Some hearing aid optional features improve your ability to hear in specific situations: Noise reduction, Directional microphones, Environmental noise control, Wireless connectivity, Re-mote controls, Direct audio input, Rechargeable batter-ies, Synchronization. When looking for the best hearing aid to fit patient’s needs, some important points should be considered. The status of tympanic membrane and correctable causes of hearing loss must be checked in the first stage. Next step is to estimate the patient’s hearing with trustworthy audiological methods. People can usu-ally get a hearing aid with a trial period, and it may take a while to get used to the device and decide whether it is right for them. According to specific demands of the individuals, the hearing aid must be chosen with the con-sideration of multi-optional features.

» 11:25-11:50

» ASSISTIvE LISTENINg DEvICES


COLLEGE OF MEDICINE, DONG-A UNIVERSITY

SUNG WOOK JEONG

Assistive listening devices (ALDs) are systems designed to help people with hearing loss hear better in difficult lis-tening situations. Most of ALDs can be used with a hear-ing aid or a cochlear implant that has a telecoil or blue-tooth system. ALDs help overcome background noises, minimize the negative impact and sound distortions of distance from the sound source, and reduce room rever-berations. The basic function of an ALD is to improve the signal to noise ratio for the listener. This means that desired sounds are amplified, and undesired sounds like noises are minimized. The working mechanism and com-mon types of ALDs were presented in this lecture.

» 11:50-12:15

» CONNECTINg TO ELECTRONIC DEvICES &

April28(Sun)




incomplete partition type 1 and 3, cochlear hypoplasia, cochlear aplasia, and cochlear nerve deficiency are con-sidered as severe IEAs. There has been the long standing concerns on CI surgery for children with severe IEAs for some reasons. CI surgery for children with severe IEAs can be difficult because they are often associated with ab-errant course of facial nerve, CSF gusher during surgery and persistent CSF leakage after surgery and the electrode mis-insertion into the internal auditory canal. More im-portantly the severe IEAs can cause poor speech percep-tion abilities after CI because children with them can also have abnormal distribution of decreased numbers of spi-ral ganglion cells and a paucity of cochlear nerve fibers. Several publications and data from Dong-A University Hospital have shown that children with severe IEAs can obtain the meaningful benefits from CI if the surgery is performed early in life and a customized habilitation is provided. More favorable speech perception outcome can be expected if the child with severe IEA has good cochlear nerve morphology and receives bilateral CI.

» 13:50-14:10

» AUDITORY NEUROPATHY SPECTRUM DIS-ORDER WITH AN INTACT CN8



BUNDANG HOSPITAL

BYUNG YOON CHOI

AUDITORY NEUROPATHY SPECTRUM DISOR-DER (ANSD) IS A DISTINCTIVE TYPE OF HEAR-ING LOSS.It appears that the etiology and manifesta-tions vary depending on the onset age of ANSD. In this talk, we present a series of ANSD cases without any an-atomical abnormality. We molecular genetically analyzed the ANSD cases, dividing them into two groups: prelin-gual vs postlingual. We also present the results of auditory rehabilitation of these ANSD subjects as well.

» 14:10-14:30

» ASYMMETRICAL SENSORINEURAL HEAR-INg LOSS


HEAD & NECK SURGERY,COLLEGE OF MEDICINE,

rehabilitation is to restore quality of life by eliminating, reducing, or circumventing these deficits and limitations for adults and is to minimize developmental delays and facilitate communication, education and social develop-ment for children. Although the simple definition could be “The assessment, intervention, and management of communicative consequences of hearing loss,” there exist many definitions about Aural Rehabilitation(AR). And some historical landmarks regarding AR was overlooked for understanding AR thoroughly. From neuroplasticity of the childhood to the improving quality of life using the AR model for the hearing impairment which was defined by International Classification of Functioning, Disability and Health (ICF: WHO, 2001) are discussed. Regarding the AR service plans, the new trends for AR for children and adults are of interest such as the early systematic fam-ily-centered AR also known as ‘intervention’ and the easy accessible web-based AR. The method, effectiveness, and the future developmental direction of those are reviewed in details. For example, world-wide early intervention technology and contents are introduced with the recent development of the Korean Auditory, language, and cog-nitive Rehabilitation for Infants (KARI) program for the hearing-impaired infants. Development and application of web-based AR in USA and Korea are looked into.


Chair : JAE YOUNG CHOI, SEUNG HWAN LEE

Cochlear Implantation in Challenging Cases

» 13:30-13:50

» SEvERE INNER EAR MALFORMATION CAS-ES INCLUDINg COCHLEAR APLASIA


COLLEGE OF MEDICINE, DONG-A UNIVERSITY

SUNG WOOK JEONG

Inner ear anomalies (IEAs) account for 20~40% of chil-dren with congenital sensorineural hearing loss and most of them are potential candidates for cochlear implanta-tion (CI). Among various type of IEAs, common cavity,

April28(Sun)






JAE YOUNG CHOI

Most annoying problem of Neurofibromatosis type II (NF2) is hearing deterioration. Nowadays pioneers tried not only preserving but also restoring of hearing in those patients. We investigated the results of cochlear implan-tation in patients with neurofibromatosis type II (NF2) and severe to profound hearing loss. 4 patients with NF2 and sever to profound hearing loss underwent cochlear implantation (CII). The follow up periods were varied from 12 months to24 months. We also evaluated the sound field pure-tone threshold, Ling 6 test, and pitch ranking data of these patients. All 4 patients can detect environmental sound after their initial mapping. Howev-er, the pure-tone threshold to sound field stimulation was elevated in the high tone area and 3 patients did not de-tect environmental sound 1 year after operation. Cochle-ar implant was removed in 2 of them for MRI. Cochlear implantation in patients with NF-2 did not show good results in our clinic.

» 14:50-15:10

» ABR RECORDINgS PRE- AND POST CI IM-PLANTATION WHY AND HOW. A gERMAN CLINICAL PERSPECTIvE




CENTER, UNIVERSITY OF COLOGNE, GERMANY.

MARTIN WALGER

The registration of Click-evoked ABR represents the gold standard of objective audiometry at any age to determine the type and degree of hearing loss. The objective eval-uation of hearing loss and the functional status of the auditory nerve and central auditory system is of great im-portance for the indication of hearing aid provision or Cochlear implantation. Due to the low frequency spec-ificity of the Click, the use of narrow- band Chirps has established itself internationally for both frequency-spe-cific ABR and ASSR technology. Especially in the low frequency range around 500 Hz the registration of chirp evoked ABR delivers the most reliable results to evaluate residual hearing. The difference between the subjective

CHUNGNAM NATIONAL UNIVERSITY ,

CHUNGNAM NATIONAL UNIVERSITY HOSPITAL

JIN-WOONG CHOI

Asymmetric sensorineural hearing loss (AHL) is used when hearing in the better ear is not normal, but can be restored using a conventional hearing aid. The other poorer ear is severe to profound hearing loss. The treat-ment of AHL is still debated. Among the different treat-ment options, one strategy indeed relies on the transfer of the sound surrounding the poor ear to the better ear so that it can be perceived, through medical devices such as CROS hearing aids or Bone Conduction devices. In some subjects, this can lead to significant improvements in the appreciation of the quality of sounds perceived in background noise. But these devices only provide a uni-lateral auditory input by stimulating the better ear and, consequently, cannot restore binaural hearing. The cur-rent indications for cochlear implantation (CI) designate that the patient must have bilateral severe to profound sensorineural hearing loss and limited functional benefit from appropriately fitted hearing aids. Limited benefit is currently defined as performance scores of 50% correct or less when evaluated using open set sentences in the ear to be implanted and 50% correct or less in the best-aid-ed condition. The best-aided condition is not clearly de-fined, though widely accepted as the score obtained when the recipient is tested in the bilateral condition. When interpreted in this manner, the current indications for unilateral implantation exclude patients with AHL. For these patients, their bilateral sentence recognition score in quiet often exceeds 60% correct, and they do not meet current candidacy criteria for CI until the better hearing ear worsens. The need for revised indications has been suggested by several researchers, and is gaining momen-tum. There are several studies that demonstrate consider-able benefit among CI recipients whose hearing loss fell outside of the current FDA guidelines. Specifically, inves-tigators have demonstrated CI benefit among adults with AHL and single-sided deafness. In this session, we discuss the benefits and performance outcomes of CI in AHL. In addition, we discuss whether CI candidacy criteria could be expanded in the case of AHL.

» 14:30-14:50

» HEARINg REHABILITATION OF PATIENTS WITH NEUROFIBROMATOSIS TYPE II USINg COCHLEAR IMPLANTS

April28(Sun)




in this study gained significant benefit with bilateral CI. In conclusion,the prolonged time interval would result in asymmetric speech perception abilities,but there may exists a balance or cooperation between the two activated auditory pathways which helps perform good enough in the bilateral condition.The improvement of the first CI may showed us that sensory integration exists between the two pathways in order to reach “an unequal balance” between the two peripheric ears and in these sequential CI users who have prolonged time interval,time interval may not have correlation with the outcomes of the se-quential one and it did not influence the better perfor-mance with bilateral CI.

hearing thresholds and the objective thresholds is less than 10 dB under good measurement conditions. In ad-dition to auditory evoked potentials, electrically evoked ABR provide a useful tool for the pre- and postoperative evaluation of the function of the auditory nerve and cen-tral auditory system. Especially in difficult clinical cases like malformations of the cochlea and/or auditory nerve, acoustic neuroma surgery or auditory synaptopathy/neu-ropathy (AS/AN) this technique can provide important indication criteria or prognostic factors regarding the re-habilitation outcome after cochlear implantation. Post-operatively, the eABR provide useful information about the integrity of the implant and the functional status of the auditory system.

» 15:10-15:30

» A LONgITUDINAL STUDY IN SEQUENTIAL BI-LATERAL COCHLEAR IMPLANTATION USERS ON OUTCOMES OF SPEECH RECOgNITION AFTER PROLONgED TIME INTERvALS

DEPARTMENT OF OTOLARYNGOLOGY, HEAD

AND NECK SURGERY, PEKING UNIVERSITY FIRST

HOSPITAL, BEIJING, CHINA

YUHE LIU

Outcomes of bilateral sequential cochlear implantation show high variability and it may depend on the inter-im-plantation times.This longitudinal study focused on that how did the prolonged length of time interval(Mean time is 15.4 years) affect speech recognition after sequential cochlear implantation. For this purpose, speech com-prehension results of 15 prelinguistic children who un-derwent sequential bilateral cochlear implantation were evaluated. All individuals underwent periodic speech perception testing in quiet and noise.The unilateral data for each side and bilateral were statistically analyzed. A statistically significant difference for speech test perfor-mance was obtained between the first implanted ear ,the second-implanted ear and bilateral CI for all CI users.12 of them finished all the tests at 5 different time points af-ter three months recovery and we have found significant improvement in the first CI alone and bilateral CI condi-tion while there was much slower progress in the sequen-tial CI. Speech test outcomes were evaluated with refer-ence to interval between implantations. There was not a significant correlation between speech test results and the inter-implant interval. Nevertheless,all participants

April28(Sun)


April 28(Sun) Rhinology


RH-GD 1Room 2-3 (White Heron)

Chair : DILYANA VICHEVA, Moderator : YOO SAM CHUNG

How to Diagnose and Treat Pediatric Rhinosinusitis

» 09:00-09:20

» MEDICAL TREATMENT OF PEDIATRIC RHI-NOSINUSITIS

THE CATHOLIC UNIV.

SOO WHAN KIM

TBD

» 09:20-09:40

» WHEN & HOW TO START SURgICAL TREAT-MENT OF PEDIATRIC RHINOSINUSITIS

DPT OTORHINOLARYNGOLOGY-HEAD AND NECK

SURGERY, SAMSUNG MEDICAL CENTER

HYO YEOL KIM

Pediatric rhinosinusitis is a common complication of viral upper respiratory infection (URI). According to the previous clinical researches, it has been found that more than 5 percent of children who suffered from URI might be diagnosed with rhinosinusitis. Especially, it might be challenging to clinicians for managing the children with high risk such as, presenting with severe symptoms, younger than 2 years, attending daycare fa-cilities, or who are suspected antimicrobial resistance. Recently, evidence-based guidelines for the diagnosis and treatment of pediatric rhinosinusitis were introduced by the international societies comprising experts of otorhi-nolaryngology, pediatrics, and infectious disease. In this presentation, I would like to focus on the diagnosis and management of pediatric chronic rhinosinusitis to update and summarize the consensus from these guidelines and recent researches.

» 09:40-10:00

» THE SURgICAL TREATMENT OF PEDIATRIC RHINOSINUSITIS




TAE HOON KIM

The role of surgery in the treatment of pediatric sinusitis is still in evolution. The consensus is that initial manage-ment should be based primarily on antibiotics and when maximal medical management fails, then surgery should be considered. In this presentation, I’d like to tell when, what, why, and how to do the surgery to treat the pediat-ric rhinosinusitis patients.

» 10:00-10:20

» JAPANESE gUIDELINE FOR MANAgEMENT OF PEDIATRIC RHINOSINUSITIS

DEP OF OTORHINOLARYNGOLOGY,

SHIGA UNIV. OF MEDICAL SCIENCE

TAKESHI SHIMIZU

Acute rhinosinusitis is defined as symptomatic inflamma-tion of the nose and paranasal sinuses with an acute onset that presents with respiratory symptoms, such as nasal obstruction, rhinorrhea, postnasal discharge and cough-ing. Japanese practical guideline for management of acute rhinosinusitis provides evidence-based recommendations on managing acute rhinosinusitis. The targeted patients are children aged 15 years or less and adults aged 16 years or above. The panel employed scoring system in line with the severity of clinical symptoms and rhinorrhea/nasal discharge. Recommendations and answers for 9 clinical questions were developed and the treatment algorithm based on the severity of the disease (mild, moderate, and severe) was proposed. Macrolide therapy is now widely used for the treatment of chronic rhinosinusitis in chil-dren (2). However, rhinosinusitis in children is often associated with bacterial infections, and the pathogens often cultured from nasal secretions in children (e.g., S. pneumoniae and H. influenzae) differ from those cul-tured in adult cases. Macrolide therapy should be used in children with chronic inflammation and purulent or mu-

April28(Sun)




Although OSA is an important disease, the rate of diag-nosis is low because of underrecognition and high cost of polysomnography (PSG). CPAP treatment also has significant barriers for long-term use because of its poor compliance and high expense. Ever since PSG and CPAP were reimbursed by Government from July, 2018, the above-mentioned barriers for diagnosis and treatment of OSA were eliminated to much extent. When CPAP was recommended as the first-line treatment, patients were frequently reluctant to choose to use CPAP before the commencement of insurance coverage in Korea. How-ever, we can assume that there must have been a lot of changes in the use of CPAP in terms of acceptance, ad-herence and compliance. A thorough systemic review of the national health system records of PSG and CPAP in future. This presentation will discuss the current status of CPAP treatment under the new insurance system.

» 09:25-09:50

» MULTILEvEL SURgERY IN APNEA

HACETTEPE UNIVERSITY,

FACULTY OF MEDICINE, TURKEY

METIN ÖNERCI

It is important to identify the site of collapse in OSAS. If surgery is necessary, the surgery should be performed according to this obstruction site. However in many pa-tients the obstruction is not only at one level but also at another site too. Therefore multilevel surgery is necessary in many patients with promising results in the treatment of snoring and sleep apnea.. In this talk it will be dis-cussed how the site of ostruction is determined and what surgeries are preferred according to the site of obstruc-tion.

» 09:50-10:15

» OUTCOME RESULTS OF UPPER AIRWAY STIMULATION FOR OBSTRUCTIvE SLEEP AP-NEA

DEPARTMENT OF ORL-HNS, THE CATHOLIC

UNIVERSITY OF KOREA, COLLEGE OF MEDICINE

CHAN SOON PARK

Treatment with continuous positive airway pressure

copurulent nasal discharge with a duration of more than 1 month, because children are likely to suffer relapse of acute bacterial infections. In cases of relapsing acute bac-terial infection, bacterial culture and drug susceptibility testing are helpful in selecting appropriate antimicrobials. Assessment of clinical efficacy in children is based on im-provements in objective findings such as nasal discharge and postnasal drip, because children cannot effectively communicate their subjective symptoms. X-rays are not suitable in the assessment of clinical effects, because X-ray findings are not informative for immature sinuses, espe-cially in children less than 6 years old. CT or magnetic resonance imaging is only applicable in cases involving severe complications, such as orbital and intracranial in-fections. References 1) Yamanaka N et al, Practical guide-line for management of acute rhinosinusitis in Japan. Au-ris Nasus Larynx 42:1-7, 2015. 2) Shimizu T, Suzaki H. Past, present and future of macrolide therapy for chronic rhinosinusitis in Japan. Auris Nasus Larynx 42:131-136, 2016

RH-SP 6Room 2-4 (Swan)

Chair : SOO-KWEON KOO, METIN ÖNERCI

What's New in Obstructive Sleep Apnea Management

» 09:00-09:25

» CPAP TREATMENT UNDER NEW KOREAN INSURANCE SYSTEM


COLLEGE OF MEDICINE, SNUBH

JEONG-WHUN KIM

Since Obstructive sleep apnea (OSA) is known as an im-portant disease to be associated with sleep quality, day-time sleepiness and major diseases such as cardio-neu-ro-metabolic diseases, the treatment is also important to eliminate the pathologic respiratory events during sleep. The recommended standard treatment of OSA is contin-uous positive airway pressure (CPAP) therapy and behav-ioral therapies, surgery including electrical stimulation, or oral devices have been recognized as an adjunctive.

April28(Sun)




or miniscrew-assisted), maxillomandibular advancement (MMA), hypoglossal nerve stimulation, and tracheosto-my. Conventional MMA (con-MMA) surgery can widen the cross-sectional area of the airway, decrease the airflow resistance and collapsibility of the airway during respira-tion, and eventually improve the airflow. However, since East Asians (i.e. Korean, Chinese, and Japanese) have a tendency of protrusive lip, acute nasolabial angle, and small nose with low dorsum, 9-12 mm advancement of the maxillo-mandibular complex would result in es-thetically unfavorable change in their facial profile. My colleagues and I have reported the concept of segmental MMA surgery (seg- MMA), which consists of (1) Le Fort I osteotomy and segmental osteotomy with advancement of the posterior segment of the maxilla, and (2) Bilateral Sagittal Split Ramus Osteotomy and segmental osteot-omy with setback of the anterior segment and total ad-vancement of the mandible. Indication of the seg-MMA procedure is OSA patients with a normally or forward positioned maxilla, labioversed maxillary incisors, a pro-trusive upper lip, and an acute nasolabial angle. The seg-MMA procedure with/without counterclockwise rota-tion might be an effective alternative to the con-MMA procedure for improving the sleep function and prevent-ing aggravation of facial esthetics simultaneously. Treat-ment modalities for OSA patients must be individualized according to age, body-mass index, airway obstruction site, degree of symptoms, severity of OSA parameters, and skeletodental and soft tissue patterns.

RH-SP 7Room 2-3 (White Heron)

Chair : YONG WOO JUNG, TAKESHI SHIMIZU

Unique Role of Immune Cells in Airway Mucosal Diseases

» 11:00-11:25

» HOMEOSTASIS OF MEMORY T CELL IN AL-LERgY

DEPARTMENT OF PHARMACY,

KOREA UNIVERSITY

YONG WOO JUNG

(CPAP) is a standard treatment for moderate and severe OSA. However, CPAP therapy is dependent on patient acceptance of and compliance to the treatment A major determining area of upper airway patency during sleep is a base of tongue(BOT), of which the genioglossus muscle is major muscle. With CPAP, upper airway remains pat-ent with the effects of pneumatic splint on whole upper airway but activation of this muscle via stimulation of the hypoglossal nerve is a direct method to open upper airway, major determining area of upper airway patency during sleep. As early as 1993, the effect of stimulation of the hypoglossal nerve to treat obstructive events was first described by Schwartz et al. in a feline model but approved by the Food and Drug Administration in 2014 (Inspire). Thereafter, hypoglossal nerve stimulation ther-apy has been used to treat OSA and many studies showed its effectiveness on breathing problems during sleep and low rate of serious adverse events. Results from the AD-HERE registry showed AHI decreased from 35.6 6 15.3 to 10.2 6 12.9 events per hour (P<.0001), Epworth Sleep-iness Scale scores decreased from 11.9 6 5.5 to 7.5 6 4.7 (P <.0001) from baseline to the posttitration visit, and The majority of patients (90%) were more satisfied with UAS than CPAP. Currently indications of hypoglossal nerve stimulation therapy(Inspire therapy) are as follows: 1) 22 years of age or older, 2) moderate to severe OSA (AHI range from 15-65 with <25% central apneas), 3) unable to use CPAP, 4) free of complete concentric col-lapse at the palate, 5) people with a BMI greater than 32.

» 10:15-10:40

» WHAT ORTHODONTISTS KNOW ABOUT SNORINg AND APNEA THAT ENT SURgEONS DON’T KNOW

DEPARTMENT OF ORTHODONTICS, SCHOOL OF

DENTISTRY, SEOUL NATIONAL UNIVERSITY

SEUNG-HAK BAEK

Obstructive sleep apnea (OSA) is a sleep disorder which consists of shallow breathing (hypopnea) and temporary cessation of breathing (apnea) due to repetitive episodes of upper airway collapse. Several treatment modalities have been used for OSA patients including diet, exercise, sleep position change, nasal continuous positive airway pressure (nCPAP), nasopharyngeal soft tissue procedures, genioglossus advancement, oral appliances, rapid palatal expansion appliances (conventional, surgically-assisted,

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diseases via the abrogation of the epithelial barrier and the induction of innate responses. We have previously re-ported that protease activities of airborne allergens such as Alternaria and house dust mites (HDM), induced the release of TSLP, IL-25, and IL-33 from airway epithe-lial cells, and that protease activated receptor (PAR)-2 of the epithelial cell was important for TSLP and IL-25 production, whereas ATP and P2Y2 receptor (P2Y2R) was involved in IL-33 release. We also found that tissue concentration and mRNA expression of TSLP, IL-25 and IL-33 in nasal epithelial cells were significantly increased in nasal polyps and inferior turbinates from ECRS pa-tients compared with those from non-ECRS patients and control subjects. Immunohistological staining demon-strated that TSLP, IL-25, and IL-33 were localized in the epithelial cells of nasal polyps, and that their expression was increased in ECRS patients. The mRNA levels of TSLP and IL-25 correlated with the clinical severity of ECRS, as indicated by the computed tomography score. Airborne allergen-induced productions of TSLP, IL-25, and IL-33 were significantly increased in cultured nasal epithelial cells from ECRS patients. These results indicate that increased induction and expression of TSLP, IL-25, and IL-33 in nasal epithelial cells contribute to the patho-physiology of ECRS. Humans are equipped with several endogenous protease inhibitors (EPIs) against endoge-nous and exogenous protease activity. Airway epithelial cells express cystatin A (cysteine protease inhibitor) and SPINK5 (serine protease inhibitor), which may regulate epithelial barrier maintenance. Indeed, genetic deficien-cies of cystatin A or SPINK5 were associated with the pathogenesis of atopic dermatitis. We have reported that ECRS patients showed significantly lower protein and mRNA expression of cystatin A and SPINK5 in the na-sal epithelium. Allergen-induced productions of TSLP, IL-25 and IL-33 in cultured airway epithelial cells were significantly inhibited by the treatment with cystatin A or SPINK5. Intranasal instillation with recombinant cystatin A or SPINK5 attenuated the goblet cell meta-plasia and epithelial disruption in mouse nasal epitheli-um induced by chronic exposures of multiple allergens (Alterinaria, HDM and protease from S. aureus). These results indicate that an imbalance of proteases and pro-tease inhibitors in the epithelial cells are involved in the initiation and maintenance of ECRS. NADPH oxidase, a key producer of reactive oxygen species (ROS), is a multisubunit enzyme comprising membrane and cytoso-lic components, which actively communicate to a wide variety of stimuli, such as stress and inflammation. We recently found that NADPH oxidase was involved in the productions of TSLP, IL-25, and IL-33 from airway

Memory T cells respond rapidly to repeated antigen ex-posure and can maintain their population for extended periods through self-renewal. These characteristics of memory T cells have mainly been studied during viral in-fections, whereas their existence and functions in allergic diseases have been studied incompletely. Since allergic pa-tients can suffer repeated relapses caused by intermittent allergen exposure, we hypothesized that allergen- specific memory Th2 cells are present and the factors necessary for the maintenance of these cells are provided by the lung and airways. Using a murine model of airway inflamma-tion, we found that allergen-specific CD4 T cells survived longer than 70 days in the lung and airways in an IL-7 dependent fashion. These T cells showing homeostatic proliferation were largely found in the mediastinal lymph node (mLN), rather than the airways; however, cells re-siding in the lung and airways developed recall responses successfully. We also found that CD4 T cells exhibited differential phenotypes in the mLN and in the lung. Al-together, we believe that allergen- specific memory T cells reside and function in the lung and airways, while their numbers are replenished through homeostatic turnover in the mLNs. Furthermore, we determined that IL-7 sig-naling is important for the homeostasis of these cells

» 11:25-11:50

» EMERgINg ROLE OF EPITHELIAL-DERIvED CYTOKINES AND ITS REgULATION IN THE PATHOgENESIS OF EOSINOPHILIC CHRONIC RHINOSINUSITIS


SHIGA UNIVERSITY OF MEDICAL SCIENCE

HIDEAKI KOUZAKI

Chronic rhinosinusitis (CRS) is a heterogeneous disease, caused by a complex interaction of local, systemic, mi-crobial, genetic, environmental, and iatrogenic factors. Eosinophilic CRS (ECRS) is a Th2 dominant subtype of CRS, characterized by prominent tissue eosinophilia, for-mation of nasal polyps, viscous and sticky mucus hyper-secretion and co-morbidity with bronchial asthma and aspirin-intolerance. Epithelial-derived cytokines, thymic stromal lymphopoietin (TSLP), IL-25, and IL-33 induce Th2 cytokines-dependent immune responses and play important roles in eosinophilic airway inflammation. The environmental proteases are key contributors to primary sensitization to allergens and the exacerbation of allergic

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DEPT. OF OTORHINOLARYNGOLOGY,

SHIGA UNIV. OF MEDICAL SCIENCE

TAKESHI SHIMIZU

Background: Regulatory T cells (Treg) are critical in ho-meostasis of immune system. Foxp3+Treg and CD4+T regulatory type 1 cells (Tr1) are subtypes of Treg, and produce anti-inflammatory cytokines, IL-35, TGF-be-ta, and IL-10, respectively. Recently, 'Th2-like Treg' are newly characterized by the expression of ST2 (IL-33 re-ceptor) and Foxp3. In the presence of IL-33, Th2-like Treg lose their immune-suppressive activity and produce Th2 cytokines such as IL-5 and IL-13. These Th2-like Treg may be involved in the pathogenesis of chronic eo-sinophilic airway inflammation. Purpose: To examine the immune-regulatory activity of Treg in eosinophilic chronic rhinosinusitis (ECRS), we analyzed the subtypes of Treg;Foxp3+Treg, Tr1 and Th2-like Treg, in nasal tis-sue-derived cells and in peripheral blood mononuclear cells (PBMC). Methods: Nasal polyps and uncinate tis-sue were obtained during endoscopic sinus surgery. We analyzed Th2 (CD4+ST2+) cells, Foxp3+Treg (CD4+C-D25+Foxp3+), Tr1(CD4+CD25-Foxp3-IL-10+), and Th2-like Treg (CD4+CD25+Foxp3+ST2+) in nasal tis-sues and in PBMC from healthy control (HC) and pa-tient with ECRS or non-ECRS by flow cytometry. Re-sults: The prevalence of Th2 cells and Th2-like Treg were significantly increased, and that of Tr1 was significantly decreased in nasal tissues form ECRS patients, com-pared to those from HC or non-ECRS patients. There was no difference in the prevalence of Foxp3+Treg, but the ratio of Th2-like Treg in Foxp3+Treg was significant-ly increased in ECRS patients. Th2-like Treg expressed IL-5 and CD45RO, indicating that they produce IL-5 and that they have memory functions. rIL-33 increased the number of Th2-like Treg in cultured PBMC from ECRS patients. Conclusion: These results indicate that IL-33 induces the conversion of immune-regulatory Fox-p3+Treg into Th2-like Treg which stimulate the eosin-ophilic inflammation by producing Th2 cytokines. The increased Th2-like Treg may be important in the patho-physiology of ECRS.

epithelial cells, and that intranasal instillation with NA-DPH oxidase inhibitors attenuated eosinophils infiltra-tion, productions of IL-33, IL-5 and IL-13, and epithe-lial disruption in mouse nasal mucosa induced by acute or chronic exposures of multiple allergens (Alterinaria, HDM and protease from S. aureus). NADPH oxidase is a family of isoenzymes, composed by seven members, Nox 1-5, Duox1 and Duox2, and we found that DUOX1 is involved in airborne allergens-induced productions of TSLP, IL-25 and IL-33 from airway epithelial cells. These results suggest that oxidative stress is also involved in the pathophysiology of ECRS.

» 11:50-12:15

» ROLE OF MACROPHAgES IN AIRWAY MU-COSAL MICROENvIRONMENT

CENTER FOR BIOMATERIALS, BIOMEDICAL

RESEARCH INSTITUTE, KOREA INSTITUTE OF

SCIENCE AND TECHNOLOGY (KIST), SEOUL,

REPUBLIC OF KOREA

SEUNG JA OH

Macrophages are phagocytes that play a critical role in the immune system. They are involved in both innate and adaptive immunity by either removing pathogens or anti-gen presentation. It has been shown that macrophages are polarized to subgroups with distinct functions, M1 and M2. M1 polarization is characterized by pro-inflamma-tory and anti-cancer functions, whereas M2 macrophages promote immune suppression and tumor growth. In this study, we investigate that exosomal miRNAs from hu-man nasal epithelial cells play roles in airway mucosal mi-croenvironment. Specifically, we demonstrated that the human nasal epithelial cells treated with urban dust could modulate airway mucosal microenvironment through upregulation and release of miRNAs. The result shows that the human nasal epithelial cells treated with urban dust altered miRNA expression profile and released miR-NAs involved in macrophage polarization. The study will further investigate exosomal miRNA mediated-commu-nications between epithelium and macrophages in airway mucosal microenvironment.

» 12:15-12:40

» ROLE OF REgULATORY T CELLS IN PATHO-PHYSIOLOgY OF CHRONIC RHINOSINUSITIS

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number per standard high-power field may be more valu-able in predicting various parameters of ECRS including clinical severity, comorbidity, and expected treatment outcome rather than its use for categorization (ECRS vs nECRS).

» 11:25-11:50

» CONTROvERSIES ON DIAgNOSIS AND MAN-AgEMENT OF EOSINOPHILIC CRS

DEP OF OTOLARYNGOLOGY,

CHULALONGKORN UNIV.

KORNKIAT SNIDVONGS

Chronic Rhinosinusitis (CRS) classification by emerging endotypes brings greater accuracy for identification of un-derlying pathophysiology. CRS most commonly is classi-fied into two subtypes of eosinophilic chronic rhinosi-nusitis (ECRS) and non-eosinophilic chronic rhinosinus-itis (nECRS). While there is evidence establishing ECRS as a recalcitrant subtype of CRS, there is no consensus on diagnostic criteria. The cut-off points for tissue eosin-ophilia used range widely from >5 to >350 cells per high power field. In addition, percentage of eosinophil in the tissue of around 5-10% has been used as the other cut-off values. Several attempts in the literature have been made to assess surrogate markers for ECRS such as the ECP/MPO ratio, major basic protein, eotaxin, Staphylococcus aureus enterotoxin, transcription factors and associated key cytokines including IL4, IL5, IL13. The majority of CRS endotype in Caucasian population is eosinophilic, while in Asian counterparts tend to display neutrophilic pattern. However, without international consensus on a clear definition and diagnostic criteria for ECRS, criteria used by study authors have not been standardized. These differences in methodology and data interpretation may prevent accurate ECRS endotyping. Therefore, diagnos-tic criteria and management of eosinophilic CRS should be reconsidered.

» 11:50-12:15

» PREDICTINg PATIENTS WITH CHRONIC RHI-NOSINUSITIS AS MACROLIDE RESPONDERS

DEPARTMENT OF OTOLARYNGOLOGY, FACULTY

OF MEDICINE, CHULALONGKORN UNIVERSITY

RH-SP 8Room 2-4 (Swan)

Chair : SAM HYUN KWON, Moderator: LOKMAN SAIM

RH-ASEAN Symposium

» 11:00-11:25

» ENDOTYPES OF CHRONIC RHINOSINUSITIS ACROSS ANCESTRY AND gEOgRAPHIC RE-gIONS

RAJAVITHI HOSPITAL, DEPARTMENT OF

OTOLARYNGOLOGY, RANGSIT UNIVERSITY

WIRACH CHITSUTHIPAKORN

Preliminary studies have suggested differences in endo-types of chronic rhinosinusitis(CRS) across ancestry/ethnic groups. Eosinophilic CRS (ECRS) is the predom-inant subtype for Western/European ancestry CRS pa-tients and noneosinophilicCRS (nECRS) for Asian pa-tients. Although tissue eosinophilia is the most common-ly used criterion for ECRS, various cut-off points are sug-gested. Surrogate markers have been extensively studied. Sixty-six cohorts with study criteria were included with a total of 8557 patients. Raw data from 11 studies 544 patients were re-analyzed using number of tissue eosino-phils. At lower cut-off values of ≥ 5 and ≥10 cells/HPF, most patients of Asian and Western/European ancestry were classified as ECRS without difference. In contrast, at cut-off points of ≥70 and ≥120 cells/HPF, the majority of both groups became reclassified as nECRS. Summa-ry After applying one consistent criteria to existing data, differences across ancestry and geographic populations in endotypes of CRS were no longer evident. Current understanding of CRS endotype regarding ancestry and geography should be reassessed. Presumed differences in ECRS/nECRS proportions in Western/European and Asian ancestry patients with CRS depend on criteria cho-sen by study authors. Patients defined as ECRS can be re-defined as nECRS when criteria are revised to match other studies. This is true for both Asian and Western/Eu-ropean ancestry populations. International consensus on ECRS diagnostic criteria and CRS classification by en-dotype should enable researchers to report and interpret data consistently. The cut-off value of tissue eosinophil

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dle turbinate is smaller and the superior turbinate is the smalle stone. Rarely, the fourth turbinate can be found near the süperior turbinate and the nasal roof. Turbinates have intense blood vessels so that they can enlarge, and the inhaled air can be heated, moistened and cleaned from the particles by contacting these turbinates. The size of the turbinates can change depending on many factors such as body activities, body position and hor-monal changes. While the lower turbinate pathology is the most common cause of nasal congestion, the role of middle turbinate pathologies in nasal obstruction is too important to ignore. The middle turbinate bullosa and its types, paradoxical, hypertrophic and lateralized, take up space in the nasal cavity and reduce the amount of inhaled air. Endoscopic nasal examination and paranasal sinus tomography are routine diagnostic methods. Med-ical treatment has almost no place in the treatment of middle turbinate hypertrophy. Surgical interventions are usually preferred. There is no standard intervention and the surgical treatment modality changes according to the type of the pathology. In my presentation, I will share my personal experience about approach to the middle turbi-nate pathologies and the problems that I encounter in 30 years of my professional life.

KACHORN SERESIRIKACHORN

Objective: To assess the prognostic factors that predict favorable outcomes of low-dose macrolides (LDMs) in treating chronic rhinosinusitis (CRS). Methods: Ran-domized controlled trials studying the effects of LDMs in treating CRS were included. Data were pooled for me-ta-analysis. Primary outcome was Sino-Nasal Outcome Test (SNOT). Six prognostic factors: CRS subtypes, serum immunoglobulin (Ig)E level, membered lactone ring of macrolides, concurrent endoscopic sinus surgery (ESS), and dosage and duration of the LDMs were as-sessed by subgroup analyses. Results: Ten studies (608 patients) met the inclusion criteria. LDMs and placebo were not different in SNOT improvement (standard-ized mean difference [SMD] = −0.23, 95% confidence interval [CI]: −0.69 to 0.24). Subgroup analyses showed that the effects favored LDMs in the patients with CRS without polyps (SMD = −0.64, 95% CI: −1.01 to −0.27) compared to CRS with polyps, and the patients receiv-ing a half dose (SMD = −0.64, 95% CI: −1.01 to −0.27) compared to a very low dose. There was no difference in SNOT improvement between LDMs plus standard treat-ment compared to standard treatment (SMD = −0.52, 95% CI: −1.57 to 0.53). Subgroup analyses showed that the effects favored LDMs in the patients receiving LDMs for a duration of 24 weeks (SMD = −1.68, 95% CI: −2.40 to −0.95) compared to 8 and 12 weeks. There was no difference between the 14-membered and 15-mem-bered ring LDMs. Assessment of concurrent ESS found mixed results. Serum IgE level could not be assessed. Conclusion: LDMs provided favorable outcomes in pa-tients with CRS without polyps. A half dose of macro-lides should be given for a duration of 24 weeks.

» 12:15-12:40

» APPROACH TO MIDDLE TURBINATE PA-THOLOgIES

UNIVERSITY OF HEALTH SCIENCES

IZMIR-TEPECIK TRAINING RESEARCH HOSPITAL

IBRAHIM CUKUROVA

There are three turbinates on both sides of the nasal cav-ity and they have important roles in nasal physiology. These finger like organs have erectile tissue. So, their size is not stable. The lower turbinate is the largest, the mid-

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HN-GD 2Room 2-6 (Peacock)

Chair : YOUNG HAK PARK, Moderator: SEUNG HO CHOI

Korean Guideline for the Management of Unilateral Vocal Fold Paralysis

» 09:00-09:10

» RECOMMENDATION OF INJECTION LARYN-gOPLASTY FOR UNILATERAL vOCAL FOLD PARALYSIS



HALLYM UNIVERSITY COLLEGE OF MEDICINE,

HALLYM UNIVERSITY MEDICAL CENTER

IL-SEOK PARK

Injection laryngoplasty is a good option for unilateral vocal fold paralysis. But There is no consensus for opti-mal follow-up period after injection laryngoplasty. The follow-up interval can be affected according to injection materials, methods of injection, size of injection needle bores, vocal fold paralysis recovery potential, etc. The temporary injectables currently in use such as collagen products, micronized dermal matrix, and hyaluronic acid are known to resorb within approximately 3 to 6 months. Several studies with hyaluronic acid reported that aug-mentation effect of hyaluronic acid was lost gradually, but it was satisfactory for most of patients up to 6 months. In an aspect of short-term follow-up, we also considered about acute complication. Several cases of complications in percutaneous injection laryngoplasty such as vocal fold hematoma, and paraglottic space hematoma, etc have been reported, but it is very rare. Post-injection complica-tions included rapid absorption of the injected materials (defined as the need to reinject within 4 weeks of the pro-cedure) and injection of the superficial lamina propria. A long-lasting injectables like calcium hydroxylapatite also be cautious for superficial injection. Therefore, many surgeons have adopted a 1st post-injection follow-up in-terval within 1 month. Then, second visit can be in 3-6 months, and 1 year follow-up would be good to detect the long-term effect. Then, how about voice rest after in-jection laryngoplasty? Unfortunately, There is no consen-sus for necessity of voice rest after injection laryngoplas-

ty. After injection, durability of benefit can be affected by viscosity of materials. Due to migration effect, early resorption or adverse effect can be occurred. For those reasons, many surgeons prefer to advise voice rest after in-jection laryngoplasty. Calcium hydroxylapatite (CaHA) paste is commonly used materials for permanent injec-tion, but its viscosity is near-water like. Six or Seven days of voice rest is prescribed after vocal fold injection to help optimize implant stability. In other study, they instructed patients to take voice rest overnight and oral analgesics if necessary. And other reports, patients are advised to use light voice for 2 days and thereafter have no voice restric-tions. The other study recommended voice rested for 2 days, although patients with scars were given strict vocal rest for 8 days. In cases of fat injection, they recommend voice rest for 48 hours. In a Korean society of voice, they requested to perform the questionnaire to fourteen voice professionals, and half of them recommend 24 hours of voice rest, and 4 of them recommend 3-4 days of voice rest. Only 2 of them no recommend voice rest. There is no evidence of benefit of voice rest, but many surgeons prefer 1 or 2 days of voice rest after injection. Then, is “Injection laryngoplasty” always the first and best op-tion for unilateral vocal fold paralysis? When vocal fold paralysis occurred without any permanent injury of re-current laryngeal nerve, patients are advised to wait or undergo a temporary injection laryngoplasty until 1 year. If vocal fold paralysis continues permanently, pa-tients can be treated by either injection laryngoplasty and medialization thyroplasty. A meta-analysis of comparing calcium hydroxylapatite injection laryngoplasty and sili-cone thyroplasty showed no differences between them in voice outcomes. In some studies, injection laryngoplasty even show better outcomes in HNR, MPT, and acoustic variables after 24 months. In conclusion, Injection laryn-goplasty and medicalization thyroplasty show compara-ble outcomes on acoustic and aerodynamic parameters, perceptual voice outcomes, and laryngoscopic findings. Injection laryngoplasty preferred to patients who does not want surgery or does not have general condition to perform surgery

» 09:10-09:20

» gUIDELINES FOR vF PARALYSIS-INJECTION LARYNgOPLASTY

DEPARTMENT OF OTOLARYNGOLOGY, SEOUL

NATIONAL UNIVERSITY, COLLEGE OF MEDICINE

TACK-KYUN KWON

April28(Sun)


April 28(Sun) Head & Neck Surgery


plasty, injection laryngoplasty, arytenoid adduction, and laryngeal reinnervation, but no significant differences be-tween treatment modality based on perceptual, acoustic, quality of life, and laryngoscopic outcomes. The patients undergoing medialization thyroplasty may benefit from addition of arytenoid adduction when a large posterior glottic gap is present. Medialization thyroplasty with ary-tenoid adduction but not medialization thyroplasty alone resulted in statistically significant improvement in large posterior glottis gap. KQ18 When delayed laryngeal re-innervation is preferred than other medialization pro-cedures to manage? Not only immediate RLN (recurrent laryngeal nerve) reinnervation, but also delayed reinner-vation is a feasible and effective approach for treatment of surgery-related unilateral vocal fold paralysis. It can restore the physiological laryngeal phonatory function to a nearly normal voice quality. Patient age is an influential factor of the surgical outcome of laryngeal reinnervation for unilateral vocal fold paralysis patients. RLN reinner-vation is less effective when patient age is more than 60 years. Children and young adults are good candidates for RLN reinnervation they could have near normal subjec-tive voice parameters.

» 09:30-09:40

» ROLE OF THE vOICE THERAPY IN PATIENTS WITH UNILATERAL vOCAL FOLD PARALYSIS

DIVISION OF HEAD & NECK SURGERY,


EWHA WOMANS UNIVERSITY SCHOOL OF

MEDICINE, SEOUL, KOREA.

HAN SU KIM

The severity of the voice quality in patients with uni-lateral vocal fold paralsysis (UVFP) can be exacerbated by the patient’s response to the voice symptoms. These responses include changes in posture and muscle tone. A patient may use compensatory maneuvers to help the voice but inadvertently place strain on the voice produc-tion system. Patients with mild symptom may be the best candidates. Also, Voice therapy before and/or after surgical intervention is helpful for optimal postoperative phonation. For accurate planning of voice therapy, two dominant pattern of voice symptoms should be assessed: hypofunctional and hyperfunctional. The hypofunction-al pattern includes the symptoms that are directly related to the paralysis. The hyperfunctional patterns emerges as

(1) Selection of Injection materials: Injection laryngoplas-ty has gained its popularity in the management of unilat-eral vocal fold paralysis (UVFP). Properties of injection materials as well as duration and cause of UVFP should be considered when choosing material for injection. Tem-porary or short duration materials are used when spon-taneous recovery of neural function is expected (Strong Recommendation /Moderate quality evidences). (2) Pre-ferred Techniques: No single technique shows superior re-sults compared with other approaches for voice outcomes (Strong recommendation/Low quality of evidence). The preference of the patient and the experience of the laryn-gologist along with availability of the resources should all be taken together in deciding the techniques of injection laryngoplasty (Strong recommendation /Moderate qual-ity of evidence). (3) Timing of injection: Injection laryn-goplasty could be applied at any stage of UVFP. Early and active intervention with temporary injection mate-rials is recommended to prevent lung complications and to ensure the quality of life of the patient with high vo-cal demands(Strong recommendation/Moderate quality of evidences). (4) Follow-Ups: First follow-up visit after injection is reasonable in a week to a month to detect short-term complication and results. Then, next visit in 3-6months and 1year follow-up would be appropriate to detect the long-term effect. (Weak recommendation/Low quality evidence). (5) Postinjection Voice Rest: There is no evidence about benefit of voice rest after injection la-ryngoplasty. However, many surgeons recommend voice rest of 1-2 days after injection(Weak recommendation/ Low-quality evidence).

» 09:20-09:30

» ARYTENOID ADDUCTION AND RECURRENT LARYNEAL REINNERvATION




SEUNG-WON LEE

KQ16 When arytenoid adduction combined with thy-roplasty type I is preferred than arytenoid adduction or thyroplasty type I only? Currently, medialization thyro-plasty with/ without arytenoid adduction are standard treatment for treating unilateral vocal fold paralysis. Multiple studies show favorable surgical outcomes fol-lowing overall procedure such as medialization thyro-

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be discussed in this session. Determining what the effec-tive treatment for an individual patient should be is still a gray area. This topic reviews and discuss the current state of the data and suggests directions in which it might move in the future.

» 09:50-10:00

» WHAT IS THE ROLE OF IMAgINg STUDIES IN THE DIAgNOSIS OF UNILATERAL PARALY-SIS?


YONSEI UNIVERSITY

JAE YOL LIM

Imaging studies (computed tomography or magnetic resonance imaging) ranging from the skull base to the thoracic inlet/arch of the aorta are recommended to in-vestigate the causes of VFP. In a review of seven published studies including a total of 1308 patients with VFP, Mac-gregor et al found that surgical trauma was implicated in 22% of cases, malignancies (predominantly lung and thy-roid cancer) accounted for a further 22%, inflammatory or infectious causes for 36%, neurological disorders for 4%, and the remaining 16% were idiopathic. Although there is an evidence-based clinical practice guideline about evaluation of certain causes of hoarseness, varia-tions in the use of imaging studies in the diagnosis of unilateral VFP still remained. The purpose of this state-ment is to improve diagnostic accuracy for VFP and re-duce inappropriate examinations to investigate the causes of VFP. No articles were found in the systematic literature review regarding the diagnostic yield of imaging studies prior to laryngeal examination. However, after laryngos-copy revealed VFP and patients didn’t receive any surger-ies which can explain the cause of the paralysis, further imaging studies are generally recommended. Imaging is not usually required if the onset of VFP coincides with surgery to the appropriate side of the neck or to the me-diastinum in left sided VFP since surgical damage to the nerve can’t be detected with current imaging techniques. A retrospective study suggests thorough radiological in-vestigation helps improve the rate of diagnosis by reduc-ing the number of “idiopathic” cases and guides appro-priate treatment. When clinicians suspect a lesion along the recurrent laryngeal nerve, imaging studies are also indicated. Unexplained VFP found on laryngoscopy war-rants imaging the skull base to the thoracic inlet/arch of

a counterproductive response to the underlying disorder and is associated with voice strain and fatigue. Accurate identification of these two patterns allows appropriate treatment. The hyperfunctional compensations include supraglottic activity that is used to compensate for lack of glottic closure and may be associate with effortful voic-ing, fatigue, and laryngeal pain. usually, these compen-sations are not eliminated by surgical intervention and the overall response to surgery may be enhanced by voice therapy. There are several voice therapy techniques. In-stead of using only one technique in therapy sessions, var-ious methods are used in consideration of the current vo-cal performance, progress, and stimulability. Voice ther-apy consists of three parts: breathing, vocalization, and muscle relaxation. limited respiratory can be reinforced by correct posture and abdominal breathing. The vocal cords are vibrated smoothly and regularly to produce the optimal voice. Relaxed muscles allow the vocal cords to vibrate in effortless conditions.

» 09:40-09:50

» WHAT IS THE ROLE OF ELECTROMYOgRA-PHY FOR EvALUATINg UNILATERAL vFP PA-TIENTS


SUNGKYUNKWAN UNIVERSITY,

KANGBUK SAMSUNG HOSPITAL

SANG HYUK LEE

Unilateral vocal fold paralysis (UVFP) is a common problem in patients who present to the otolaryngolo-gist and has a significant impact on a patient's quality of life. The most frequent cause of UVFP is injury to the recurrent laryngeal nerve. The most common etiologies of RLN injury include extralaryngeal malignancy, trau-ma, iatrogenic causes, and idiopathic cases. The optimal treatment of UVFP has been the subject of debate for a long times. Until now, a lot of different studies have been described, however, there is no consensus on the most op-timal treatment methods of UVFP. The Korean Society of Laryngology, phoniatric and logopedics recently develop the guideline for the management of UVFP. Among the full recommendation, 3 questions (What is the role of electromyography in the management of UVFP? What are considerations for selecting injection materials in UVFP? Are medialization surgical procedures helpful for reducing aspiration in unilateral VFP patients?) will

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The primary purpose of this guideline is to enhance the quality of care for patients with unilateral vocal fold pa-ralysis (UVFP) based on current best evidences. Expert consensus to fill evidence gaps, when used, is explicitly stated, and is supported with a detailed evidence profile for transparency. Specific objectives of the guideline are to reduce inappropriate variations in patient’s care pro-duce optimal health outcomes and minimize harm. The guidelines suggested an appropriate diagnostic workup and management modalities, specifically focus on the time after diagnosed with UVFP. The chairman of this Task Force (SHC) for the development of guidelines for the management of UVFP was recommended by Kore-an Society of Laryngology, Phoniatrics and Logopedics (KSLPL). The chairman led a committee that included one secretary (CHR) and 8 members (TKK, STK, ISP, JHW, SWL, SHL, JYL, and HSK). The committee start-ed kick-off meeting in 12th June 2017 and held several online and offline meetings. We divided topics into 4 categories: initial evaluation, ear-ly and late management of early unilateral VCP, the role of voice therapy and the role for aspiration prevention. After setting the key questions, the committee reached a consensus about the keywords that would be used in the literature search for systematic review of the key ques-tions.After thoroughly review of literature, we made 17 recommendations including 28 sub recommendations for key questions. This topic will describe the process of the guideline development.

HN-SP 9Room 2-6 (Peacock)

Chair : EUN CHANG CHOI, Moderator : SHENG-PO HAO

ASHNO Symposium: Update on the Management of NPC

» 11:00-11:25

» DIAgNOSIS OF rNPC IMAgINg AND MOLEC-ULAR

DEP. ORL-HNS, UNIV. INDONESIA, CIPTO

MANGUNKUSUMO HOSP.

MARLINDA ADHAM

the aorta. Including these anatomic areas allows for eval-uation of the entire path of the recurrent laryngeal nerve as it loops around the arch of the aorta on the left side. On the right, it will show any lesions in the lung apex along the course of the right recurrent laryngeal nerve as it loops around the subclavian artery.

» 10:00-10:10

» WHAT IS THE ROLE OF THE vOICE ASSESS-MENTS IN UNILATERAL vFP?


GACHON UNIVERSITY SCHOOL OF

MEDICINE, GIL MEDICAL CENTER

JOO HYUN WOO

Dysphonia is the primary concern of unilateral vocal fold paralysis (UVFP). The specific nature of the dysphonia may vary among patients: insufficient loudness, vocal fa-tigue, globus sensation, effortful voicing, impaired sing-ing quality, and sensation of breathlessness on exerting or speaking, resulting in a significant impact on patients’ activity and participation. Although it is well known that these symptoms are caused by vocal cord dysfunction, it is difficult to give clear answers about the choice of treatment method, the effect of treatment, and the in-terpretation of results. In particular, if the outcome of the treatment does not match the patient's expectations, unnecessary frustrating may occur and the treatment pro-cess becomes more complicated. Therefore, in order for otolaryngologists and speech therapists to treat patients with vocal cord paralysis, the voice status should be defi-nitely assessed and the goal of treatment should be set be-fore treatment. Both the patient and the therapist should be able to obtain feedback on the treatment process and share reliable data on the treatment outcome.for this pur-pose, voice assessments should be from multidimensional perspective, mainly divided into acoustic, aerodynamic, and perceptional area.

» 10:10-10:20

» PROCESS OF THE gUIDELINE DEvELOP-MENT

NATIONAL CANCER CENTER

CHANG HWAN RYU

April28(Sun)




therapy has been modestly successful. This treatment par-adigm is currently explored in a phase 3 clinical trial com-paring with standard chemotherapy agents. In this ses-sion, the use of cellular based immunotherapy for rNPC is discussed, focusing on the rationale, indications and future direction of immunotherapy against virally driven NPC. Additionally, I will share on the recent works at my laboratory on dissecting the tumor microenvironment and how this knowledge can translate to novel cellular based immunotherapy in rNPC.

» 11:50-12:15

» CONSIDERATIONS AND POLICY OF SAL-vAgE NASOPHARYNgECTOMY


KAOHSIUNG CHANG GUNG MEMORIAL HOSP.

YU-TSAI LIN

Nasopharyngeal carcinoma (NPC) is the most common cancer originating in the nasopharynx. Take South China as an example, the incidence rates are as high as of 20–30 per 100,000 in men populations and 8 to 15 cases per 100,000 in women populations, respectively, especially among Chinese people. Advances in diagnostic imaging, radiation therapy, and concurrent chemoradiotherapy have achieved better locoregional control; however, fi-nal treatment outcomes are not satisfactory, the 5-year survival rate is approximately 50-60%. The severe side effects and limitations of conventional treatments have led to the widespread application of complementary and/or alternative medicines. Salvage nasopharyngectomy plays an important role in operable NPC patients, but is still a challenge operation because of complexity of anat-omy, carotid artery and many cranial nerves nearby. Re-construction of skull base defect may be necessary when carotid exposure or perioperative CSF leak was found. Effective hemostasis is another important issue for safety of salvage nasopharyngectomy. Salvage nasopharyngec-tomy included external approach such as superior trans-skull base approach, lateral infratemporal fossa approach and current approach such as trans-maxillary swing, endoscopic nasopharyngectomy and Robotic assisted trans-palatal approach.

» 12:15-12:40

» ENDOSCOPIC vS ROBOTIC NASOPHARYN-

Tumor recurrence is a major cause of Nasopharyngeal Carcinoma(NPC) treatment failure. NPC is very sensi-tive to radiotherapy and/or adjuvant chemotherapy. Even with the best treatment, local recurrence can be seen in 10-36% patients after chemotherapy, 5 years local con-trol rates of recurrent NPC(rNPC) range from 25-60% depending on the T classification at recurrence. The re-currence rates of stages T1-T2, T3 and T4 NPC are 1%, 6% and 17%. rNPC diagnosis depends on imaging and biopsy of tissue, but growth and invasion patterns of inflammation pattern post radiotherapy and scar tissue hinder the process of obtaining proper biopsy. Contact endoscopu provide a better view and Narrow Band Imag-ing endoscopy could improve the detection rate with the high sensitivity, specificity and accuracy. unfortunately, there are no serum biomarker available for rNPC pre-diction. Cell-free EBV DNA can easily be detected by quantitative polymerase chain reaction and has been used as a biomarker for screening,monitoring, and pre-dicting NPC. evaluarion of EBV genomic DNA latent membrane protein 1 or Epstein-Barr nuclear antigen-1 have also been used for early detection of rNPC. Tumor recurrence can also be identified by LMP1(now called PSMB10) and EBNA1 gene expression. in an aim to identify new biomarkers for rNPC and to analyze serum expressed protein, there are study of proteomic biomark-ers like tandem mass tag labeling and high performance liquid chromatography(HPLC) fractionation followed by liquid chromatography tandem mass spectrometry (LC-MS/MS). both 18F-FDGPET/CT and SPECT are very accurate for the detection of local residual or rNPC, they are superior to MRI in distinguishing rNPC from fibro-sis or scar tissue after RT in irradiated fields with distor-tion of normal architecture. For early diagnosis relapsing tumor after treatment and recessive forms of metastases still remains difficult and requires more clinical trial data analysis and research.

» 11:25-11:50

» CELLULAR BASED IMMUNOTHERAPY FOR rNPC

NATIONAL UNIVERSITY OF SINGAPORE

CHWEE MING LIM

Immunotherapy has been touted as the 4th pillar in the treatment option against cancer. In. recurrent/relapsed nasopharyngeal cancer (rNPC), the use of cytolytic T cell

April28(Sun)




HN-SP 10Room 2-5 (Crane)

Chair : YUH-SEOG JUNG, JASON CHAN

Recent Updates : Immunooncolgy in Head and Neck Cancer

» 13:30-14:00

» DEvELOPINg IMMUNOONCOLOgIC THERA-PY FOR HEAD AND NECK CANCER

DEPT OF OTORHINOLARYNGOLOGY-HEAD

AND NECK SURGERY, DIVISION OF TUMOR

IMMUNOLOGY, CENTER FOR THYROID

CANCER, CENTER FOR CANCER KNOWLEDGE &

INFORMATION, NATIONAL CANCER CENTER

YUH-SEOG JUNG

Head and neck area has been classically a usual target for gene therapy, mainly due to its easier accessibility. Proper strategy to booster immunogenic microenvironment is the key. Meanwhile, genomic landscape for HNC reveals different immunologic profiles between HPV+ and HPV- HNCs, as well as individual HNC cases, even within the same HPV status. Notwithstanding, proper immune- competent animal model pipeline could give us central starting point for this immune modulating strategy. We’ve been using HPV16+ tonsil cancer, immune- competent syngeneic mouse model, to preclinically evaluate viruses and immune- modulating agents developed in National Cancer Center, Korea. For example, an adenovirus har-boring the HSV thymidine kinase (HSVtk) gene under the regulation of a trans- splicing ribozyme that targets telomerase is cytotoxic to cancer cells because it inhib-its DNA replication (Ad5mTR). Overall, it induces an-ti-tumor immunity by activating cytotoxic T cells in our HPV16+ HNC model. Oncolytic virus therapy could be another breakthrough for immune boostering within the tumor, especially in immune desert tumors. Meanwhile, we found that a low dose of cisplatin potentiates CD8+ T-cell-mediated anti-tumor immunity, and its addition to the HSVtk-based adenovirus results in additional therapeutic benefits for HPV16- HNC model. We then detected improved immune clearance by increasing the number of E7-specific CD8+ T cells inside tumors (40%, P < 0.05) as a result of the combination of suicide gene

gECTOMY

UNIVERSITY OF HONG KONG

RAYMOND KING YIN TSANG

The nasopharynx is located deep in the head and has been considered an area difficult to perform surgical resection. Various open approaches have been devised but all open procedures require facial incisions and transgression of normal soft tissue and bones, with associated morbidities. Improvement in instrumentation and endoscopic surgi-cal techniques expanded the application of endoscopic sinus surgery. Steady improvement in endoscopic endo-nasal operative techniques, including the “two surgeons four hands” technique allowed more complex procedures and excision of larger tumors. Although endoscopic en-donasal surgery provides excellent visualization of the pa-thologies, endoscopic instruments are inferior in tissue manipulation and surgical dexterity. Good cooperation between the surgeon and his assistant is required. The surgical robot was invented partly to circumvent the loss of dexterity and degrees of movement in endoscopic sur-gery. The da Vinci surgical robot has been successfully adapted to perform surgical resections of pathologies in the nasopharynx. Comparing to endoscopic nasopharyn-gectomy, robotic platform provides a steady endoscopic view that is all under control of the surgeon. There are more degrees of freedom of the robotic instruments. On the other hand, there is of loss of tactile sensation and limited choice of surgical instruments. Removal of bony structures is frequently required in nasopharyngectomy and lack of bony instruments makes deployment of sur-gical robot less than ideal. Also, the current generation of robot is still too bulky and only suitable for selected tumors and selected patient anatomy. In reality, the two minimally invasive techniques are not mutually exclusive and actually compliments each other. A combined endo-scopic and robotic nasopharyngectomy can actually facil-itate the operation, extend the indications and improve the safety of the operation.

April28(Sun)




JASON CHAN

Head and neck squamous cell carcinomas (HNSCC) frequently metastasize to the regional lymph nodes that is a consequence of the ecosystem of the primary HN-SCC which involves an interplay of the tumor microen-vironement with cancer cells, fibroblasts and infiltrating immune cells. These all participate in the agreesiveness of tumors and their likellihood for metastases.

HN-SP 11Room 2-6 (Peacock)

Chair : KEE HWAN KWON, TSUNG-LIN YANG

TSOHNS : Tentative Topic: Application of US for Otolaryngology and HNS by ENT-HN Surgeon

» 13:30-13:50

» CURRENT DEvELOPMENT OF ULTRASOUND PERFORMED BY THE SPECIALISTS OF OTO-RHINOLARYNgOLOgY AND HEAD NECK

DEP. OTOLARYNGOLOGY,

NATIONAL TAIWAN UNIV.

TSUNG-LIN YANG

Ultrasound has been applied in many medical fields as a useful and handy imaging tool. It can be used for vi-sualizing the anatomical landmarks and disease focus in a real time manner. For the fields of otolaryngology and head and neck, ultrasound is beneficial for making the accurate diagnoses and conduct appropriate treatments. Ultrasound has recently been embraced as a powerful di-agnostic instrument since it can serve as an extension of the physical examination to achieve the correct diagnoses and offer useful information for potential surgical inter-vention. Ultrasound performed by surgeons, especially for head and neck specialist, has become a positive trend because ultrasound provides more imaging information than the conventional physical examination. Ultrasound also offers the opportunities to directly guide the sam-pling procedures, even to mediate the target-guided treatment in a minimally invasive manner. Although with different procedures and settings, the ultrasound

and low-dose cisplatin therapy. We’re currently exploring the possible role of myeloid-related immune checkpoint, CD200, and starting to explore the role of oncolytic vac-cina virus, especially as a member of immune combina-tion therapy. Detailed ongoing data will be presented.

» 14:00-14:30

» OvERCOMINg RESISTANCE TO IMMUNO-THERAPY

KAIST

EUI-CHEOL SHIN

During immune responses, antigen-specific T cells are regulated by various mechanisms including inhibitory receptors and regulatory T cells to avoid excessive and persistent immune responses. These regulatory mecha-nisms, called ‘immune checkpoint’, suppress T cell re-sponses particularly in chronic viral infection and cancer, in which viral antigens or tumor antigens persist for a longtime, and lead to T cell exhaustion in patients with chronic viral infection or cancer. Among them, cytotoxic T lymphocyte-associated protein 4 (CTLA-4) and pro-grammed cell death 1 (PD-1) are the most well-known receptors and have been targeted for drug development. As a result, anti-CTLA-4 and anti-PD-1 (or anti-PD-L1) blocking antibodies were developed for cancer treatment and known as ‘immune checkpoint inhibitors’. However, anti-CTLA-4 and anti-PD-1 (or anti-PD-L1) blocking antibodies fail to control tumors in a significant pro-portion of cancer patients. Therefore, it is an important question how the coverage of immune checkpoint inhib-itors can be extended to the majority of cancer patients who do not have control or regression of their cancer. In this lecture, strategies to improve treatment respons-es of anti-PD-1 will be discussed, including novel im-muno- modulators and biomarkers predicting treatment responses.

» 14:30-15:00

» PATHOLOgICAL FINDINgS IN NECK DISSEC-TION OF HNSCC

DEP. OTORHINOLARYNGOLOGY, HEAD AND NECK

SURGERY, THE CHINESE UNIVERSITY OF

HONG KONG

April28(Sun)




USCB is used for tissue sampling transcutanesously. For patients with supraclavicular masses, USCB helps in tis-sue sampling via small wound and provides pathological information to determine primary origin of metastasis. In summary, USCB behaves as an extended hand of ENT-HN surgeon to get tissue samples for making accurate diagnoses.

» 14:10-14:30

» APPLICATION OF HEAD AND NECK ULTRA-SOUND IN CHILDREN WITH OBSTRUCTIvE SLEEP APNEA



AND CHILDREN HOSP.

CHE YI LIN

The prevalence of sleep disordered breathing (SDB) in children is 9%–12%. Adenotonsillar hypertrophy is an important cause of obstructive sleep apnea in children. However, residual obstructive sleep apnea and abnormal polysomnographic findings have been reported in up to 75% of cases after adenotonsillectomy. Thus, there might be some other anatomic or physiologic factors to influence the presence of childhood SDB. Except for the direct oropharyngeal examinations used to evaluate the grade of tonsillar hypertrophy and the position or size of the tongue and palate, the cephalometry, comput-ed tomography and magnetic resonance image provide more accurate views in estimation of airway volume in upper airway. Drug-induced sleep endoscopy also allows real-time visualization of the narrowing in upper airway. However, these image modalities are invasive and much cost. The applications of ultrasounds in sleep study had been reported in several study, including the relationship between the OSAS and anatomic features of tongue or parapharyngeal structures in adult. Using the ultrason-ic measurement, we found the estimated tonsillar size has no correlation with the severity of OSA in children. However, the thickness of lateral pharyngeal wall and to-tal neck thickness at retro-palateal level is related to the presence of childhood OSA. Ultrasounds, are non-inva-sive and non-radiation, have potential benefits for pro-viding the extraluminal structure of upper airway in pe-diatric population.

performed by surgeons is recognized and acknowledged as an efficient and effective way of improving clinical di-agnoses and treatments of otolaryngology and head neck. For the specific topics where surgeon-performed ultra-sound is deemed as an effective for guiding diagnoses and treatments, ultrasound can serve as the stethoscope for ENT-HN doctors in the routine clinical practice.

» 13:50-14:10

» ULTRASOUND-gUIDED CORE BIOPSY AS AN ExTENDED HAND OF ENT-HN SURgEON FOR MAKINg ACCURATE DIAgNOSES




CHUN-NAN CHEN

Neck masses are frequently encountered in the daily prac-tice of ENT-HN surgeon. Conventionally, detailed his-tory taking and basic physical examination by surgeons’ hands give the first diagnostic impression. Nowadays, the advancement of ultrasound imaging provides the oppor-tunity to translate our imagination into imaging. Based on the images of tumor locations and structures, various possibilities of diagnoses will be narrowed to several dis-eases, which will be easy for the next step of tissue sam-pling for confirming the appropriate treatment. Ultra-sound-guided fine needle aspiration (USFNA) is a useful first-line approach to differentiate malignant from benign lesions. However, no information of tumor structure limits its application in providing accurate and specific diagnoses. Open biopsy (OB) is the gold standard pro-cedure for decision making in these circumstances, but larger wounding and longer time for waiting and opera-tive procedures limit its accessibility in clinical practice. Ultrasound-guided core biopsy (USCB) helps to solve these difficulties. It is applied directly during ultrasound examination with minimized wound sizes and provides pathological and even pathogenic information to guide further treatment. In our hands, it helps to solve sever-al clinical challenges in our daily practice. For patients with suspicious Kikuchi-Fujimoto diseases, USCB pro-vides pathological information for definite diagnoses. For unexplained infected benign lymphadenopathy, USCB provides an alternative approach to confirm the tuber-culosis infection. For patients with difficult exposure of hypopharyngeal and tongue base tumor endoscopically,

April28(Sun)




influence on muscle kinetics and thus affect functions of swallowing and voicing. Much research has focused on the voice quality after thyroid surgery but little at-tention has been paid to swallowing function related to neck strangling. Ultrasound is a non-invasive diagnostic tool for providing the real-time image to visualize mus-cle kinetics. Our preliminary study uses the ultrasound and acoustic examination of swallowing simultaneously to analyze the muscle kinetics of swallowing processes of patients receiving uncomplicated unilateral thyroidecto-my 4-6 weeks postoperatively. Each patient was drinking 10 ml water for a repetitive saliva swallowing test in 30 seconds. Characteristics of swallowing movements in re-lation to the pharyngeal muscle contraction, larynx ele-vation, cricopharyngeal muscle relaxation and the upper esophageal sphincter were examined and acoustic data of swallowin! g sound was analyzed. Meanwhile, a question-naire including symptoms of neck muscles and swallow-ing was also completed by all participants. Results indi-cated that post-thyroidectomy patients might not suffer directly from dysphagia, however, saliva swallowing was found significantly more difficult than normal swallow-ing cases. The ultrasound can help us to visualize the swallowing movement of pharyngeal and esophageal pro-cesses and evaluate the usefulness of the related muscles. Furthermore, acoustic analysis of swallowing sound can provide us quantization of the neck strangling objectively. Inclusion of this kind of post-thyroidectomy evaluation is convenient, quick, non-radiation, and noninvasive to de-fine and to focus on the potentially swallowing problems for the efficacy of a further logopedic rehabilitation.

» 14:30-14:50

» ULTRASONIC ASSESSMENT OF THE OUT-COME AFTER INJECTION LARYNgOPLASTY FOR PATIENTS WITH UNILATERAL vOCAL CORD PARALYSIS

DEP. ORL-HEAD AND NECK SURGERY


WEN HSUAN TSENG

Unilateral vocal fold paralysis (UVFP) is a common cause of dysphonia and aspiration. UVFP is caused by diseases associated with laryngeal nerve. In cases of uncompensat-ed UVFP, medializing the paralyzed vocal ford by means of surgical correction is beneficial. Temporary injection medialization can be performed to improve glottic clo-sure while waiting for spontaneous recovery of motion or voice. Hyaluronic acid (HA), a common injectable material used, is known to undergo reabsorption in 2-4 months. However, longer effects on voice quality over the longevity of HA and decreased rates of subsequent per-manent thyroplasty have been noted on patients under-went the procedure. Current evaluation and follow-up of the voice and deglutition function depends on patients’ subjective questionnaire and physicians’ impression of glottal closure upon videolaryngostroboscope. None of them provide direct information about the HA injected. The goal of our study was to evaluate and document the remaining volume of HA. We aimed to develop a conve-nient and well-tolerated procedure to objectively evaluate the injectable. Also, it could be the first step towards ex-ploring the mechanism of the possible prolonged effects of HA on voice outcome.

» 14:50-15:10

» SONOgRAPHIC ASSESSMENT OF SWAL-LOWINg IN POST-THYROIDECTOMY PA-TIENTS


AND NECK SURGERY, KAOHSIUNG VETERANS

GENERAL HOSPITAL, TAIWAN (ROC)

YUNYING SHE

Surgeries involved the head and neck region may have

April28(Sun)





Chair : JAE YUN JUNG, SHI NAE PARK

Best Oral Presentation

» OTOP-82 15:50~16:00

» THE FACTORS INFLUENCINg THE ACCU-RACY OF HEAD POSITION DURINg CANALITH REPOSITIONINg PROCEDURE USINg 9 AxIS INERTIAL SENSOR


INHA UNIVERSITY HOSPITAL, INCHEON, KOREA 1INHA INSTITUTE OF AEROSPACE MEDICINE ,

INCHEON, KOREA 2INSTITUTE FOR INFORMATION

& ELECTRONICS RESEARCH,

INHA UNIVERSITY, INCHEON, KOREA

HYUN JI KIM1, KI NAM KIM1, HYUNG SUN HONG1, JIN GU KANG2,

SANGMIN LEE2, KYU-SUNG KIM1

Objectives: The canalith reposition procedure(CRP) for the treatment of BPPV involves a series of specifically pat-terned head and trunk motion, and accuracy of position may affect the therapeutic efficacy of CRP We investigate the accuracy of head position in CRP and influencing factors during the procedures measuring the position by inertial sensors and 3D remodeling. Methods: Twen-ty-eight patients diagnosed as BPPV were included. To evaluate the accuracy of the of head position during CRP, We use the 9 axis inertial sensor(Wireless AHRS mod-ule, EBIMU24G V3, E2Box, Korea) on patient’s goggle. Data from the sensors were sent to the computer by using 2.4GHz wireless receivers(EBRCV24GV3, E2Box, Ko-rea). Head movement of the patient was calculated using quaternion. By these data, we evaluated how accurate the treatment compares to textual treatment during CRP. We also evaluated patient factors(age, BMI, cervical spine dis-ease) which affect the accuracy of head position as well as compare the accuracy of lateral semicircular canal(LSCC) and posterior semicircular canal(PSCC) canalith reposi-tion procedure. Results: Among 28 patients, 18 patients were affected on lateral semicircular canal and 10 pa-

tients were affected on posterior semicircular canal.On the PSCC group, the average error rate of each stage was 12.6 ± 5.8%, and10.2 ± 5.2% on the LSCC group. There was no significant difference in error rate between the two groups. In the PSCC group, the error rate was 18.5 ± 5.9% with the BMI above 25. The error rate was 10.0 ± 3.5% in the patients with BMI less than 25. The error rates of the two groups were significantly differ-ent.(P<0.05). Conclusion: In this study, we found that errors in the CRP procedure caused by various factors could affect treatment.BMI could affect the accuracy of CRP and treatment of BPPV. Further studies are needed for several factors(age,spinal disease)that were thought to affect the exact CRP. (2018R1A6A1A03025523 & 2010-0020163)

» OTOP-83 16:00~16:10

» HYPERgRAvITY STIMULATION DETERIO-RATES vESTIBULAR FUNCTION WITH HAIR CELL DEgENERATION IN THE MOUSE WITH SELECTIvE P2Rx2 DEFICIT




JEJU UNIVERSITY COLLEGE OF MEDICINE1

HANSOL HONG1, MICHELLE J SUH2, JINSEI JUNG1, JAE YOUNG CHOI1,

SUNG HUHN KIM1

Objectives: P2RX2 was reported to contribute cochlear hair cell protection against severe mechanical stimulation such as loud noise exposure by the stimulation of para-crine ATP. This study was designed to investigate if P2RX2 have similar function in the vestibular system. Methods: ATP secretion in the vestibular system was investigated after mechanical stimulation by luciferin-luciferase as-say. Mechanical stimulation was given to the mice using mouse centrifugation system (4- 6G for 4 – 48 hours). Vestibulo-ocular reflex and histology of vestibular epithe-lia of those mice were analyzed with animal rotator after hyper-gravity acceleration stimulation. Histopathological changes of vestibular organ was determined by the obser-vation of hair cell loss in whole mount preparation using confocal microscopy.Results: ATP secretion was detected in the vestibular system with the order of ampulla > utri-cle > common crus > saccule. Expression and function of

April28(Sun)




rejection of implants; incorrect placement of electrodes array (insert into horizontal semicircular canal) in 2 cases (one case with Mondini deformity, the other case with narrow basal turn); complications of secondary secretory otitis media in 2 cases (secondary cholesteatoma in 1 case, electrodes protruded into the external auditory canal in 1 case), and cerebrospinal fluid otorrhea in 1 case with the combination of Mondini deformity and large vestibular aqueduct syndrome. Conclusion: Cochlear implantation is though a safe procedure,but also bring out fewer risks and complications. For infants,it is not rear to present dislocation of CI components after head trauma because of careless care, rejection associated with product quality or individual differences. In addition, it is very import-ant to prevent and actively treat secretory otitis media in children after CI implantation, in case of resulting from long-term negative pressure and inflammatory reaction, which may lead to thin posterior wall of the ear canal rupture.And then, this above pathological process can lead to secondary cholesteatoma or bone rupture of the posterior wall of the external auditory canal.For rare case with Mondini malformation combined with vestibular aqueduct enlargement should be carefully processed to pack the implant hole with fascia. As for those cases with the poor development of basal turn, such as Mondini deformity, the insertion position of the electrode arrays should be carefully checked to avoid incorrect insertion into the horizontal semicircular canal.

» OTOP-85 16:20~16:30

» ANALYSIS OF THE THERAPEUTIC UTILITY OF PLURONIC F127 BASED NANOPARTICLES IN ACUTE HEARINg LOSS

DEPARTMENT OF OTOLARYNGOLOGY, DAEJEON

ST MARYS HOSPITAL, COLLEGE OF MEDICINE,


CLINICAL RESEARCH INSTITUTE, DAEJEON ST



OF MEDICAL LIFESCIENCE, COLLEGE OF

MEDICINE, THE CATHOLIC UNIVERSITY OF

KOREA3, CATHOLIC PHOTOMEDICINE RESEARCH

INSTITUTE, COLLEGE OF MEDICINE, THE


DONG-KEE KIM1, KEUM-JIN YANG2, SO-YOUNG JUNG1, GAWON YI3, JIHYE YOO3,

p2rx2 was observed in the supporting cell and transition-al cell of the vestibular labyrinth with dose dependent manner in KO, hetero, and wild type p2rx2 mice. Af-ter the hypergravity stimulation (6G, 48 hrs), VOR gain and time constant were more decreased in p2rx2 hetero and KO mice than that of wild type (p=0.001); however, mean slow phase veolocity of nystagmus in off-vertical axis rotation was not significantly among the different genotypes. Vestibular hair cells in crista ampullaris were revealed to be damamged in the mice with reduced VOR after hypergravity stimulation. Damage of vestibular hair cells in utricular macula after the hyper gravity stimula-tion were not significantly different among the different genotypes. Conclusion: The results of this study implies that p2rx2 stimulated by paracrinely secreted-ATP plays an important role in the protection of vestibular hair cell during severe acceleration stimulation.

» OTOP-84 16:10~16:20

» RETROSPECTIvE ANALYSIS OF 12 CAS-ES WITH REOPERATION OF COCHLEAR IM-PLANTS IMPLANTATION

DEPARTMENT OF OTOLARYNGOLOGYTHE FIRST

AFFILIATED HOSPITAL OF

CHONGQING MEDICAL UNIVERSITY

HOU-YONG KANG, SHIXUN ZHONG, YI QIAN, ZHENG-YAN XU, TAO CHEN,

GUOHUA HU

Objectives: To analyze the causes of reoperation of CI implantation in order to reduce its incidence. Methods: A retrospective study design. The clinical data of patients who received CI implantation were collected from Janu-ary 2014 to December 2018 in the First Affiliated Hos-pital of Chongqing Medical University. Results: All 368 cases were involved into this retrospective evaluation. 12 cases with re-operation of CI implantation were record-ed,and re-operation rate was 3.26%. The initial operation age ranged from 1 to 18 years, and the interval periods before re-operation ranged from 1 month to 4 years.7 cases were right ear and 5 cases were left ear. There were 7 cases (1.90%) were testified with non-operative causes, other 5 cases (1.36%) with operative cause. All of these 12 cases, displacement of the coil or stimulator of CI were examined in 3 cases after head trauma;2 cases were found the internal part of CI system didn’t work with unknown bug; infection of skin flaps in 2 cases due to

April28(Sun)




DEFICIT AFTER HEARINg LOSS STATISTICAL PARAMETRIC MAPPINg AND OPTIMIzED vOx-EL-BASED MORPHOMETRY STUDY

DIVISION OF RI APPLICATION, KOREA INSTITUTE

OF RADIOLOGICAL AND MEDICAL SCIENCES1,

DIVISION OF RADIATION BIOMEDICAL RESEARCH,

KOREA INSTITUTE OF RADIOLOGICAL AND

MEDICAL SCIENCES2, DEPARTMENT OF BIO-

CONVERGENCE ENGINEERING, KOREA

UNIVERSITY3, RADIOLOGICAL AND MEDICO-

ONCOLOGICAL SCIENCES, UNIVERSITY OF

SCIENCE AND TECHNOLOGY4, DEPARTMENT OF

OTORHINOLARYNGOLOGY, BORAMAE MEDICAL

CENTER, SEOUL METROPOLITAN GOVERNMENT-

SEOUL NATIONAL UNIVERSITY5, DEPARTMENT

OF OTORHINOLARYNGOLOGY, COLLEGE OF

MEDICINE, SEOUL NATIONAL UNIVERSITY6,

NATIONAL PRIMATE RESEARCH CENTER, KOREA

RESEARCH INSTITUTE OF BIOSCIENCE AND

BIOTECHNOLOGY (KRIBB), CHEONGJU, REPUBLIC

OF KOREA7

JIN SU KIM1,4, HAE-JUNE LEE2, SEONHWA LEE1,3, HO SUN LEE5,6,

YE JI JEONG2, YEONGHOON SON2,7, JUNG MIN KIM3, YONG JIN LEE1,

MIN-HYUN PARK5,6

Objectives: The study of cognitive impairment associat-ed with hearing loss has recently garnered considerable interest. However, the relationship between them has not been directly investigated. Methods: We used positron emission tomography (PET) and magnetic resonance imaging (MRI) to evaluate changes in glucose metabo-lism and gray matter concentrations in the 5xFAD Alz-heimer's Disease transgenic mouse model with (AD-HL) and without (AD) hearing loss. Results: We found lower cerebral glucose metabolism in the frontal association cortex in the AD-HL group than in the AD group at 3 and 7 months following induction of hearing loss. While we found lower glucose metabolism in the hippocam-pus and cerebellum in the AD-HL group than in the AD group at 3 months, gray matter concentrations in these regions were not significantly different between the groups. Further, gray matter concentrations in the simple lobule, cingulate/retrosplenial cortex, substantia nigra,

HEEBEOM KOO3,4

Objectives: The purpose of this study was to develop a therapeutic drug for acute hearing loss using an antiox-idant-containing nanoparticle based on pluronic F127. In our previous study, nanoparticles coated with polyeth-yleneglycol (PEG) showed an advantage in penetrating the mucosa when delivering medication to inner ear. Pluronic F127 is approved by the FDA for use in the ear and has two PEG blocks. Methods: We selected al-pha lipoic acid through literature search to be loaded in nanoparticles. The safety of nanoparticle in HEI-OC1 cells, and the protective effect of nanoparticle against aminoglycoside toxicity, were investigated, and to investi-gate the antioxidant action of nanoparticle, we measured the intracellular levels of ROS in response to kanamycin with or without nanoparticle, as well as levels of anti-oxidant proteins. For investigating the mechanism of antioxidant activity, we down-regulated NRF2 in HEI-OC1 cell lines by Nrf2 siRNA. In mice, we delivered he nanoparticle by intratympanic injection 4h before oto-toxicity induction and analyzed the therapeutic utility of nanoparticles in acute hearing loss. Results: The size of particles was about 109.1 nm, and in the analysis of drug release, about 28% of the drug was released gradually from nanoparticle for 40 hours at room temperature. In vitro results, nanoparticles showed safety in MTT assay up to 2.5mg/ml and cytoprotective effects at concentra-tions from 0.25 mg / ml to 2.5 mg / ml. It also showed an increase in antioxidant proteins such as Nrf2, HO-1, SOD-1 and SOD-2. However, this effect was counter-acted when Nrf2 siRNA was treated, indicating that the nanoparticles act on the Nrf2 / HO-1 pathway for an-tioxidant effect. In vivo results, the hearing of animals injected with nanoparticles into the middle ear cavity, was also significantly preserved after ototoxicity induc-tion compared to the control group, and the increase of Nrf2 was also observed in cochlea of these animals, which indicating that the nanoparticle showed the protective effect of hearing through the same antioxidant mecha-nism. Conclusion: Pluronic F127 nanoparticles loading alpha lipoic acid showed effective hearing protection in acute hearing loss, which appears to be mediated through the Nrf2 / HO-1 pathway. Considering the known safety and long release times of the nanoparticle, it appears to be a potential new drug for intratympanic injections.

» OTOP-86 16:30~16:40

» PET AND MR EvIDENCE OF COgNITIvE

April28(Sun)




HOSPITAL, DAEJIN MEDICAL CENTER11

MIN YOUNG KWAK1, CHAN JU YANG1, HYUN JOON SHIM2, CHAN IL SONG3,

JONG YANG KIM4, IL WOO LEE5, SUNG WOOK JUNG6, HYUN WOO LIM7,

JOONG KEUN KWON8, JUN HO LEE9, JUNE CHOI10, YUN SUK AN11,

JONG WOO CHUNG1

Objectives: To compare the effect of time intervals for intratympanic(IT) dexamethasone(DEX) in patients with idiopathic sudden sensorineural hearing loss (ISSN-HL). Methods: Study design : Retrospective case series Patients : Seventy- five adults with ISSNHL Intervention : Patients were divided into four groups according to the IT DEX interval. In addition to concurrent oral steroid medication for 2 weeks, patients received IT DEX injec-tions every 1, 2, 3, and 4 days, respectively. (Group 1, Group 2, Group 3, and Group 4) Results: There were no significant differences in demographics and baseline au-diometric data. The mean of pure tone audiometry (PTA) and speech discrimination score (SDS) were significant-ly improved after oral steroid and IT DEX treatment in all four group. Group 1 showed significantly higher im-provement than Group 4 in PTA and SDS. We evaluated the treatment outcomes according to “Clinical Practice Guideline: Sudden Hearing Loss” from the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) to justify treatment success. There was sig-nificant higher complete recovery(CR) rate in Group 1 than Group 4 by the modified AAO-HNS guideline (P=0.008*). Group 2 also showed significantly better CR rate than Group 4. Conclusion: We found statistically significant difference in complete and partial hearing re-covery rate, and audiometric results(PTA and SDS) be-tween the group with a daily interval of injections and the group with a four-day time interval. We suggest that shorter time interval in each IT DEX injection for ISSN-HL may be considered as an advisable therapeutic option for improvement of hearing in patients with ISSNHL.

retroethmoid nucleus, medial geniculate nucleus, and anterior pretectal nucleus at 7 months were significantly lower in the AD-HL group than in the AD group. Be-havioral data from the Y-maze and passive avoidance tests revealed greater memory deficits in the AD-HL group than in the AD group. Conclusion: Together, these re-sults indicate that even partial hearing loss can aggravate cognitive impairment in Alzheimer’s Disease.

» OTOP-87 16:40~16:50

» INTRATYMPANIC STEROID INJECTION FOR SUDDEN SENSORINEURAL HEARINg LOSS THE EFFECT OF THE INTERvAL BETWEEN IN-JECTIONS ON THERAPEUTIC EFFICACY


HEAD AND NECK SURGERY, ASAN




SURGERY, EULJI UNIVERSITY SCHOOL

OF MEDICINE, EULJI MEDICAL CENTER2,


COLLEGE OF MEDICINE, YONSEI UNIVERSITY3,


NATIONAL POLICE HOSPITAL4, DEPARTMENT OF

OTOLARYNGOLOGY, COLLEGE OF MEDICINE,

PUSAN NATIONAL UNIVERSITY5, DEPARTMENT OF

OTOLARYNGOLOGY AND HEAD & NECK SURGERY,

COLLEGE OF MEDICINE, DONG-A UNIVERSITY6,


GANGNEUNG ASAN HOSPITAL, UNIVERSITY OF

ULSAN COLLEGE OF MEDICINE7, DEPARTMENT

OF OTOLARYNGOLOGY-HEAD AND NECK

SURGERY, ULSAN UNIVERSITY HOSPITAL,




UNIVERSITY HOSPITAL9, DEPARTMENT

OF OTORHINOLA,RYNGOLOGY-HEAD AND

NECK SURGERY, KOREA UNIVERSITY



SURGERY, BUNDANG JESAENG GENERAL

April28(Sun)




RHOP-12Room 2-3 (White Heron)

Chair : KYUNG SU KIM, PONTUS STIERNA


» RHOP-69 15:50~16:00

» SURvIvAL IMPACT OF TREATMENT DELAYS IN SURgICALLY MANAgED SINONASAL CAN-CER IN THE UNITED STATES

DEPARTMENT OF HEAD AND NECK SURGERY,

UCLA SCHOOL OF MEDICINE,

LOS ANGELES, CALIFORNIA

ALEXANDER N. GOEL, JIVIANNE T. LEE, MARILENE B. WANG, JEFFREY D. SUH

Objectives: To characterize treatment delays in sinon-asal cancer managed with surgery and adjuvant radi-ation and determine the associated impact on survival. Methods: We identified adults in the National Cancer Database treated for sinonasal squamous cell carcinoma with definitive surgery followed by adjuvant radiation from 2004-2014. We examined intervals of diagnosis to surgery (DTS), surgery to radiation (SRT), and ra-diation duration (RTD). We performed recursive par-titioning analysis (RPA) to identify thresholds for these treatment intervals that estimated the greatest differences in survival. We determined the association of treatment delay with overall survival using Cox proportional haz-ards regression. Results: Among 2,267 patients included, median durations of DTS, SRT, and RTD were 32, 49, and 47 days, respectively. Predictors of treatment delay included care transitions, black race, and Medicare in-surance. We identified thresholds of 26, 64, and 51 days for DTS, SRT, and RTD, respectively, as estimating the largest survival differences. Delays in SRT (Hazard ratio (HR) 1.20 95% confidence interval (CI), 1.03- 1.40) and RTD (HR, 1.27 95% CI, 1.10-1.46) beyond these thresholds independently predicted mortality. Delay in DTS beyond the RPA- derived threshold was not signifi-cantly associated with mortality after adjusting for other covariates. Conclusion: Delays in SRT and RTD inter-vals are associated with decreased overall survival. Median durations may serve as national benchmarks. Treatment

delays could be considered quality indicators for sinon-asal cancer treated with surgery and adjuvant radiation.

» RHOP-70 16:00~16:10

» vIRTUAL REALITY TRAININg TOOL FOR ANATOMY OF PARANASAL SINUSES




CHANGWON HOSPITAL1 AND VIRTUAL REALITY

LABORATORY, SAMSUNG CHANGWON HOSPITAL2

JUNG YONG GI1,2, KO JUNG-YON2

Objectives: Paranasal sinuses are very complex struc-tures, and the 3-dimensional (3D) structure of the si-nuses can not be grasped easily through 2D CT imag-es. Virtual reality (VR) technology is a widely applied method for various training and practice. We created the VR environment with actual patient's CT scan. We re-leased the VR model a year ago and refined the model by further study. Methods: DICOM (Digital Imaging and Communications in Medicine) data of 0.6- 0.8mm slice thickness was extracted from the original CT image of the patient, and reconstructed 3-dimensionally using 3D modeling software. Then reconstruction and surface tex-turing were performed to apply 3D data to HMD(Head Mounted Display). And the important structures such as major vessels, nerves and muscles around the sinuses were implemented in the virtual reality environment. To eval-uate the feasibility of the VR model, the user experience for the model was evaluated. Results: The nasal cavity and paranasal sinuses (maxillary, ethmoid and sphenoid sinus) of real patients were successfully reconstructed in to 3D model, and the VR space were mounted on the HMD. All of the 5 users reported that they had a great help in understanding the structure of the sinus, and they understood the structure to be much easier than when using CT. Conclusion: The virtual reality model is very helpful for understanding the anatomy of the cavity structure as the paranasal sinuses. In addition, this ap-proach can be used extensively in anatomical education of cavity structures other than paranasal sinuses.

» RHOP-71 16:10~16:20

» vALIDATION OF A RHINOLOgIC vIRTUAL SURgICAL SIMULATOR FOR PERFORMINg A

April28(Sun)




actual cadaver dissection. Our rhinologic VSE may be used for pre-surgical planning and rehearsal prior to the actual Draf3 procedure in the operating room.

» RHOP-72 16:20~16:30

» vIRTUAL REALITY SIMULATORS FOR ENDO-SCOPIC SINUS AND SKULL BASE SURgERY CONSIDERATION IN DEvELOPMENT


NECK SURGERY, SEOUL ST MARYS HOSPITAL,


UNIVERSITY OF KOREA, SEOUL, KOREA1,

DEPARTMENT OF NEUROSURGERY, SEOUL ST



SEOUL, KOREA2

DO HYUN KIM1, JAE-SUNG PARK2, SOO WHAN KIM1, SUNG WON KIM1

Objectives: Virtual reality simulators for endoscopic si-nus and skull base surgery can create a computerized en-vironment in which the patient’s anatomy is reproduced and interaction with endoscopic handling and realistic haptic feedback is possible. However, there were several challenging points to break through for completion of virtual reality simulators. Methods: From July 2017 to December 2018, we has been developed a virtual real-ity simulators for endoscopic sinus and skull base sur-gery. Real-time simulation framework was designed by SOFA with an emphasis on medical simulation (www.sofa-framework.org). Graphics rendering was carried out by Unity 3D (https://unity3d.com/kr). Two 3D Systems Touch X Haptic Device improved for for endoscopic sinus and skull base surgery were applied for haptic re-sponses. Electromagnetic Sensor was used for endoscope location recognition. Results: Assessment mechanism is the most source of trouble during development. Simple performance-success model could not enhance surgeon’s skill. Also, comprehensive assessment algorithm would be needed for data based assessment adjustment. Hap-tic responses in a narrow nasal cavity area might cause annoyance to the trainers. Also, 3D model deformation is still challenging in virtual reality simulators especially during cutting and removing action. Conclusion: Virtu-al reality simulators mimicking real surgical settings are available and have improved over time. However, there

DRAF3 ENDOSCOPIC FRONTAL SINUSOTOMY


HEAD & NECK SURGERY, SEOUL NATIONAL

UNIVERSITY BUNDANG HOSPITAL1, DEPARTMENT

OF OTORHINOLARYNGOLOGY-HEAD & NECK


HOSPITAL2, DEPARTMENT OF NEUROSURGERY,

SEOUL NATIONAL UNIVERSITY HOSPITAL3,

DEPARTMENT OF COMPUTER SCIENCE,

UNIVERSITY OF CALGARY4, DEPARTMENT OF

COMPUTER SCIENCE, STANFORD UNIVERSITY5,


NECK SURGERY, STANFORD UNIVERSITY7

TAE-BIN WON1, SUNG-WOO CHO1, HYUNG GU KIM1, DONG-YOUNG KIM2,

JEONG-WHUN KIM1, HYUN-JIK KIM2, CHAE-SEO RHEE2, SUN HA PAEK3,

SONNY CHAN4, KENNETH SALISBURY5, NIKOLAS H BLEVINS6, PETER HWANG7

Objectives: We have recently introduced a patient spe-cific rhinologic virtual surgical environment (VSE) and showed its potential for surgical rehearsal of various skull base lesions. The purpose of this study was to validate the usefulness of the rhinology VSE in performing the Draf3 procedure. Methods: An inside-out Draf 3 proce-dure was performed in 4 cadaver heads. Thin sliced CT scans were obtained prior and after the cadaver dissection (CD). Pre-dissection CT scans were used to construct a cadaver-specific VSE. A virtual Draf3 dissection (VD) was performed using the same technique. Validation was conducted by comparing the final common frontal out-flow tract. A subjective comparison of the post dissection endoscopic findings (CD vs VD) and an objective mea-surement was performed using the post-dissection CT scan for the CD and the reconstructed CT scan obtained from the data after the VD. Results: Subjective overall resemblance of the two dissections (CD vs VD) assessed by the 4 point Likert scale (0-3) was 2.5 (interquartile range , IQR :0.25) for the four cadavers. The average dif-ference of the anterior-posterior dimension of the fron-tal neo-ostium (CD vs VD) assessed in the mid-sagittal view was 0.11 mm, while the average difference of the lateral dimension assessed in the coronal view was 2.71 mm, showing no statistical difference. Conclusion: The virtual dissection showed near matching results with the

April28(Sun)




Demographics, nose-specific symptoms, olfactory func-tion, blood eosinophil counts (EoB), Lund-Mackay CT score (LMCTscore), and tissue eosinophil counts (EoT) were collected. Univariate and multivariate analyses were performed and finally established a prediction equa-tion for postoperative endoscopic objective outcomes. Results: In total (n=1249), 27.0% was not satisfied un-der postoperative endoscopic examination. Of 10 vari-ables, LMCTscore(>5), sinus dominancy(maxillary sinus and ethmoid sinus), EoB(>210), and EoT(>100) were statistically significant in univariate analysis (p<0.05, all). In multivariate analysis, EoT(>100) and LMCT-score(>5) were significantly associated with poor post-operative outcome. Furthermore, 5 significant variables were employed to establish the risk model of postopera-tive outcomes and P (the value of prediction probability) = 1/(1+exp[-0.392+1.088xEoT(>100)+0.123xLMCT-score(>5)-0.366xsinus dominancy(maxillary)+0.064xsi-nus dominancy(similar)+0.200xEoB(4%)+0.344xE-oB(>210)] was developed. The accuracy, sensitivity, specificity, positive predictive value and negative predic-tive value was 70.30%, 76.19%, 42.13%, 86.29% and 27.00%, respectively. Conclusion: Tissue eosinophil counts and radiographic severity predispose to a poorer outcome of ESS and the risk model established may be helpful to predict postoperative outcomes of ESS.

» RHOP-74 16:40~16:50

» THE ExPRESSION OF EzRIN, A MEMBRANE CYTOSKELETON CROSS LINKER PROTEIN, DECREASED IN CHRONIC RHINOSINUSITIS AND ITS POSSIBLE CONTRIBUTION TO MAIN-TAIN EPITHELIAL BARRIER INTEgRITY IN SI-NUS MUCOSA

DEPT OF OTORHINOLARYNGOLOGY-HEAD AND

NECK SURGERY, COLLEGE OF MEDICINE, KOREA

UNIVERSITY

JAE WOONG HWANG, KI JUNG LEE, TAE HOON KIM, SANG HAG LEE

Objectives: Emerging evidence indicates that epithelial barrier function is compromised in chronic rhinosinus-itis (CRS). Ezrin, a membrane-cytoskeleton protein, maintains cellular morphology and intercellular adhesion and protects the barrier function of epithelial cells. We analyzed the role of ezrin in the maintenance of human

are still several challenging points to break through for completion of virtual reality simulators.

» RHOP-73 16:30~16:40

» ANALYSIS OF PROgNOSTIC FACTORS OF POSTOPERATIvE OUTCOMES AND RISK MODEL ESTABLISHMENT OF ENDOSCOPIC SINUS SURgERY IN PATIENTS WITH CHRON-IC RHINOSINUSITIS A MULTICENTER STUDY IN KOREA


NECK SURGERY, SCHOOL OF MEDICINE, KYUNG

HEE UNIVERSITY, SEOUL1, CHUNGNAM NATIONAL

UNIVERSITY, DAEJEON2, SEOUL METROPOLITAN

GOVERNMENT SEOUL NATIONAL UNIVERSITY

BORAMAE MEDICAL CENTER3, SEOUL NATIONAL

UNIVERSITY COLLEGE OF MEDICINE, SEOUL4,

KONKUK UNIVERSITY, SEOUL5, DANKOOK

UNIVERSITY COLLEGE OF MEDICINE, CHEONAN6,


SEOUL7, PUSAN NATIONAL UNIVERSITY SCHOOL

OF MEDICINE, BUSAN8, DEPARTMENT OF MEDICAL

STATISTICS, SCHOOL OF MEDICINE, CATHOLIC

UNIVERSITY OF DAEGU9, DEPARTMENT OF


SCHOOL OF MEDICINE, CATHOLIC UNIVERSITY OF

DAEGU10, SOUTH KOREA

JIN-YOUNG MIN1, YONG-MIN KIM2, DAE-WOO KIM3, JEONG-WHUN KIM4,

JIN-KOOK KIM5, JI-HUN MO6, JAE-MIN SHIN7, KYU-SUP CHO8, SANG GYU KWAK9,

SEUNG-HEON SHIN10

Objectives: Endoscopic sinus surgery (ESS) is the main-stay treatment for refractory chronic rhinosinusitis (CRS). Since various factors may contribute to the surgical out-come, it is challenging for physicians to predict surgical outcomes. The aim of study was to analyze the prognos-tic factors of postoperative outcomes and to establish the model of risk factors that impact the postoperative out-comes. Methods: Medical records of CRS patients who underwent ESS at 9 institutions between 2005 and 2016 were retrospectively reviewed. We classified the patients into 2 groups based on endoscopic objective outcomes.

April28(Sun)




sinonasal epithelial barrier integrity. Methods: The ex-pression levels of ezrin in normal and inflammatory sinus mucosa were analyzed by real time PCR, western blot, and immunohistochemistry. The expression levels of ez-rin, transepithelial permeability and electrical resistance were measured in epithelial cells treated with Th1 and Th2 cytokines, in cells silenced with Ezrin-specific siR-NA. Furthermore, the expression and distribution pat-tern of tight junctional complex proteins were also evalu-ated in cells silenced with ezrin-specific siRNA. Results: ezrin was constitutively expressed in epithelial cells, and submucosal glands of sinonasal mucosa. Its levels are de-creased in inflammatory mucosa of CRS patients with or without nasal polyps and is down-regulated in epithelial cells treated with Th1 and Th2 cytokines. Increased epi-thelial a permeability associated with decreased electrical resistance were found in cells treated with ezrin specific siRNA where the expression levels of ZO-1, occludin, and claudin-1 were decreased. Conclusion: Ezrin is con-stitutively expressed in normal human sinonasal mucosa and is down-regulated in inflammatory mucosa where it could potentially contribute to maintain the sinonasal epithelial barrier integrity.

April28(Sun)




HNOP-8Room 2-5 (Crane)

Chair : YOUNG GYU EUN, HAN SIN JEONG

Basic

» HNOP-48 09:00~09:10

» FERROPTOSIS OF SUBMANDIBULAR gLAND IN OvARIECTOMIzED RATS



UNIVERSITY YANGSAN HOSPITAL1, PUSAN

NATIONAL UNIVERSITY HOSPITAL2, PUSAN

NATIONAL UNIVERSITY MEDICAL RESEARCH

INSTITUTE, PUSAN NATIONAL UNIVERSITY

SCHOOL OF MEDICINE3

HYUN-KEUN KWON1, HWA-BIN KIM2, HAN-SEUL NA2, HYO-SEOK SEO2, JI MIN KIM3,

BYUNG-JOO LEE2

Objectives: Xerostomia is representative post-menopaus-al oral symptoms that may result from decreased salivary secretion. Menopause-related hormonal deficiency may affect the oral conditions by various mechanisms. Ferro-ptosis is a newly recognized type of cell death that result from iron-dependent lipid peroxidation and is different from other type of cell death. This study was performed to determine the histological and molecular changes of salivary gland in order to clarify effects of estrogen defi-ciency on lipid accumulation and cellular dysfunction of submandibular gland in ovariectomized rats. Methods: Forty eight female Sprague-Dawley rats aged eight weeks were randomly divided into four groups: group I (1 month after sham-operated rats as CON-OVX1), group II (1 month after ovariectomized rats as OVX1), group III (3 month sham-operated rats as CON-OVX3) and group IV (3 month after ovariectomized rats as OVX3). To investigate whether estradiol effect on lipid accumu-lation and fibrosis production in submandibular gland, hematoxylin-eosin, masson’s trichrome and transmission electron microscope methods were used. Malondealde-hyde (MDA) and hydroxyalkens (HAE) absorbance assay was used to evaluate lipid peroxidation levels. Total Fe

and Fe2+ of submandibular gland was measured. Results: To begin with present study, we confirmed serum estra-diol levels were down regulated by surgery and estrogen receptors were well expressed on submandibular gland. MDA and HAE levels were increased on serum and cytosolic fraction in OVX group. Total Fe and Fe2+ of submandibular gland were also increased in OVX group. Conclusion: Our finding confirms that estrogen effects on iron repletion and lipid accumulation. Iron-depen-dent lipid peroxidation can regulate ferroptosis and its related pro-inflammatory response in estrogen deficien-cy rats. Furthermore, present results might have clinical important evidence and these results could be used for therapeutic targeting of post-menopausal oral symptoms include xerostomia.

» HNOP-49 09:10~09:20

» PROgNOSTIC SIgNIFICANCE OF THE Ex-PRESSION OF CLAUDIN-1 IN HEAD AND NECK CANCER


HEAD AND NECK SURGERY1, PATHOLOGY2,

KANGBUK SAMSUNG HOSPITAL, SUNGKYUNKWAN


JIN LEE1, HYE-SOO KIM1, SEUNG-HO NOH1, SUNG-MIN JIN1, SANG-HYUK LEE1,

SUNG-IM DO2, HYUN-JOO LEE2

Objectives: Claudin-1(CLDN-1) is an integral compo-nent of tight junctions and functions in controlling cell to cell adhesion. Certain CLDNs were proved to have prognostic significance in several human cancers, how-ever, its clinical significance has been poorly understood in head and neck squamous cell cancer (HNSCC). The aim of this study was to investigate the correlation be-tween CLDN-1 expression and clinicopathological pa-rameters as well as survival rate in HNSCC. Methods: The surgical specimens of primary HNSCCs from a con-secutive cohort of 91 patients were retrospectively col-lected. Immunohistochemical staining for CLDN-1 was performed, and quantified blindly by two pathologists who had no clinical information of the patients. CLDN-1 staining intensity was scored on a scale of 0 to 3 (0: negative; 1: weak; 2: moderate; 3: strong), and for the statistical analysis, the expression levels were classified as low (negative and weak) or high (moderate and strong).

April28(Sun)




We aimed to compare the expression of PD-L1 and the infiltration CD8+ TILs between primary and recurrent HNSCCs. We also evaluated whether the changes of those immunologic properties in recurrent HNSCCs af-fect the oncologic outcome. Methods: Forty-two con-secutive patients with SCCHN, who had been treated for both primary and recurrent HNSCCs in a tertiary medi-cal institution from March 2000 to December 2015, were included. For matched analysis, pathologic specimens from initial surgery and salvage surgery were obtained in each patient and immunohistochemical staining of CD3, CD8, PD-1 and PD-L1 were performed. Also, neutro-phil-to-lymphocyte ratio (NLR) and platelet-to lympho-cyte ratio (PLR), the laboratory biomarkers, were also examined. Results: PD-L1 expression in tumor cells was consistent between primary and recurrent cancers in 66.7 % of patients. In the remaining patients, it changed from negative to positive (9.5%) or vice versa (23.8%). The ratio of CD8 expression in primary and recurrent cancers (CD8 R/P ratio) was 0.6. (range 0.3 ~ 2.1, p=0.936). R/P ratio of PD1 and PD-L1 was 0.5 (range 0.2 ~ 1.4, p=0.014) and 0.4 (range 0.2 ~ 1, p=0.006), respectively. In contrast, R/P ratio of NLR and PLR was 1.6 (range 1.0 ~ 2.6, p=0.001) and 1.4 (range 1.0 ~ 2.4, p<0.001), respectively. In multivariate analysis, increased CD8 R/P ratio (>1) was the only significant prognostic factor for better OS (hazard ratio 0.228, p=0.018). Conclusion: Immunologic properties in recurrent HNSCC may not be consistent with primary cancer. The degree of CD8 TIL and PD-L1 changes at recurrence may vary from pa-tient to patient. Increased CD8 TIL with recurrence may be a good prognostic factor.

» HNOP-51 09:30~09:40

» HIgH-RESOLUTION FLUORESCENCE LYM-PHOgRAPHY USINg NIR-FLUORESCENT ALBUMIN FOR SENTINEL LYMPH NODE MAP-PINg IN ORAL SQUAMOUS CELL CARCINOMA MICE xENOgRAFT



MEDICINE1, DEPARTMENT OF RADIOLOGY,





JI HOON KIM1, MINHEE KU2, JINHO PARK2,

Next, association between CLDN-1 expression and clini-copathological features & clinical outcomes was assessed. Results: Expression of CLDN-1 was scored as high for 72 patients, 13 (18%) oral cavity cancer, 11 (15%) oro-pharynx cancer, 26 (36%) larynx cancer, 11 (15%) hy-popharynx cancer, 8 (11%) others. A high expression of CLDN-1 was related to gender (P=0.002) and lymphat-ic invasion (P = 0.059), however, is not associated with pathological T stage, lymph node metastasis and recur-rence. Kaplan-Meier analysis shows that 5 years cumula-tive survival rate was 49% in patients with high CLDN-1 expression and 68% in patients with low CLDN-1. A significantly poor cumulative survival rate was recorded in patients with high CLDN-1 expression versus patients with low CLDN-1 (P<0.05). Conclusion: Our results suggest that high CLDN-1 expression is correlated with lymphatic invasion and poor survival rate. It can be used helpful prognostic marker in patients with HNSCCs.

» HNOP-50 09:20~09:30

» COMPARISONS OF IMMUNOLOgIC PROP-ERTIES BETWEEN INITIAL AND RECURRENT HEAD AND NECK CANCER ACCORDINg TO MATCHED SAMPLE ANALYSIS


HEAD & NECK SURGERY, INJE UNIVERSITY


PATHOLOGY, HALLYM UNIVERSITY DONGTAN

SACRED HEART HOSPITAL2, DEPARTMENT OF

PATHOLOGY,SUNGKYUNKWAN UNIVERSITY

SCHOOL OF MEDICINE, SAMSUNG MEDICAL

CENTER 3, OTOLARYNGOLOGY-HEAD & NECK

SURGERY, SUNGKYUNKWAN UNIVERSITY

SCHOOL OF MEDICINE, SAMSUNG MEDICAL

CENTER4

YOON KYUNG SO1, BYUNSUN JOO2, YOUNG HYEH KO3, YOUNG-IK SON4,

MAN KI CHUNG4

Objectives: Recently, cancer immunotherapy has been shown promising outcomes in many cancer types includ-ing head and neck squamous cell carcinoma (HNSCC). The immunologic properties of cancers can change during clinical course and the expression of the biomarkers for cancer immunotherapy might change with recurrence.

April28(Sun)




enabled to evaluate the interplay between HNCs and lymphatic endothelial cells (LEC) in vitro. The tumor conditioned media from FaDu cells were supplemented on the LEC-grown plates to see whether paracrine fac-tors from tumors affect LECs. The conditioned media from stimulated LECs were added on the HNC-grown plates to see whether LECs affect tumor cells vise versa. Results: The tumor conditioned media significantly in-creased LEC proliferation in a dose-dependent manner. The pErk signaling was responsible for the increment of LEC proliferation. On the other hands, conditioned media from LECs increased the migration of HNC cells with increased levels of pSTAT1 and pSTAT3 expression while the proliferation did not changed. Chemokine ar-ray indicated CXCL5 secretion was strikingly increased from stimulated LECs and the upregulated CXCL5 was at least partially responsible for the increments of HNC migration. Conclusion: The conditioned media culture system uncovered the intimate crosstalk between HNC tumor cells and LECs. Identifying the secretory factors and responsible signaling pathways beyond these cross-talk might offer a potential therapeutic target in HNC.

» HNOP-53 09:50~10:00

» MACROPHAgE DEPLETION IMPAIRS EPI-THELIAL REMODELINg OF FLAP MARgIN IN MICE


AJOU UNIVERSITY SCHOOL OF MEDICINE1,


- HEAD AND NECK SURGERY, CHUNGNAM

NATIONAL UNIVERSITY HOSPITAL2,

DEPARTMENT OF PATHOLOGY,

AJOU UNIVERSITY SCHOOL OF MEDICINE3

JEON YEOB JANG1, HO-RYUN WON2, JIN ROH3, CHUL-HO KIM1, YOO SEOB SHIN1

Objectives: Macrophages have been known to have di-verse roles either after tissue damage or during the wound healing process. However their role in flap wound healing is poorly understood. In this study, we aimed to evaluate the role of macrophages in a murine model of flap wound healing. Methods: A mouse model of a pedicled local flap was generated, and the time-course of the wound healing process was determined. Especially, the interface between the flap and the residual tissue was histopathologically

NARA YOON2, JAEMOON YANG2, HYUNG KWON BYEON3

Objectives: We aimed to compare the sentinel lymph node (SLN) detection efficacy of free ICG, physically mixed contrast agent of ICG and bovine serum albumin (ICG/BSA), and chemically conjugated contrast agent of ICG and bovine serum albumin (ICG-BSA), using a high resolution imaging device in a xenograft mouse model of oral cancer with cervical lymph node metastasis. Methods: The SLN targeting ability of free ICG, ICG/MSA, ICG-BSA was examined in vitro using the UM-SCC-1 cell line and in vivo in a oral cancer mouse mod-el using high quality near infrared fluorescence imaging devices, VISQUE® InVivo Elite and VISQUE® InVivo Smart (Vieworks, Korea). Results: The biodistribution of ICG varied depending on the combination method of ICG and albumin. ICG combined with albumin showed clearer lymphatic circulation compared to free ICG, while ICG-BSA displayed more sensitive fluorescence signal than ICG/BSA. The fluorescence intensity of the ICG-BSA was more concentrated in the tumor and the metastatic lymph node, compared to the free ICG group. Conclusion: ICG-BSA has more specific targetable ac-tivity for visualizing SLN than currently used free ICG and could provide more enhanced intraoperative SLN mapping as a good surgical guidance.

» HNOP-52 09:40~09:50

» CONDITIONED MEDIA CULTURE SYSTEM UNvEILS AN INTIMATE CROSSTALK BE-TWEEN HEAD AND NECK CANCER AND LYM-PHATIC ENDOTHELIAL CELLS A PRELIMINARY STUDY



JEON YEOB JANG, BOK-SOON LEE, YOO SEOB SHIN, CHUL-HO KIM

Objectives: Crosstalk between cancer cells and lym-phatic endothelial cells (LEC) have been known to play pivotal roles in lymph node metastasis of solid cancer. However, phenotypic changes and mechanisms of the interaction between head and neck cancer (HNC) cells and lymphatic vessels are still unclear. Methods: Here we developed conditioned media cell culture system which

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Murine SCC VII (squamous cell carcinoma) cells were inoculated to female C3H/J. We divided 6 treatment groups; control, radiation therapy, anti-PD-1, radiation, anti-PD-1 with MPD-1, RT with MPD-1, and triple therapy (anti-PD-1 + RT + MPD-1) (n = 5/group). After a tumor grew up to 100 or 200 mm3, each treatment was initiated. Tumor size and mice weight were measured. Distribution of CD45+, CD8+, CD4+, and FoxP3+ cells was analyzed. Results: The synergistic anti-tumor activ-ity compared single treatment was observed in RT with MPD-1, anti-PD-1 with MPD-1, and triple treatment group. CD45+ tumor- infiltrating lymphocytes (TILs) were increased in anti-PD-1 containing groups rather than RT-added or only group. A tumor treated with an-ti-PD-1 plus MPD-1 was decreased like RT plus MPD-1 group. Anti-PD-1 was likely to initiate apoptosis produc-ing caspase-3, an activator of MPD-1. TILs were slightly increased more in the triple treatment group, which pre-sented a better anti-tumor effect than any other group. Body weight of each treatment group was not significant-ly different. Conclusion: Systemic anti-PD-1 initiates apoptosis and produces caspase-3 activating MPD-1. It also changes the population of TILs possibly augmenting immunogenic cell death.

» HNOP-55 10:10~10:20

» COMPREHENSIvE MOLECULAR CHARAC-TERIzTION OF DUCTAL vERSUS ACINAR CELL IN SALIvARY gLAND


HEAD AND NECK SURGERY, INHA UNIVERSITY,

COLLEGE OF MEDICINE

JI WON KIM, JEONG MI KIM, MI EUN CHOI, YOUNG-MO KIM, JEONG-SEOK CHOI

Objectives: The molecular difference between ductal and acinar cell in salivary gland is not well characterized. The aim of this study was to identify specific molecular markers and therapeutic targets of salivary gland cells in the setting of radiation therapy. Methods: Differential gene expression between ductal and acinar cell lines from microarray data was tested by Student's t-test. Differen-tial expression was confirmed in immunohistochemistry (IHC) and reverse transcription polymerase chain reac-tion (qRT-PCR) in human salivary gland. Within novel differentially expressed genes, we selected genes associat-ed with junction proteins. Irradiation induced physiolog-

evaluated. Using clodronate liposome, a macrophage-de-pleting agent, the functional role of macrophages in flap wound healing was investigated. Coculture of human ke-ratinocyte cell line HaCaT and monocytic cell line TCP-1 was performed to unveil relationship between the two cell types. Results: Macrophage depletion significantly impaired flap wound healing process showing increased necrotic area after clodronate liposome administration. Interestingly, microscopic evaluation revealed that epi-thelial remodeling between the flap tissue and residual normal tissue did not occurred under the lack of macro-phage infiltration. Coculture and scratch wound healing assays indicated that TCP-1 cells significantly affected HaCaT cell migration. Conclusion: Macrophages play a critical role in the flap wound healing process. Especially, epithelial remodeling at the flap margin is dependent on proper macrophage infiltration. These results implicate to support the cellular mechanisms of impaired flap wound healing which occasionally causes devastating events in clinic.

» HNOP-54 10:00~10:10

» COMBINATION OF ANTI-PD-1 INHIBITOR AND DOxORUBICIN PRODRUg ENHANCES CYTOTOxICITY MEDIATED BY TUMOR INFIL-TRATINg LYMPHOCYTES


ASAN MEDICAL CENTER, UINIVERSITY

OF ULSAN, COLLEGE OF MEDICINE1,

DEPARTMENT OF MOLECULAR MEDICINE AND

BIOPHARMACEUTICAL SCIENCES, GRADUATE

SCHOOL OF CONVERGENT SCIENCE AND

TECHNOLOGY, SEOUL NATIONAL UNIVERSITY2

YOON SE LEE1, IN KYUN SON1, GUI CHUL KIM1, HYO WON CHANG1, YOUNGRO BYUN2,

SANG YOON KIM1

Objectives: Various combination modalities have been to overcome the limited treatment efficacy of anti-PD-1 therapy. Previously, we developed caspase-3 specific prod-rug, MPD-1 made of doxorubicin. It is linked to peptide moiety cleavable by caspase-3 produced during apoptosis induced by radiation therapy (RT). We evaluated the role of anti-PD-1, activating MPD-1 by producing caspase-3 and the treatment efficacy of combination treatment in the murine squamous cell carcinoma model. Methods:

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ry T stage (P = 0.023), and disease stage (P = 0.032). Small RNA interference- mediated HMX2 suppression significantly reduced cell migration and invasion via down-regulation of epithelial-to-mesenchymal transi-tion (EMT)-associated proteins. HMX2 regulated the activity of the Akt/Wnt/β-catenin signaling axis which closely associated with EMT. Conclusion: Our findings indicate that HMX2 regulate cell migration and invasion in HNSCC by regulating Wnt signaling pathway at the transcriptional level.

» HNOP-57 10:30~10:40

» CARBONYL REDUCTASE 1 INHIBITION IN-DUCES METASTASIS OF HEAD AND NECK SQUAMOUS CELLCARCINOMA THROUgH Β-CATENIN-MEDIATED EPITHELIALMESENCHY-MAL TRANSITION ACTIvATION


& NECK SURGERY, KYUNG HEE UNIVERSITY


BIOINDUSTRY AND BIORESOURCE ENGINEERING,

COLLEGE OF LIFE SCIENCES,

SEJONG UNIVERSITY2

JEONG WOOK KANG1, MIYONG YUN2, YOUNG CHAN LEE1, AE JIN CHOI1,

YOUNG-GYU EUN1

Objectives: Human carbonyl reductase 1 (CBR1) plays key roles in the regulation of oxidative stress and tumor progression. However, the detailed mechanism and clin-ical correlation between CBR1 and tumor progression in head and neck squamous cell carcinoma (HNSCC) is largely unexplored. Methods: CBR1 mRNA expression was analyzed according to lymph node metastasis (LNM)status in patients with HNSCC from publicly available databases. CBR1 protein levels were measured and com-pared in HNSCC patient tissues, with or without metas-tasis, using immunohistochemistry (IHC). The invasive ability of HNSCC with modulated CBR1 expression was assayed using an invasion assay. Expression levels of EMT marker proteins were analyzed using immunoblotting. Results: HNSCC patients with LNM showed lower ex-pression of CBR1 than those without LNM. In addition, IHC in tissues indicated that patients with LNM had relatively lower levels of CBR1 in cancer tissue. Consis-tently, in vitro invasion assay, we found that CBR1 in-

ic change were evaluated by western blot, qRT-PCR, and confocal fluorescent images. Also, the cell proliferation and transepithelial electrical resistance (TEER) were eval-uated after target gene silencing. Results: In microarray analysis, 785 genes increased and 555 genes decreased more than five-folds in salivary gland ductal cells than in acinar cells. Within these, twelve genes were selected in ductal cells dominant compared to acinar cells. In IHC and qRT-PCR, GREM1, HAS2, KIAA1199, KRT34, CDH2 and SNAIL1 related molecules were highly ex-pressed in ductal cells. Functional categories for differ-entially expressed genes included junction proteins. We identified mRNA expression of CDH2, SNAIL1, GJC1, HAS2, ITB3 and CCL2 in ductal cell is higher than aci-nar cells (P<0.05). After radiation, SNAIL1, TLR4, and HSPB6 related mRNA expression in ductal cells were sig-nificantly decreased compared to acinar cells. After ZO-1 siRNA administration, ductal cells showed lower prolif-eration and decreased TEER. Conclusion: Differentially expressed genes between ductal and acinar cells of salivary gland included junction proteins.

» HNOP-56 10:20~10:30

» H6 FAMILY HOMEOBOx 2 PROMOTES EP-ITHELIAL-TO-MESENCHYMAL TRANSITION IN HEAD AND NECK SQUAMOUS CELL CAR-CINOMA BY REgULATINg WNT SIgNALINg PATHWAY

CHUNGNAM NATIONAL UNIVERSITY

COLLEGE OF MEDICINE

JAEWON CHANG

Objectives: Although recent enormous progress in can-cer therapy, the prognosis of head and neck squamous cell cancer (HNSCC) is ominous yet. Thus, identifica-tion of novel prognostic factors and therapeutic targets in HNSCC is essential. Besides its function in tran-scription factor, the oncogenic role of H6 Family Ho-meobox 2 (HMX2) in HNSCC have never been dis-covered. Methods: Here, we used The Cancer Genome Atlas (TCGA) data to evaluate the correlations between HMX2 expression and various HNSCC clinicopatho-logical factors. Likewise, we revealed that HNSCC cell lines exhibited increased HMX2 expression compared to normal fibroblast cell lines. Results: TCGA data showed that HMX2 was overexpressed in HNSCC compared to normal tissues and significantly associated with prima-

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Objectives: Reactive oxygen species (ROS) affects the cell defense mechanisms and is involved in wound healing and aging. MSCs are involved in the tissue regeneration by various functions, such as angiogenesis, immunomod-ulation, anti-inflammation, anti-apoptosis, and anti-oxi-dation. This study investigated the change of the prolif-eration and ECM genes of human vocal fold fibroblasts (hVFFs) after oxidative stress. We also evaluated the an-ti-oxidant effect of TMSCs on oxidative stress in hVFFs. Methods: tert-Butyl hydroperoxide (tBHP) was used to induce oxidative stress to the hVFFs. The hVFFs were exposed to the different gradient concentrations of exog-enous tBHP (0, 30, 50, 100,200μmol). Then cell prolif-eration, viability assay and assessment of ROS were per-formed to assess oxidative stress of hVFFs. RT-qPCR and Western blot for ECM related genes including various collagens, elastin, hyaluronic synthase were performed af-ter tBHP exposure and co-culture with TMSCs. Results: The hVFFs cell number and viability were decreased after tBHP exposure. Representative ECM protein including collagen I and III were increased after oxidative stress, and they were decreased after co-culture with TMSCs. Hyaluronic acid synthase showed no change in tBHP exposure and co-culture with TMSCs. Conclusion: TMSCs improve wound healing with the function of a potent antioxidant agent. The anti-oxidant function of T-MSC is thought to be related to the effect of improving wound healing and preventing scar.

» HNOP-59 11:10~11:20

» SURgICAL OUTCOMES OF LARYNgOMALA-CIA FOLLOWINg SUPRAgLOTTOPLASTY UN-DER SELF-vENTILATION TECHNIQUE




HYUN-KYUNG CHA, JUNGIRL SEOK, SEONG KEUN KWON

Objectives: The aim of this study was to review and present the outcomes in patients with laryngomalacia who underwent supraglottoplasty under self-ventilation technique. Methods: The medical records of 9 children with laryngomalacia who underwent suspension exam with supraglottoplasty, between 2017 and 2018 were retrospectively reviewed. Surgery was performed by the single pediatric airway surgeon at Seoul National Uni-

hibition using specific short interfering RNA treatment resulted in two- to three-fold increased invasion ability of HNSCC cell lines. Also, we proved that depletion of CBR1 activated marker proteins participating in epitheli-al-mesenchymal transition (EMT) signaling. CBR1 inhi-bition increased levels of intracellular reactive oxygen spe-cies (ROS) in HNSCC cells leading to upregulation of β-catenin, one of main transcription factors that induce EMT-related genes. Conclusion: Our findings suggested that CBR1 plays an important role in metastasis of HN-SCC tumors via regulation of ROS-mediated β-catenin activity, and that CBR1 may be marker for progression of HNSCC to metastasis.

HNOP-9Room 2-5 (Crane)

Chair : JIN HWAN KIM, TACK KYUN KWON

Larynx & Voice

» HNOP-58 11:00~11:10

» TONSIL-DERIvED MESENCHYMAL STEM CELLS HAvE STRONg ANTIOxIDANT POTEN-TIAL AgAINST OxIDATIvE STRESS OF HUMAN vOCAL FOLDS


HEAD AND NECK SURGERY, PUSAN

NATIONAL UNIVERSITY SCHOOL OF

MEDICINE,PUSAN NATIONAL UNIVERSITY

HOSPITAL1, DEPARTMENT OF LIFE SCIENCE IN

DENTISTRY, SCHOOL OF DENTISTRY, PUSAN

NATIONAL UNIVERSITY2,DEPARTMENT OF

OTORHINOLARYNGOLOGY, HEAD AND NECK

SURGERY, PUSAN NATIONAL UNIVERSITY

SCHOOL OF MEDICINE,PUSAN NATIONAL

UNIVERSITY YANGSAN HOSPITAL3

SUNG-CHAN SHIN1, HYUNG-SIK KIM2, YOOJIN SEO2, CHO HEE KIM1, JI MIN KIM1,

HYUN-KEUN KWON1, JIN-CHOON LEE3, EUI-SUK SUNG3, BYUNG-JOO LEE1

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mined by CNN-based deep learning, and to compare accuracy of CNN models. Methods: Rigid laryngosco-py videos recorded in outpatient clinic were screen-cap-tured at their vocal folds abducted state, and 720 x 720 pixel-sized jpeg images were obtained. Each image was cropped manually to include only vocal folds region and resized to 224 x 224 pixel. Totally 2216 image samples (899 normal, 1317 abnormal) were used in this study. Abnormal findings included were vocal polyp, vocal nod-ules, vocal process granuloma, leukoplakia, and cancer. Samples in each group were randomly allocated to train-ing, validation and test set in the ratio of 0.7:0.15:0.15. Training with hyperparameter tuning was performed with the training and validation set using a constructed CNN model with 6 layers (CNN6), VGG14, InceptionV3 and Xception model. Trained models were applied to the test set. For each model, ROC curve and cutoff value were obtained from prediction values. Sensitivity, specificity, PPV, NPV and accuracy was calculated. Results: Train-ing accuracy was 86.3%, 99.9%, 99.9% and 91.9% for CNN6, VGG16, InceptionV3 and Xception, respective-ly. All models showed high area under the ROC curve (AUC) more than 0.9. Accuracy of the CNN models deciding normal and abnormal vocal fold in the inde-pendent test set was 82.3%, 99.7%, 99.1%, and 83.8% 93% for CNN6, VGG16, InceptionV3 and Xception. Conclusion: For determination of vocal fold normality, all 4 models showed acceptable diagnostic accuracy. Per-formance of VGG16 and InceptionV3 was better than the simple CNN6 model and recently published Xcep-tion model.

» HNOP-61 11:30~11:40

» URBAN PARTICULATE MATTER PROMOTES vOCAL CORD FIBROSIS vIA MAPK/NF-ΚB SIg-NALINg PATHWAYS


HEAD AND NECK SURGERY, RESEARCH

INSTITUTE FOR MEDICAL SCIENCE, CHUNGNAM

NATIONAL UNIVERSITY, COLLEGE OF MEDICINE,

HO-RYUN WON, SEUNG-NAM JUNG, JAE WON CHANG, KI SANG RHA,

BON SEOK KOO

Objectives: Airborne pollutants, especially particulate matter, represent elements of significant environmental

versity. All was performed under self-ventilation anesthe-siology technique. Surgery was indicated if the patients have following signs of life-threatening dyspnea, failure to thrive probably due to swallowing difficulty or OSA. To evaluate the effect of the surgery, objective findings including body weight gain were checked and post-oper-ative complications were checked as outcomes. Results: The number of patients Type I, II, III were 2, 5, 1. One patient had combined feature of type I and III. In one patient, diagnosis of laryngomalacia was confirmed only after micrlaryngobronchoscopy under self-ventilation. 2 patients had no other co-morbidity or syndrome. 3 pa-tients had craniofacial malformation. 2 patients had sub-glottic stenosis with intubation history. 4 patients had neurological disorder including seizure, hypoxic ischemic encephalopathy, microcephaly, congenital hypotonia. 3 patients had cardiac anomalies (ASD, VSD, PDA). 8 patients showed improvement of symptoms after supra-glottoplasty, and 3 of them gained weight despite remain-ing dyspnea. Only one patient performed tracheostomy, right after supraglottoplasty failed T-can weaning due to HIE and glossoptosis. Conclusion: Supraglottoplasty under self-ventilation is effective technique for diagnosis and management of laryngomalacia children with severe respiratory symptoms or failure to thrive. Tracheostomy should be advised and prepared for patients with severe neurologic deficit.

» HNOP-60 11:20~11:30

» COMPARISON OF CONvOLUTIONAL NEU-RAL NETWORK MODELS FOR DETERMINA-TION OF vOCAL FOLD NORMALITY IN LARYN-gOSCOPIC IMAgES




ASAN MEDICAL CENTER

WON KI CHO, SEUNG-HO CHOI

Objectives: Deep learning using convolutional neural network (CNN) is widely used in various fields, includ-ing researches on medical imaging. Laryngoscopic images may be suitable for CNN-based deep learning because they are relatively standardized, and the data volume is large due to the availability of videolaryngoscopic equip-ment. This study was performed to investigate if vocal fold normality in laryngoscopic images can be deter-

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injection into the vocal folds. Objective voice outcomes and stroboscopic findings were comparatively analyzed between pre- and post-operatively. Results: The acoustic parameters including jitter, shimmer, noise to harmonic ratio (NHR) were significantly improved postoperatively (P=0.007 in jitter, P < 0.001 in shimmer and NHR). The mean fundamental frequency was significantly increased after LMS (129.05 ± 40.64 before surgery, 153.80 ± 43.30 at 2 weeks after surgery, 151.39 ± 39.05 at 3 months after surgery, P=0.003). Stroboscopic findings indicated that mucosal wave after surgery with steroid injection was well preserved. Conclusion: LMS with simultaneous steroid injection is feasible and effective for improving objective voice outcomes and increasing fundamental frequency. However, long-term follow-up results are warranted.

» HNOP-63 11:50~12:00

» THE EvALUATION OF THE EFFICACY AND SHORT-TERM vOICE OUTCOME OF A NEW CALCIUM HYDROxYAPATITE INJECTION MA-TERIAL COMPARED TO RADIESSE



UNIVERSITY OF KOREA COLLEGE OF MEDICINE,

YEOUIDO ST MARYS HOSPITAL

HYUN HO LEE, SUNG JOON PARK, YOUNG-HAK PARK

Objectives: Radiesse is a widely used calcium hydroxy-apatite (CaHA) injection material used for vocal fold in-jection. Recently, a new CaHA injection material which complements the structural disadvantages of Radiesse has been developed and released in the market. The aim of this study is to compare the efficacy and short-term voice outcome of these two CaHA materials. Methods: Retrospective analysis of 70 patients with unilateral vocal fold paralysis(UVFP) who underwent vocal fold injec-tion using CaHA materials from June 2008 to July 2017 were performed. Videostroboscopic evaluation, acoustic voice analysis results, maximal phonation time(MPT), and voice handicap index(VHI) were evaluated prior to the injection and 6-8 weeks after injection. These objec-tive and subjective voice analysis results were compared between Radiesse injection group and Facetem injec-tion group. Results: Among the 70 patients who were included in this study, 46 patients were treated with

exposure adversely influencing human health. Especial-ly, particulate matter is a high risk factor for various re-spiratory diseases and triggers an inflammatory response in lung tissues. However, the mechanism by which such particulate matter affects the vocal fold mucosa has not yet been evaluated. Methods: Vocal fold fibroblasts were isolated from human vocal folds and performed to in vi-tro experiments. Vocal fold fibroblasts were treated with the urban particulate matter for assessment of the inflam-matory respons. The effect of particulate matter on vocal fibroblast and mechanism was analyzed using Western blot and RT-PCR. Results: The proliferation of vocal fold fibroblasts were significantly decreased by particulate matter treatment. Particulate matter increased the expres-sion of interleukin (IL)-1β and IL-6 in a time-dependent manner. ROS generation and activation of MAPK and NF-κB pathways were detected in particulate matter - exposed vocal fold fibroblasts. Furthermore, urban par-ticulate matter was induced fibrosis-related molecules. Conclusion: Urban particulate matter decreased vocal fold fibroblasts proliferation and induced inflammation and fibrosis. Particulate matter exposure enhanced the inflammatory response significantly through ROS medi-ated activation of MAPK and downstream NF-κB sig-naling pathways. These results suggested that particulate matter caused vocal fold fibrosis.

» HNOP-62 11:40~11:50

» ASSESSMENT OF vOICE QUALITY AFTER LARYNgEAL MICROSURgERY WITH STEROID INJECTION FOR REINKE EDEMA



JEON YEOB JANG, DONG YOUNG KIM, GA YOUNG LEE, SO HYOUNG PARK,

YOO SEOB SHIN, CHUL-HO KIM

Objectives: Reinke edema is characterized by diffuse ede-ma of the superficial lamina propria of the vocal folds. The management includes smoking cessation and voice therapy while the roles and techniques of surgery are still under discussion. This study aimed to evaluate the changes of phonatory characteristics in patients with Reinke edema after laryngeal microsurgery (LMS) with steroid injection. Methods: We retrospectively analyzed medical records of 40 consecutive patients with Reinke edema who underwent LMS with simultaneous steroid

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for safe and convenient VFI. Herein, we describe the ef-ficacy of RL-VFI as a training tool to educate otolaryn-gology residents. Methods: The extracted ex vivo canine larynges were vertically mounted on the fixator to mimic the sitting position adopted during office-based VFI. As in real office-based VFI using the CT approach, flexible laryngoscopy was used to secure the procedure field. Each Trainee then performed two sessions of conventional VFI and RL-VFI. The end-point of session was defined to inject hyaluronic acid on the vocal process precisely. A visual analog scale was used to measure the participants’ comfort and confidence levels during the workshop. The length of time to complete VFI was measured in each training session. Results: The mean comfort and confi-dence levels were 1.73 and 2.09 (0=have no confidence at all and 10=have confidence) before the workshop. The post-workshop mean comfort levels were 4.91 and 7.45 for conventional VFI and RL-VFI, and the post-work-shop mean confidence levels were 5.27 and 7.64 for VFI and RL-VFI. The mean time length was 146.36 seconds in conventional VFI and 42.73 seconds in RL-VFI. All participants showed significantly shorter time length in RT-VFI than conventional VFI. And they preferred RT-VFI to conventional VFI for the future choice for VFI method. Conclusion: The training program with RL-VFI appears to improve participants’ comfort level and confidence level for VFI. This education program may be useful for residents to understand the anatomical path of CT approach, and to be accustomed to VFI before attempting these techniques on actual patients.

» HNOP-65 12:10~12:20

» SAFETY OF OFFICE-BASED PERCUTA-NEOUS INJECTION LARYNgOPLASTY WITH CALCIUM HYDROxYLAPATITE




MINHYUNG LEE, SEUNG HEON KANG, DOH YOUNG LEE, TACK-KYUN KWON

Objectives: To evaluate the safety of office-based calci-um hydroxylapatite (CaHA) injection laryngoplasty via the cricothyroid approach through an analysis of all pro-cedures performed over a period of 10 years at a single institution. Methods: In total, 962 office-based CaHA injection laryngoplasty via the cricothyroid approach

Radiesse injection and 24 patients were treated with Facetem injection. There were no sinificant difference of age, gender, vocal fold paralysis side, the cause of UVFP, injection volume, pre-injection objective voice evalua-tion parameters, and the interval between the injection laryngoplasty and follow up voice evaluation between two groups. However, there were significant difference of gender proportion between two groups with higher pro-portion of male patients included in the Facetem group. Both groups showed a signifcant improvement of MPT and VHI following the procedure. The Facetem group showed similar voice improvement compared to Radiesse group when pre- and post-injection objective and subjec-tive voice evaluation results were compared. Conclusion: Our study reveals that there is no significant difference in efficacy and a short-term vocal improvement between Radiesse and Facetem. Therefore, the usage of Facetem as a CaHA injection material could be considered as an alternative treatment option for patients with unilateral vocal cord paralysis.

» HNOP-64 12:00~12:10

» REAL-TIME LIgHT-gUIDED vOCAL FOLD IN-JECTION (RL-vFI) AS A TRAININg TOOL FOR vOCAL FOLD INJECTION



RESEARCH INSTITUTE,

PUSAN NATIONAL UNIVERSITY HOSPITAL1,



DONG-A UNIVERSITY COLLEGE OF MEDICINE2,


HEAD AND NECK SURGERY, DONGNAM INSTITUTE

OF RADIOLOGICAL & MEDICAL SCIENCES3

JI-A KIM1, HYO-SEOK SEO1, HAN-SEUL NA1, DONG KUN LEE2, HEE YOUNG SON3,

WONJAE CHA1

Objectives: Transcutaneous vocal fold injection(VFI) with cricothyroid(CT) approach is becoming increasingly popular. However, most training programs fail to educate residents in performing this technique. Recently, the re-al-time light-guided VFI(RL-VFI) and its device, which provides visual feedback of the needle tip, were developed

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once daily. Patients in the study group were treated with oral rabeprazole 20mg once daily and inhaled NAC twice a day. Patients were followed once a month for two months. Results: RSI and RFS showed significant improvement after treatment in both control and study groups. The extent of improvement of RSI was 13.4 ± 5.1 in the control group and 15.2 ± 4.7 in the study group (p=0.319). The extent of improvement of RFS was 5.7 ± 2.8 in the control group and 6.7 ± 3.1 in the study group (p=0.390). In poor early responders whose RSI improved less than 9 points at the first follow-up, RSI became sig-nificantly lower in the study group (4.6 ± 2.0) than in the control group (9.5 ± 4.6) at second follow-up (p= 0.019). In contrast, in good early responders, RSI was not differ-ent between the two groups also at the second follow-up. Conclusion: In this randomized controlled study, there was no significant difference in the overall outcome be-tween patients treated with inhaled NAC and PPI and those with PPI alone. However, an additional positive therapeutic effect of NAC appeared late for patients with poor early response. Further studies are required to con-firm the effect of NAC in patients with poor response to PPI and to investigate the mechanism underlying the effect of NAC.

» HNOP-67 12:30~12:40

» ADDITIONAL 2nd INJECTION LARYNgO-PLASTY FOR PATIENTS WITH UNILATERAL vOCAL FOLD PARALYSIS





NAYEON CHOI, WOORI PARK, YOUNG-IK SON

Objectives: Injection laryngoplasty (IL) has become the one of major treatment options for unilateral vocal fold paralysis (UVFP). In case of insufficient voice improve-ment after IL, additional IL or laryngeal framework sur-gery will be the next option of treatments. However, little is known for the voice outcome regarding an additiona IL with a long-lasting injection material. Methods: In this study, we enrolled the patients of UVFP, who received two times of IL with Artesense® (N=76). Mean age was 58.4±14.0 years, and etiologies of UVFP were thoracic & esophagus surgery (51.3%), neck surgery (30.3%), skull base surgery (7.9%) and unknown (10.5%). The subjec-

procedures were performed by a single physician at our institution between 2007 and 2016. From these, 955 procedures performed in 617 patients were included in our analysis. The medical records of all 617 patients were retrospectively reviewed. We classified all procedure-re-lated complications according to the time of onset. Complications that occurred during the procedure were considered intraprocedural complications, while com-plications that developed within 1 week after injection and those that developed after 1 week and were recorded more than twice in the medical records were considered acute and delayed complications, respectively. And the failed cases were categorized separately as failure. Results: Five cases were failed (0.5%). Intraprocedural complica-tions included superficial injection in eight cases (0.8%). Acute and delayed onset of dyspnea was observed in three (0.3%) and two (0.2%) cases, respectively. The incidence of failures and major complications requiring active in-tervention was 1.6%. Conclusion: Our findings suggest that office-based CaHA injection laryngoplasty via the cricothyroid approach is as safe as conventional transoral injection laryngoplasty.

» HNOP-66 12:20~12:30

» THE EFFECT OF INHALED N-ACETYLCYSTE-INE FOR LARYNgOPHARYNgEAL REFLUx DIS-EASE A RANDOMIzED CONTROLLED TRIAL




YONG-SEOK JO, BYUNG-HYUN HAN, JAE-KEUN CHO, YOON-KYOUNG SO

Objectives: Laryngopharyngeal reflux disease (LPRD) is the result of reflux of gastric contents entering the laryn-gopharyngeal region. Symptoms of LPRD are generally more refractory to medical treatment than the typical symptoms of GERD. Here, we aimed to study wheth-er aerosolized inhaled N-acetylcysteine (NAC) helps to relieve the symptoms of LPRD and whether it has any additive effects for the treatment of LPRD when used in conjunction with PPIs. Methods: Forty-two consec-utive patients with LPRD with RSI greater than 13 and RFS greater than 7 were prospectively enrolled from June 2016 to August 2018. Enrolled patients were randomly assigned to the control or study group. Patients in the control group were treated with oral rabeprazole 20mg

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diagnosis of the neck lipoma 12 - with diagnosis - second branchial cleft cysts 1- with the diagnosis of the thyro-glossal duct cyst 6 - with the diagnosis of the subman-dibular salivary gland adenoma 6 - with the diagnosis of the sialolithiasis of submandibular salivary gland 6 - with Eagle syndrome 3 - with the diagnosis of the pleomor-phic adenoma of parotid salivary gland. We used endo-scope-assisted approaches from occipital region of head and axillary approaches. For excision second branchial cleft cyst, submandibular salivary gland, elongated sty-loid process, lymph node biopsy we use patent right sin-gle hairline approach from the hairline of the occipital region approximately 6 centimeters long. We use retro-auricular hairline approach for endoscopically-associated excision tumors of parotid gland as well as removal of the submandibular salivary gland after severe chronic si-aloadenitis. There was no complications as emphysema, hematoma, seroma, subcutaneous scars and facial nerve paralysis. Results: Aesthetic and functional results leave no doubt about the advisability of using this method, the need to develop new and improve existing approaches. In our opinion, axillary approach to the anatomical struc-tures and formations of the upper third of the neck rais-es doubts. Conclusion: The results of this study suggest that endoscopically-associated approaches allow achiev-ing high functional and aesthetic results of operations, are effective and safe.

» HNOP-69 13:40~13:50

» gASELESS TRANSORAL ENDOSCOPIC THY-ROIDECTOMY OUR INITIAL ExPERIENCE OF 15 CASES

DEPARTMENT OF

OTOLARYNGOLOGY HEAD AND NECK SURGERY, 1INJE UNIVERSITY COLLEGE OF MEDICINE,

2YONSEI UNIVERSITY COLLEGE OF MEDICINE, 3CATHOLIC UNIVERSITY COLLEGE OF MEDICINE

YEONG JUN PARK1, MI RA KIM1, YOON WOO KOH2, JUN-OOK PARK3

Objectives: The transoral endoscopic thyroidectomy vestibular approach (TOETVA) has been the subject of increasing interest from several institutions around the world over the last 2 years. The possibility of CO2 gas-related complications is an obstacle that must be overcome for TOETVA to become a more widely used

tive and objective voice parameters were collected before and 3- 6 months after each IL. Results: There was no IL-related complication in all subjects. Aspiration, MPT, Jitter, shimmer, and NHR were significantly improved after both 1st and 2nd IL (P<0.05). VHI-30 and VHI-10 were also significantly improved after 1st and 2nd IL (P<0.001). Regarding GRBAS score, grade of dysphonia (G), roughness (R) and breathiness (B) were significantly improved after 1st IL, but only G and R after 2nd IL (P<0.05). In comparison between postprocedural voice parameters of 1st and 2nd IL, MPT was significant-ly improved from 5.5±3.5 seconds to 7.3±7.5 seconds (P=0.001). Grade of dysphonia (1.9±0.8) and breathiness (1.7 ± 0.9) of post-1st IL were significantly (P<0.001) improved to them of post-2nd IL (1.3±0.7 and 1.2±0.7, respectively). VHI-30 and VHI-10 of post-1st IL (72.0±20.7 and 25.7±7.4, respectively) were significantly improved (P<0.001) to them of 2nd IL (57.2±23.7 and 21.3±8.2, respectively). Conclusion: In selected patients, repeated IL could provide further improvement of voice in patient who had unsuccessful voice results after 1st IL.

HNOP-10Room 2-4 (Swan)

Chair : SEUNG KUK BAEK, HYUN JUN HONG

Endoscopic & Robotic Surgery

» HNOP-68 13:30~13:40

» ENDOSCOPICALLY-ASSOCIATED ExCISION OF BENIgN NECK TUMORS.

DEP. OF MAXILLOFACIAL SURGERY, PAVLOV

FIRST SAINT PETERSBURG STATE

MEDICAL UNIVERSITY

TATIANA E. KOLEGOVA, ANDREI I. IAREMENKO

Objectives: Development, justification and introduc-tion in clinical practice of endoscopically-associated ap-proaches to anatomical structures and formations of the and neck. Minimally invasive diagnosis and treatment of neck pathologies. Methods: patients with the following nosological forms of diseases were operated 3 - with the

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function of the DaVinci SP, the endoscopic arm could be made into the shape of a 'cobra' to secure proper visu-alization of the surgical site, which helps surgeons iden-tify specific anatomic structures such as cranial nerve or vessels. We did not have any cases where robotic surgery was converted to open surgery due to severe bleeding or technical issues during surgery. The mean operative time was 150 minutes and the average hospital stay was 7 days. The average amount of bleeding during surgery was 143 mL. There were no significant complications in our study. Conclusion: Based on our early experiences performing RA robotic neck surgery using the DaVinci SP, we con-firmed that the system provided advanced technical ad-vantages over the previous Si and Xi system in performing robotic surgery. In future studies, it will be important to ascertain how much these technical advantages improve treatment outcomes in patients with head and neck tu-mors who received robotic surgery via DaVinci SP.

» HNOP-71 14:00~14:10

» RECENT PROgRESS OF TRANSORAL RO-BOTIC SURgERY USINg NOvEL FLExIBLE SINgLE PORT ROBOTIC SYSTEM IN THE TREATMENT OF HEAD AND NECK CANCER



YOUNG MIN PARK, DA HEE KIM, MIN SEOK KANG, JAE YOL LIM,

YOON WOO KOH, EUN CHANG CHOI, SE-HEON KIM

Objectives: The purpose of this study was to evaluate the feasibility and safety of the DaVinci SP system during transoral robotic surgery (TORS). Methods: From Octo-ber 2018 to December 2018, we retrospectively reviewed the medical records of 17 patients who underwent TORS using the DaVinci SP system. Results: During TORS, three robotic arms could be used to perform a geometric resection of the lesion in a narrow working space. The mean total operation time was 60 minutes and the average time required to set up the robotic system was within 10 minutes. All patients successfully underwent TORS. All robotic arms were inserted through a single arm, which widened the working space around the patient's head and allowed for the operative assistant to easily approach the patient during operation. The joggle joint of the robot-

thyroid treatment. Recently, we successfully performed TOETVA in live human patients without CO2 gas us-ing our newly designed retractable blade. Methods: We reviewed the medical records of 15 consecutive patients who underwent gasless TOETVA using a self-retaining retractor. Results: We successfully performed 13 thyroid lobectomies and 2 total thyroidectomy in 15 patients. No patient exhibited serious postoperative complication such as recurrent laryngeal nerve palsy and permanent hypo-calcemia. One patient developed transient hypocalcemia but recovered within 2 months. No patient developed a wound infection; furthermore, no visible scar or dimpling was evident on the neck of any patient, and no patient developed any CO2-related complication. Conclusion: The main advantage of gasless TOETVA is the lack of any risk of CO2 gas- related complications. It has sev-eral other minor advantages compared to conventional TOETVA. Therefore, the operation could be performed with better visibility in a more stable environment. Gas-less TOETVA seems to be a safe and feasible technique for thyroid surgery.

» HNOP-70 13:50~14:00

» FEASIBILITY AND SAFETY OF RETROAURIC-ULAR ROBOTIC NECK SURgERY USINg THE DAvINCI SP SYSTEM



MIN SEOK KANG, YOUNG MIN PARK, DA HEE KIM, JAE YOL LIM, SE-HEON KIM,

EUN CHANG CHOI, YOON WOO KOH

Objectives: We performed robotic neck surgery through a retroauricular approach (RA) using the DaVinci SP and analyzed our experiences to evaluate the feasibility and safety of this system for performing RA neck sur-geries. Methods: A total of 14 patients were enrolled in this study, consisting of 7 males and 7 females. Results: Patients received RA robotic neck surgery for the remov-al of various neck diseases (robotic parotidectomy (n=3), robotic neck dissection (n=6), robotic thyroidectomy (n=2), robotic benign neck mass excision (n=2), and submandibular gland resection (n=1)) and all operations were successfully completed. Using DaVinci SP, it is easy to insert three robotic arms into a long and narrow RA working space because all robotic arms and an endoscope are inserted through a single arm. Using the navigation

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» HNOP-73 14:20~14:30

» COMPARATIvE ANALYSIS OF vOICE OUT-COMES BETWEEN TRANSORAL ENDOSCOPIC THYROIDECTOMY vESTIBULAR APPROACH (TOETvA) AND TRANSAxILLARY APRROACH


CATHOLIC UNIVERSITY COLLEGE OF MEDICINE1,

IN-JE UNIVERSITY COLLEGE OF MEDICINE2

DONG-HYUN LEE1, GEUN-JEON KIM1, YEON-SHIN HWANG1, MI-RAN SHIM1,

SANG-YEON KIM2, MI-RA KIM2, JUN-OOK PARK1, DONG-IL SUN1

Objectives: There have been a number of reports regard-ing the safety and utility of transoral endoscopic thyroid-ectomy vestibular approach (TOETVA), but nothing is known about voice dysfunction after such surgery. There-fore, this study was designed to assess functional voice outcomes after TOETVA and compare with preexisting remote access approach. Methods: The voice functional outcomes of 27 patients who underwent TOETVA and 58 patients after trans-axillary approach for hemithy-roidectomy were analyzed. Thyroidectomy-related voice questionnaire (TVQ), auditory perceptual voice analysis, videolaryngostroboscopy and objective acoustic voice analysis were carried out before and 1 month after sur-gery. The changes in these values after the operation, and the differences between the TOETVA and trans-axillary groups were analyzed. Results: There was no significant changes in perceptual evaluation or TVQ score, nor in a number of parameters of acoustic voice analysis (fun-damental frequency, shimmer, noise to harmonic ratio, pitch range), after surgery in TOETVA group. The value of perceptual evaluation, TVQ score, speech fundamental frequency (SFF) and shimmer were significantly changed in trans-axillary group. After surgery, clinically signifi-cant changes in voice pitch (ΔSFF > 12) were evident in 3 (11.1%) and 14 (24.1%) patients in the TOETVA and trans-axillary groups, respectively, and the group difference was not statistically significant (P=0.162). Conclusion: The results showed acceptable subjective and objective postoperative voice outcomes in patients undergoing TOETVA compared with preexisting remote access approach.

ic arms aided in easy manipulation within the confined working space. Joggle joints of the endoscopic arm were controlled through the navigation system, which was very helpful in securing the three-dimensional visualization of the surgical site. Conclusion: Based on our experiences of performing TORS using the DaVinci SP system, we confirmed that it provided us technical advantages above the Si or Xi systems for performing TORS. Especially, it was helpful to ensure proper visualization of the surgi-cal field and to perform precise surgery when operating the tongue-base or the hypopharyngeal lesion. In future studies, it is important to ascertain how much these tech-nical advantages improve treatment outcomes in patients with head and neck cancer who undergo TORS using the DaVinci SP system.

» HNOP-72 14:10~14:20

» PERSONAL ExPERIENCES OF vARIOUS APPROACHES OF ENDOSCOPIC THYROIDEC-TOMY



KOREA CANCER CENTER HOSPITAL

MYUNG-CHUL LEE, IK JOON CHOI, BYEONG CHEOL LEE, GUK-HAENG LEE

Objectives: Since Huscher et al first introduced endo-scopic thyroid surgery, various endoscopic techniques have been developed with the aim of minimizing or elim-inating incisional scar formation on the neck.The aim of this study is to share my experiences and some tips. Methods: We performed 642 cases of endoscopic thy-roidectomy since 2008. Unilateral axillo-breast approach with gas (UABA) around 450 cases, Transaxillary (TA), bilateral axilla-breast approach (BABA) around 100 cases, retroauricular(RA) 10 cases and transoral (TO) 13 cases. Most of these cases were done by me. Demographic, clin-icopathologic, and surgical data according to approaches were collected and analyzed retrospectively. Results: De-mographic, clinicopathologic, complication results were similar among 5 approaches. Pain and dysesthesia were worse in TA and BABA group, and comesis was best in TO group. Surgical view, feasibility of instrumentation, and learning curves were compared subjectively by au-thor. Conclusion: This may help surgeons who are inter-ested in endoscopic thyroidectomy to choose and prac-tice endoscopic approach.

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nostic value of lymphoma based on core needle biopsy for Group CNB and Group CNB+SEB were 0.94 and 0.25, respectively (0=not diagnosed as lymphoma, 1=di-agnosed as lymphoma). The level nor the size of lymph node at which the CNB was performed had any correla-tion with the necessity for surgical excisional biopsy, as the mean values of level or size of lymph node between Group CNB and Group CNB+SEB were not signifi-cantly different (p=0.130, p=0.321). Conclusion: Of 56 patients diagnosed with lymphoma, 48 (85.7%) patients were diagnosed with CNB alone, showing the potential of CNB being the primary means of diagnosing lympho-ma. The age and the result of CNB are factors that can call for the role of SEB in lymphoma diagnosis and thus should be considered with more attention.

» HNOP-75 14:40~14:50

» AERODIgESTIvE TRACT FOREIgN BODY CLINICAL STUDY IN 12 INDONESIAN ACADEM-IC HOSPITAL

DEP. OTORHINOLARYNGOLOGY-HEAD AND

NECK SURGERY, FACULTY OF MEDICINE, UNIV.

AIRLANGGA

ADITYA W. BUANA, SRI HERAWATI, RIZKA F PERDANA

Objectives: Aerodigestive foreign body is an emergency case with high potency of morbidity and mortality and also challenges in diagnostic and therapeutic. The entry process of the object is divided into aspiration trough the airway tract and ingestion through the upper digestive tract. The disease can occur in both of children or adult and the object are devided in organic and anorganic type. Common symptom of airway aspiration are shortness of breath and stridor, while common symptom of esopaha-geal foreign body are dysphagia and blocking sensation. Methods: This retrospective study was conducted in the 12 Departemen of Otorhiolaryngology Head and Neck Surgery Center around Indonesia. The data collected from each academic hospital, especially from the emergen-cy departemen. Samples in this study included patients who had performed foreign body extraction using rigid bronchoscopy. Data obtained from medical record oper-ating room in emergency departemen from 12 academic hospital and presented as distributive and freqeuncy. The object divided into organic and anorganic. All processed by using Microsoft Excel 2013 program. Results: There


Chair : MAN KI CHUNG, JUN HEE PARK

Neck

» HNOP-74 14:30~14:40

» ROLE OF CORE NEEDLE BIOPSY AND SUR-gICAL ExCISIONAL BIOPSY IN DIAgNOSINg LYMPHOMA SINgLE INSTITUTION ExPERI-ENCE OF CNB FOR THE Dx OF LYMPHOMA



SEOUL NATIONAL UNIVERSITY BUNDANG HOSPITAL

SEUNG KOO YANG, YOUNG SEOK KIM, JIN HO BAEK, MINHYUNG LEE,

YOUNG HO JUNG, SOON-HYUN AHN, WOO-JIN JEONG

Objectives: There has been controversy on the efficacy of surgical excisional biopsy(SEB) in diagnosing lym-phoma in comparison to fine needle aspiration(FNA) or core needle biopsy(CNB). In this study, two groups of lymphoma patients—a group diagnosed with CNB alone and another group diagnosed with CNB followed by SEB—were analyzed to discover the factors that demand the role of SEB in diagnosing lymphoma. Methods: Pa-tients who underwent CNB and immunohistochemical detection of EBV at Seoul National University Bundang Hospital from January 2016 to January 2019 were ac-quired. Patients were divided into two groups: a group of lymphoma patients diagnosed with CNB (n=48), and another group of lymphoma patients diagnosed with CNB followed by SEB (n=8). Gender, age, EBV result, diagnosis of lymphoma based on CNB, size of sample tissue, size of lymph node, number of sample tissue, final diagnosis, level of lymph node—between these groups were compared by running T-test or by chi-square analy-sis. Results: Of the factors analyzed, only age (p=0.013) and diagnosis of lymphoma based on CNB (p=0.004) were significantly different between two groups. The mean age for Group CNB and Group CNB+SEB were 56.5 years and 35.13 years, respectively, and mean diag-

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ence and waist circumference. 70.7% of the women had an upper margin of CTM of 0.42 cm (sitting position)/ 0.66cm (lying position) with an upper direction of lower skin crease. 65.5% of the women had an upper margin of CTM of 0.45 cm (sitting position)/ 0.69cm (lying position) with an upper direction of lower skin crease. Conclusion: This study shows that, in the event of an emergency, many patients are likely to have CTM 0.5 cm above the neck's lower creases regardless of gender, BMI, neck circumference, or waist circumference. If the anato-my of the neck cannot be distinguished in an emergency, upper or lower neck skin creases may be a landmark of emergency cricothyrotomy.

» HNOP-77 15:00~15:10

» xENOgENIC ACELLULAR RESPIRATORY MUCOSAL MATRIx (ARMM) FOR TRACHEAL MUCOSAL RECONSTRUCTION A PILOT ANI-MAL STUDY



MEDICINE, EWHA WOMANS UNIVERSITY

SOO YEON JUNG, AN NGUYEN-THUY TRAN, SOJEONG KIM, MIN JI LEE, SUNG MIN CHUNG,

HAN SU KIM

Objectives: Respiratory mucosa defects result in airway obstruction and infection, requiring subsequent func-tional recovery of the respiratory epithelium. Because site-specific extracellular matrix (ECM) facilitates resto-ration of organ function by promoting cellular migration and engraftment, previous studies considered decellu-larized trachea an ideal ECM; however, incomplete cell removal from cartilage and mucosal-architecture destruc-tion are frequently reported. Here, we developed the xe-nogenic acellular respiratory mucosal matrix (ARMM) using decellularization and evaluated its feasibility by an-imal study. Methods: Porcine tracheas were obtained at a local abattoir from market sized pig. The 15 cm-sized trachea was frozen at -80°C. After Thawing, the respi-ratory mucosa was separated from the tracheal cartilage. The detergent (Trypsin + Triton X-100 + Perasafe)-based decellularization protocols were applied with agitation. DNA quantification, histological evaluation, mechanical test, and collagen assay were performed to characterize the scaffold. Tracheal mucosal defect animal models were

were 1986 cases that were successfully extracted. 487 air-way foreign body cases from compare to 1499 upper di-gestive cases. 1177 male patients compare to 809 female. The highest number sufferers in the group of 0-10 years n = 827 (42%). The oldest patients in the age > 90 years n = 1 (0%). Most organic objects of airway is peanut n=84 (74%), while anorganic is needle n=180 (48%). Highest organic object of upper diggestive is meat n=271 (51%), while anorganic is coin n=481 (49%) Conclusion: The highest rate of aerodigestive foreign bodies occurs at the age of 0-10 years, with no apparent gender difference. The number of cases is not evenly distributed on each center. This difference may be due to local customs, re-ligion and age factor. Children in age less than 10 years becomes a major determinant in some of these cases

» HNOP-76 14:50~15:00

» CORRELATION BETWEEN CRICOTHYROID MEMBRANE AND SKIN CREASE


NECK SURGERY, COLLEGE OF MEDICINE AND

RESEARCH INSTITUTE FOR CONVERGENCE OF

BIOMEDICAL SCIENCE AND TECHNOLOGY,

PUSAN NATIONAL UNIVERSITY YANGSAN HOSPITAL1

DA-HEE PARK1, SUNG-WOOK CHOI1, DONG-JO KIM1, MIN-SIK KIM1, SANG-HYO LEE1,

JIN-CHOON LEE1, EUI-SUK SUNG1

Objectives: Successful cricothyrotomy is predicated on accurate identification of the cricothyroid membrane (CTM) by palpation of superficial anatomy. However, recent research has indicated that accuracy of the iden-tification of the CTM can be as low as 30%, even in the hands of skilled providers. To date, there are very little data to suggest how to best identify this critical landmark. The objective was to compare the correlation between CTM and skin crease. Methods: The subjects were 201 patients at Pusan National University Hospital who had never undergone neck surgery or neck radiotherapy from Jan. 2018 to Dec. 2018. The distance between the upper margin of the cricothyroid membrane (CTM) and the upper or lower skin crease was measured by sitting and lying during neck extension. Results: The subjects were 120 men (59.7%) and 81 women (40.3%). There was no correlation between CTM and skin crease (upper / lower) in relation to gender, age, BMI, neck circumfer-

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showed worse survival and it was statistically significant.

» HNOP-79 15:20~15:30

» FEASIBILITY OF PERCUTANEOUS DILATA-TIONAL TRACHEOSTOMY DURINg THE HEAD AND NECK CANCER SURgERY



UNIVERSITY OF KOREA COLLEGE OF MEDICINE

INN-CHUL NAM

Objectives: Percutaneous dilatational tracheostomy (PDT) is a technique that can place a tracheostomy tube safely without visually identifying trachea. This tech-nique has many advantages such as less bleeding, easi-er technique and shorter procedural time compared to conventional open tracheostomy. The aim of this study is to evaluate the feasibility of PDT during the head and neck cancer surgery. Methods: Twelve patients who un-derwent PDT during the head and neck cancer surgery from September 2016 to March 2018 were enrolled and their medical records were reviewed retrospectively. For comparison, medical records of another twelve patients who underwent conventional trahceostomy during the head and neck cancer surgery were randomly acquired and analyzed. PDT was performed using Ciglia Percuta-neous Tracheostomy SetⓇ(Cook Critical Care, Bloom-ington, USA). The tracheotomy point was determined by palpation without the guidance of bronchoscopy or ultrasonography. Parameters of blood loss, procedural time, communication between the cervical wound and tracheostomy wound and complications were compared between the PDT group and the convetional group. Results: PDT group showed less blood loss and less pro-cedural time and less incidence of communication be-tween the cervical wound and tracheostomy wound. On complication, there was one case of convertion to con-ventional tracheostomy due to wrong tracheal penetra-tion in PDT group. There were two cases of tracheostomy site minor bleeding in convetional group. Conclusion: PDT is a safe and effective procedure as the adjuctive pro-cedure during the head and neck cancer surgery.

created using 8 New Zealand rabbits. ARMMs were ap-plied in 4 animals. Laryngoscopic and histological evalu-ation was performed. Results: ARMM demonstrated low antigenicity and proper ECM contents. Laryngoscopic evaluation revealed that ARMM applied tracheas showed no signs of stenosis. ARMM applied groups showed early respiratory epithelia regeneration when compared with defect only control group. Conclusion: Xenogenic ARMM displayed suitable biocompatibility as a scaffold material for respiratory mucosa defect reconstruction.

» HNOP-78 15:10~15:20

» ANALYzINg SURvIvAL AND RISK FACTORS OF ADvANCED HEAD AND NECK CANCER PA-TIENTS WITH OR WITHOUT INDUCTION CHE-MOTHERAPY



ASAN MEDICAL CENTER,

UNIVERSITY OF ULSAN COLLEGE OF MEDICINE

DOYEON KIM, AH RA JUNG, JONG-LYEL ROH, SEUNG-HO CHOI, SANG YOON KIM,

SOON YUHL NAM

Objectives: To compare survival and risk factors of ad-vanced head and neck cancer patients with or without induction chemotherapy. Methods: 38 patients with ad-vanced head and neck cancer who underwent surgery at Asan medical center between 2005 and 2016 were en-rolled. 19 patients underwent surgery after induction chemotherapy and the other 19 patients underwent surgery without induction chemotherapy. These two groups were matched by age, sex, cancer stage and can-cer location. Survival of the two groups were compared using Kaplan-Meier survival analysis. Risk factors were analyzed by Cox proportional hazards model. Results: Median follow-up of 38 patients was 36.5 months. Ac-cording to Kaplan-Meier survival analysis, there was no significant difference in survival rates between the two groups (P=0.490). Variables such as age, sex, BMI, mari-tal status, smoking history, degree of education were an-alyzed by Cox proportional hazards model and only the variable of age was significant (P=0.036, Exp(B)=1.356). Conclusion: In advanced head and neck cancer patients, the use of induction chemotherapy did not change the survival of patients after surgery. Patients with older age

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ness entailed in the deep learning process, we performed data partitioning and model building experiments 100 times and averaged the performance values. The per-formance of laryngeal tumor judgment (benign or ma-lignant dichotomous classification) was composed and final evaluated by using Python library such as sklearn and matplotlib. Results: The source used to identify the presence and type of tumor is a total of 745 endoscopic images, consisting of 98 normal, 393 benign, and 254 malignant tumors. Of these, 52 images were discarded (for example, the shape of the larynx was cut off), and finally 693 images, including 85 normal, 355 benign tu-mors, and 253 malignant tumors, respectively. Accuracy rate was 80%. Conclusion: The overall level of perfor-mance of the proposed method was very promising to en-courage applications in clinical environments. Automatic classification using deep learning technique as proposed can be used to complement manual inspection efforts for practitioners to minimize dangers of missed out positives resulting from repetitive sequence of endoscopic frames and weakening attentions.

» HNOP-81 16:00~16:10

» THE PROSPECTIvE COHORT STUDY OF vOICE AND SWALLOWINg STUDY RESULTS OF LARYNgOPHARYNgEAL REFLUx DISEASE PATIENTS AND THE EFFECT OF PROTON PUMP INHIBITOR MEDICATION FOR EIgHT WEEKS ON THE vOICE OUTCOME



UNIVERSITY OF KOREA, COLLEGE OF MEDICINE,


SUNG JOON PARK, HYUNWHA LEE, HYUN HO LEE, HEY-RIM KIM,

YOUNG-HAK PARK

Objectives: The purpose of this study was to present de-scriptive voice and swallowing study results and effect of PPI medication for laryngopharyngeal reflux disease(L-PRD) patients. Methods: Patients aged between 19 and 85-years-old with subjective symptoms and laryngo-scopic findings of LPRD were prospectively enrolled in this study. The reflux finding score(RFS), reflux symp-tom index(RSI), and objective and subjective acoustic parameters were evaluated on the initial visit and after


Chair : SEONG KEUN KWON, SANG JOON LEE

Other Head & Neck Disease

» HNOP-80 15:50~16:00

» DEvELOPMENT OF DIFFERENTIATION DIAg-NOSIS PROgRAM OF LARYNgEAL CANCER BASED ON ARTIFICIAL INTELLIgENCE

DEPARTMENT OF OTOLARYNGOLOGY-


MEDICINE AND RESEARCH INSTITUTE FOR

CONVERGENCE OF BIOMEDICAL SCIENCE AND

TECHNOLOGY, PUSAN NATIONAL UNIVERSITY

YANGSAN HOSPITAL1,SMES SUPPORT

CENTER, KOREA INSTITUTE OF SCIENCE AND

TECHNOLOGY INFORMATION2DEPARTMENT OF


COLLEGE OF MEDICINE AND MEDICAL3

EUI-SUK SUNG1, JONG-SEOK KANG2, JUNG-WOO LEE3, JI-SEUNG MOON1,

SUNG-CHAN SHIN3, BYUNG-JOO LEE3I, IL-WOO LEE1, JIN-CHOON LEE1

Objectives: Laryngeal cancer is the second most com-mon cancer in the head and neck area. Cancer develop abnormal morphologies through courses of progression. Laryngoscopy is a routinely adopted means for examina-tion of larynx for malignancy. Early and timely detection of malignancy closely correlate with good prognosis. However, laryngomicroscopic surgery with biopsy is per-formed because it is difficult to confirm malignancy with only laryngoscopy. Diagnosis with only laryngoscopic image without biopsy often missed out true patients in practitioner and leads to higher medical cost and unnec-essary morbidity. Highly needed is an automatic means for spotting visual abnormality. Methods: We conduct classification of benign and cancer for laryngoscopic col-or images using deep neural network and transfer-learn-ing approach.Three classes were defined normal, benign, and cancer. For each task, considering inherent random-

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oral cavity and the pharynx which were treated utilizing KTP laser. Age, gender, total procedure time, total energy used during the procedure, method of anesthesia, bleed-ing during the procedure, and post-operative pain and presence of blood tinged sputum were analyzed accord-ing to the anatomical sites of the benign lesions. Results: 15 patients consist of 6(40%) male and 9(60%) female with mean age of 50.40 years-old were included in this study. 10(66.7%) patients were treated due to squamous papilloma and 5(33.3%) patients were treated due to hy-perpigmentation, telangiectasia, and fibroepithelia polyp. The contact mode was used in 11(73.3%) patients for excision of the lesion and near contact mode was used in 4(26.7%) patients for ablation. Majority of the lesion was located at oropharynx (8, 53.3%) while 5(33.3%) patients had oral cavity lesion and 2(13.3%) patients had hypopharyngeal lesion. The mean energy used during the procedure was 293.67J(27.50-1139.60J). All of the hy-popharyngeal lesion and one oropharyngeal lesion were treated under general anesthesia. Significantly more en-ergy was used to treat hypopharyngeal lesion compared to oral cavity lesion when post-hoc test after one-way ANOVA was conducted. Additionally, procedure time was significantly longer to treat pharyngeal lesion when compared to oral cavity. There was no significant differ-ence in intra-op bleeding and post-op pain according to the site of the benign lesions. Conclusion: The benign lesions at oral cavity and oropharynx can be efficienty treated utilizing KTP laser at office-based setting while hypopharyngeal lesions accompany more energy used to treat and longer procedure time due to need for general anesthesia for the procedure.

» HNOP-83 16:20~16:30

» A COMBINATION EFFECT OF MUCOLYT-ICS WITH PROTON PUMP INHIBITORS FOR TREATMENT OF LARYNgOPHARYNgEAL RE-FLUx A PRELIMINARY RESULT


EULJI MEDICAL CENTER,

EULJI UNIVERSITY SCHOOL OF MEDICINE

MIN SUK CHAI1, YONG TAE JO1, HYEON SIK OH1, MINSU KWON1

Objectives: Laryngopharyngeal reflux (LPR) is usually diagnosed based on patient symptoms and laryngoscopic findings. On the other hand, the current guideline rec-

eight weeks of medication. Additionally, dysphagia ques-tionnaire and modified barium swallowing study(MBS) findings were evaluated on the initial visit. Results: To-tal of 45 patients with LPRD were enrolled in the study. 16 patients were male and 29 patients were female. The mean age of the study cohort was 61.78±12.86, ranging from 29 to 81 years-old. The average RFS and RSI of the cohort were 11.88±2.69 and 18.04±3.36. The sub-jective voice analysis was done using VHI-10 and GR-BAS scale (VHI 5.24±6.79, G 1.13±0.46, R 0.87±0.59, B 0.71±0.59, A 0, S 0.20±0.40, and GRBAS 2.91±1.31). The objective acoustic analysis was done in 44 patients(F0 162.56±39.60, vF0 2.65±4.26, jitter 8.57±33.78, shim-mer 3.57±1.64, vAm 13.55±6.13, NHR 0.13±0.04). The MBS was done in 44 patients (penetration (4, 8.9%), as-piration (1, 2.2%), residue (7, 15.6%), mean pharyngeal delay time (seconds, 5ml barium liquid; 10ml barium liquid; barium paste : 0.15±0.16; 0.11±0.09; 0.19±0.28), and mean pharyngeal transit time (0.91±0.25; 0.89±0.15; 0.92±0.27). There were significant improvement of RFS and RSI in 23 patients and jitter, vAm, VHI-10, G, R, B, and total GRBAS score in 21 patients who followed up before and 8 weeks after the medication. Conclusion: Through our study, we were able to describe the base-line voice and swallowing study results of LPRD patients. Additionally, eight weeks medication of PPI to LPRD pa-tients showed significant improvement in RFS and RSI along with certain objective and subjective acoustic pa-rameters of their voice.

» HNOP-82 16:10~16:20

» THE PRELIMINARY REPORT ON TREAT-MENT OUTCOME OF KTP LASER USE FOR BENIgN LESIONS IN THE ORAL CAvITY AND THE PHARYNx



UNIVERSITY OF KOREA, COLLEGE OF MEDICINE,


SUNG JOON PARK, HARAM KANG, YOUNG-HAK PARK

Objectives: To report treatment outcome of KTP laser use for benign lesions in the oral cavity and the pharynx. Methods: Retrospective cohort study was performed with medical records of patient with benign lesions in the

April28(Sun)




SOO HYUN JOO1, YOUNG-HYE KANG2, WON PARK3, JEONG-SEOK CHOI1,

YOUNG-MO KIM1, JI WON KIM1

Objectives: Sjögren’s syndrome (SS) is an autoimmune inflammatory disorder of exocrine glands characterized by dry mouth and eye. Recently, Ultrasonography has be-come a valuable tool for the assessment of salivary gland involvement in SS, however, the study about the useful-ness of salivary gland computed tomography (CT) is rare. Therefore, we investigated to evaluate the diagnostic ac-curacy of parotid gland CT for SS. Methods: Of total 91 patients with sicca symptoms, all patients took parotid CT, serology test, ophthalmologic examination and mi-nor salivary gland biopsy. Exclusion criteria were histories of head and neck radiation and radioiodine therapy, and medication causing xerostomia. As the gold standard, we finally diagnosed primary SS according to the Amer-ican College of Rheumatology/European League Against Rheumatism classification criteria. Diagnostic value of parotid CT was compared by the McNemar test. Results: Of total 91 patients with parotid CT, 37 (40.7%) pa-tients met the SS classification criteria. On parotid CT, heterogeneity of the parotid gland has the sensitivity 78.4 %; specificity 75.9%; accuracy 76.9%. Abnormal fat tis-sue deposition showed the sensitivity 78.4%; specificity 88.9%; accuracy 76.9%. Diffuse calcification was seen in 1/91 SS patients (sensitivity 2.7%; specificity 100%, accuracy 60.4%). Overall, parotid CT for identifying for SS had 81.1% of sensitivity, 75.9 % of specificity, 78.0% of accuracy, 69.8% of positive predictive value, 85.4% of negative predictive value (P < 0.05). Conclusion: Parotid CT is reasonably helpful for diagnosis of SS. The pres-ence of heterogeneity and fat tissue deposition are highly sensitive for SS. Diffuse calcifications in bilateral parotid glands is highly specific for SS.

» HNOP-85 16:40~16:50

» SUPERFICIAL TEMPORAL ARTERY AND vEIN AS RECIPIENT vESSELS FOR RECON-STRUCTION AFTER NASAL AND PARANASAL MALIgNANCY REMOvAL




PILKEUN JANG1, DOH YOUNG LEE1,

ommends 3 months of proton pump inhibitors (PPIs) at the time of initial treatment. In this study, we inves-tigated whether the combination of mucolytics in LPR treatment is expected to improve the patients’symptoms more rapidly and effectively. Methods: From March 2017, patients who visited our clinic for LPR symptoms with appearances of RSI >13 and RFS >7 have been en-rolled in this study under their consent. Randomly as-signed patients were prescribed PPI (rabeprazole 10 mg) plus mucolytics (acebrophylline 200 mg) twice a day in experimental group, and PPI only in the control group, respectively. The patients revisit the outpatient clinic 1 month after the treatment to testify a rapid symptomatic improvement based on changes in RSI and RFS. Results: A total of 56 patients was enrolled in the study to date, and 54 patients were included in the analysis. The number of subjects allocated to control and experimental groups were 25 and 29, respectively. Pre-treatment mean RSI was each 19.3 in control group and 22.5 in experimental group, but there was no statistical difference (p=0.064). At the first month after treatment, the responder whose RSI decreased by 4 points or more after initial treatment were identified in 9 patients (31%) in the test group and 9 patients (36%) in the control group, respectively. The mean decrement of RSI was each -6.9 in experimental group and -3.6 in control group, however, there was no statistical significance (p=0.216). Conclusion: At the one month after treatment with PPI plus mucolytics in LPR patients, rapid symptomatic improvement was not signif-icant compared to PPI alone. We will review the effect of mucolytics combination on the improvement of ear-ly symptoms in LPR patients and we will also examine changes at 3- and 6-months to see the usual treatment responses.

» HNOP-84 16:30~16:40

» DIAgNOSTIC ROLE OF PAROTID COM-PUTED TOMOgRAPHY FOR IDENTIFYINg SJögREN SYNDROME


NECK SURGERY, INHA UNIVERSITY COLLEGE

OF MEDICINE, INCHEON, REPUBLIC OF KOREA1,

DEPARTMENT OF RADIOLOGY, INHA UNIVERSITY

COLLEGE OF MEDICINE, INCHEON, REPUBLIC OF

KOREA2, DEPARTMENT OF INTERNAL MEDICINE,

INHA UNIVERSITY COLLEGE OF MEDICINE,

INCHEON, REPUBLIC OF KOREA3

April28(Sun)




HNOP-13Room 2-6 (Peacock)

Chair : YOON WOO KOH, BON SEOK KOO


» HNOP-86 15:50~16:00

» PP2, A SELECTIvE INHIBITOR OF C-SRC, IS A NEW THERAPEUTIC CANDIDATE FOR CETUxIMAB-RESISTANT HNSCC, ACTINg vIA REgULATION OF THE EPITHELIAL-MESEN-CHYMAL TRANSITION


COLLEGE OF MEDICINE, KONYANG UNIVERSITY

HOSPITAL, KONYANG UNIVERSITY

MYUNGGOK MEDICAL RESEARCH INSTITUTE1,


SCHOOL OF MEDICINE, AJOU UNIVERSITY2

YEON SOO KIM1*, SUNJUNG PARK1, BOK-SOON LEE2, CHUL-HO KIM2

Objectives: Head and neck squamous cell carcino-ma (HNSCC) is the sixth most common cancer in the world. Despite numerous studies on cancer treatment, the treatment outcome remained virtually unchanged, and the 5-year survival rate of HNSCC is only 40% for current treatment strategies. One of the most common strategies for HNSCC is cetuximab (CTX), an FDA-ap-proved monoclonal antibody that targets EGFR against HNSCC; however, due to CTX resistance, only a small number of patients respond positively to CTX. Methods: In this study, we assessed the effect of 4-amino-5-(4-chlo-rophenyl)-7-(dimethylethyl)pyrazolo[3,4-d] pyrimidine (PP2), a selective inhibitor of c-Src, on CTX-resistant HSNCC. PP2 was originally used as a treatment for my-eloid leukemia and has recently been studied with respect to other cancers; such studies have reported an associ-ation between c-Src and EGFR resistance in the treat-ment of cancer, including HNSCC. However, the role of PP2 in EGFR-resistant HNSCC and related mecha-nisms is not well understood.To investigate the anti-can-cer role of PP2 in CTX-resistant HNSCC, we screened eight HSNCC cell lines for CTX resistance. Results: Of

WOO-JIN JEONG1, EUN-JAE CHUNG1, YOUNG HO JUNG1, TAE-BIN WON1,

SEONG KEUN KWON1, TACK-KYUN KWON1, SOON-HYUN AHN1, MYUNG-WHUN SUNG1,

WON SHIK KIM1

Objectives: When choosing the recipient vessels for re-construction, proximity to the defect, vessel caliber, and ease of dissection should be considered. The superficial temporal artery/vein (SupfTA/V), the superior thyroi-dal artery/vein (STA/V), or the facial artery/vein (FA/V) have been considered as recipient vessels in midface re-construction. Here, we will review the eight consecutive cases of reconstruction after nasal and paranasal malig-nancy removal. Methods: A retrospective analysis of eight patients who underwent free flap reconstruction for nasal and paranasal defects after surgical management of malignancy between April 2018 and October 2018 was performed. Demographic data, primary cancer site, pa-thology, postoperative complications, neck dissection, recipient vessels, previous radiotherapy history, and sur-gical outcomes were evaluated. Results: All of the eight patients underwent anterolateral thigh free flap trans-fers. In six cases, the SupfTA was used as the recipient artery. SupfTV was used as the recipient vein in all of these six cases. In two cases, however, flaps were failed due to venous congestion. One patient required a return to the operating room. Ant. branch of external jugular vein (EJV) was harvested and it was used to connect the donor vein and the post. branch of EJV. In the other case, venous congestion was observed intraoperatively, and EJV was harvested and it was used to connect the donor vein and FV. There was no late flap loss. Conclusion: The advantage of using SupfTA/V as the recipient vessel is that cervical incision could be avoided. SupfTA/V had shorter distance from the upper and midface relative to the FA/V. By avoiding cervical skin incision, lymphatic drainage can also be preserved. However, suitable recipi-ent SupfTV couldn’t be identified in some cases, because the SupfTA/V did not run in parallel. Proper selection of the recipient vessels should be considered depending on the patient’s individual vessel anatomy in the reconstruc-tion of nasal and paranasal area.

April28(Sun)




patients that were treated with adjuvant therapy and also to those who have undergone conventional surgery with no adjuvant therapy. All patients were analyzed of tradi-tional risk factors, postoperative function stratified with overall and disease-free survival by Kaplan-Meier meth-od. Results: Among the 11 HPV positive- node positive OPSCC patients that have not received adjuvant thera-py, 8 patients were recommended for adjuvant therapy, but refused by the patient’s demand, the other 3 patients had traditional risk factors, however determined surgery alone by the surgeon. After case matching with the ad-juvant therapy treated group and conventionally treated groups, and controlling for age, pathological stage, the receipt of adjuvant therapy was not significantly associat-ed with disease-free survival (adjusted hazard ratio, 0.90). Conclusion: Depending on our results, adjuvant treat-ment can be chosen for highly-selected patients in HPV related OPSCC based on other risk factors. Furthermore, de-escalation of adjuvant therapy HPV-related OPSCC is required to prevent potential radiation-induced late complications.

» HNOP-88 16:10~16:20

» USEFULNESS OF ENDOTRACHEAL TUBE WITH PRESSURE SENSOR TO PREDICT vO-CAL FOLD PARALYSIS BY TRACTION DURINg THYROID SURgERY


NECK SURGERY, COLLEGE OF MEDICINE AND

RESEARCH INSTITUTE FOR CONVERGENCE OF

BIOMEDICAL SCIENCE AND TECHNOLOGY, PUSAN

NATIONAL UNIVERSITY YANGSAN HOSPITAL1,


AND NECK SURGERY, COLLEGE OF MEDICINE

AND MEDICAL2, DEPARTMENT OF BIOMEDICAL

ENGINEERING, PUSAN NATIONAL UNIVERSITY

HOSPITAL3

EUI-SUK SUNG1, HWA-BIN KIM2, SANG-HOON KIM2, YOUNG-IL CHEON2,

SUNG-CHAN SHIN2, HYUN-KEUN KWON2, JUNG- HOON RO3, BYUNG-JOO LEE2

Objectives: The endotracheal tube with electrodes has quite low and variable positive predictive value due to loss of signal in thyroidectomy. Thus, we developed a novel in-

the eight cell lines, we defined SCC1483 and YD15 as CTX-resistant HNSCC based on cell viability assays in the presence of CTX. The therapeutic role of PP2 was then investigated in SCC1483 and YD15. Of note, can-cer cell growth and progression, including migration and invasion, were inhibited by PP2 in both cell lines. Cell apoptotic activity was also increased, and correspond-ingly cleaved caspase-3 expression was up-regulated. Fi-nally, we found that the EMT pathway downstream of c-Src was regulated by PP2. Specifically, PP2 exposure down-regulated the expression of ERK, AKT/Slug, and Snail and up-regulated the expression of E-cadherin in SCC1483 and YD15. Conclusion: These results suggest that PP2 inhibits cell growth and progression in CTX-re-sistant HNSCC through regulation of the EMT pathway.

» HNOP-87 16:00~16:10

» CRITICAL ASSESSMENT OF ADJUvANT THERAPY FOLLOWINg ROBOT-ASSISTED NECK DISSECTION(RAND) COMBINED WITH TRANSORAL ROBOTIC SURgERY(TORS) FOR HPv POSITIvE NODE POSITIvE OROPHARYN-gEAL CANCER PATIENTS



DA HEE KIM1, YOUNG MIN PARK1, MIN SUK KANG1, EUN CHANG CHOI1,

SE-HEON KIM1, YOON WOO KOH1

Objectives: Since HPV-related OPSCC has a favorable prognosis, multiple clinical trials for adjuvant therapy de-escalation in p16-positive OPSCC are currently be-ing considered with the goal of decreasing treatment-as-sociated morbidity without compromising tumor con-trol. Also, as the operation trend in OPSCC after FDA approval of TORS has shown great increase of robotic surgery, our institute have previously applied and proved the feasibility of robot-assisted neck dissection combined with TORS. This study aims to analyze the natural course of HPV positive & node positive OPSCC that have un-derwent RAND without any adjuvant therapy. Methods: Among 118 cases of TORS & RAND on oropharyngeal cancer between April 2011 and July 2018, we selected 11 patients that have matched the NCCN guideline indica-tions for adjuvant therapy, but however managed to re-main surgery alone. These patients were case controlled to

April28(Sun)




SEOK-HO HONG2, JAE-YOL LIM1

Objectives: Salivary organoids hold promise for studying the mechanisms of salivary gland diseases. In this study, we developed hybrid spheroids, in which perivascular cells (PVCs) support mesenchymal interactions with sal-ivary gland stem cells (SGSCs), and tested applicability of the hybrid spheroid-based disease modeling for mim-icking radiation-induced hypofunction in salivary glands. Methods: Human SGSCs were cocultured with human umbilical-cord–derived PVCs within growth factor–re-duced Matrigel. Results: Gene Ontology analysis revealed that genes related to salivary organogenesis were upregu-lated and salivary epithelial and stromal markers were ex-pressed more in the hybrid spheroids than SGSC-derived spheroids. When we cultured SGSCs with a conditioned medium from PVCs to assess the niche function of PVCs, structural marker levels as well as acinar and ductal func-tional indices declined compared to SGSCs cocultured with PVCs, indicating the importance of cell-to-cell contact. Finally, we set up a salivary hypofunction–mim-icking model based on our salivary spheroids, in which radiation-induced structural and functional deterioration caused by depletion of salivary cells post-irradiation was recapitulated. Conclusion: In conclusion, PVCs support organization from SGSCs, and our novel salivary hybrid spheroids can serve as a model of radiation-induced sali-vary hypofunction.

» HNOP-90 16:30~16:40

» TRANSORAL ROBOTIC SURgERY FOR PARAPHARYNgEAL SPACE TUMOURS A SYS-TEMATIC REvIEW

DEP. OF SURGERY,

ROYAL PRINCE ALFRED HOSP. AUSTRALIA

PHYLANNIE K.F.CHEUNG, DOMINIC KU, MICHELLE M.P. HUI

Objectives: Transoral robotic surgery (TORS) has emerged as a minimally invasive alternative to open surgery for the management of selected head and neck malignancies. The aim of this systematic review is to summarise the current evidence on the use of TORS for parapharyngeal space (PPS) tumours and to evalu-ate the outcomes of patients treated with this approach. Methods: A systematic review of literature was conduct-

traoperative neuromonitoring(IONM) with an endotra-cheal tube with pressure sensor to detect laryngeal twitch-ing. The objective of this study was to evaluate the useful-ness of endotracheal tube with pressure sensor to predict vocal fold palsy(VFP) by traction during thyroid surgery in a porcine model. Methods: We developed an endotra-cheal tube with pressure sensor that uses the piezoelectric effect to measure laryngeal twitching. The transcartilage electromyography(EMG) needles were placed in thyroid cartilage. Stimulus thresholds, amplitude, and latency of laryngeal twitching measured using the endotracheal tube with pressure sensor were compared to those mea-sured through EMG of the vocalis muscle in 8 recurrent laryngeal nerves(RLNs) of 4 pigs. And we compared the changes in amplitudes of EMG and pressure sensor after RLN traction with time and investigated whether there was postoperative VFP. Results: No significant differences in stimulus thresholds between the transcartilage needle EMG and endotracheal tube with pressure sensor were observed. The amplitude of EMG decreased by 60% on average immediately after RLN traction but decreased by mean 44% after 20 minutes. The amplitude of pressure sensor decreased by 44% on average immediately after RLN traction and decreased to mean 13% after 20 min-utes. VFP was not observed in all 8 RLNs. Conclusion: When RLN traction was performed, the amplitude val-ue of the pressure sensor was reduced or recovered low-er than the amplitude of the EMG, but the amplitude decreased immediately after traction and recovered over time. This is a similar EMG change pattern when there is traction injury of the RLN. In other words, pressure sen-sor is predictive of nerve damage such as traction, which is the most common nerve injury, so pressure sensor can be an alternative to EMG in the future.

» HNOP-89 16:20~16:30

» 3D HYBRID SPHEROIDS BY COCULTUR-INg OF SALIvARY gLAND STEM CELLS AND PERIvASCULAR CELLS ENABLE MODELINg OF RADIATION DAMAgE IN SALIvARY gLAND TISSUE



DEPARTMENT OF INTERNAL MEDICINE,

KANGWON NATIONAL UNIVERSITY

SCHOOL OF MEDICINE2

HYUN-SOO SHIN1, SONGYI LEE1,

April28(Sun)




ed by two independent reviewers using Ovid Medline, PubMed and EMBASE databases using the search terms robotics or transoral robotic surgery or robotic surgical procedure and parapharyn*. The search was limited to peer-reviewed human subject articles published between 1946 and October 2018. Statistical analysis was conduct-ed after data extraction using Microsoft Excel and SPSS Version 21. Results: Thirteen papers comprising 72 pa-tients undergoing TORS for PPS tumors, were includ-ed. 47 patients had pleomorphic adenomas (64.4%). 14 patients (19.2%) had capsular disruption or tumor frag-mentation intra-operatively. 9 patients were converted to an open approach due to intraoperative difficulties lim-iting the safety of the dissection. The estimated average blood loss was 110ml (range 2-400ml). Complications were reported in 14 patients, including dysphagia, tris-mus, haematoma and pharyngeal dehiscence. The mean time to oral intake was 1.0 days while the mean length of stay was 3.4 days. The mean follow-up time was 18.0 months and no recurrences were reported. Conclusion: Patients undergoing TORS for PPS tumors achieve good functional and recurrence outcomes, with few major complications. TORS is therefore a viable alternative to open surgery in patients with PPS tumors.

April28(Sun)




HNPX


Poster Exhibition

» HNPX-01

» INTRAOPERATIvE CT IMAgEgUIDED NAv-IgATION SYSTEM ASSISTED ENDOSCOPIC ENUCLEATION OFA MANDIBULAR ODONTO-gENIC KERATOCYST


NECK SURGERY COLLEGE OF MEDICINE, THE


SEOUL, KOREA

YU-PYO HONG, CHOUNG-SOO KIM

A 62-year-old man presented with a mass lesion of the left mandibular ramus and coronoid process, confirmed by facial bone computed tomography (CT). Facial bone CT revealed a well-defined 52.5 × 50.6 × 29.0 mm cystic lesion involving the left mandibular ramus and coronoid process. The adjacent bony structure was severely thinned and eroded, and the lining of the bone showed partial discontinuity.(Fig. 1) Considering the findings described above, under suspicion of Odontogenic keratocyst (OKC) of the mandible, navigation system–assisted en-doscopic enucleation and chemical ablation was chosen as the treatment strategy. Under general anesthesia, the endoscopic system and CT-guided navigation were ap-plied. (Fig. 2) The OKC was exposed sufficiently via left buccal mucosal incision. A navigation connected probe was used to determine the extension of the cyst and loca-tion of adjoining anatomic structures. After the main le-sion was removed, intracortical curettage was performed with a diamond bone drill burr to eradicate the residual lesion. The bony cavity was ablated chemically with 80% ethanol solution. A drain was inserted into the cavity, and the incision site was sutured. The drain was removed at 2 weeks after surgery in the outpatient department. During regular follow-up including additional facial bone CT, no signs of recurrence or complications were noted for 24 months after surgery. (Fig. 3) In our case, mandibular

OKC was treated with navigation assisted endoscopic cu-rettage in addition to application of 80% ethanol, for the first time, an intraoperative CT image–guided navigation system was used for exhaustive and safe surgery. As the navigation system yields accurate anatomic information, surgeons can recognize the area that the surgical tools ma-nipulate, so that enucleation and bone drill-assisted intra-cortical curettage can be performed thoroughly, leaving no residual cystic lesions. As demonstrated from the facial bone CT images of our case, the cortex of the involved lesion is extremely thin and vulnerable, and therefore in-depth information about orientation and anatomy is necessary to preserve the normal bony structure. In treat-ment of OKC, the biggest challenge has been clearing away the lesion with no recurrence and few complica-tions. With the help of the navigation system, surgeons could achieve these two goals concurrently

» HNPX-02

» A CASE OF FALSE vOCAL FOLD SOLID MASS


HEAD & NECK SURGERY, HALLYM UNIVERSITY

DONGTAN SACRED HEART HOSPITAL1

SUNG MIN PARK1, SUNG KYUN KIM1, SEOK JIN HONG1, SEOK MIN HONG1,

YONG BOK KIM1, IL SEOK PARK1, HEEJIN KIM1

A 38-year-old man who had been a life-long smoker presented complaining of hoarseness (duration of two years). He had initially referred by local otolaryngologist due to right false vocal cord mass. Fiber-optic larygosco-py showed elevated lesion at right false vocal cord with solid and cystic portion. CT scan showed ill-defined soft tissue density mass at right false vocal cord with mild en-hancement, small calcifications, and suspicious submu-cosal invasions. Preoperative aerodynamic study revealed breathy voice. The mass was removed with CO2-assisted microlaryngeal surgery. Histological analysis revealed dif-fuse accumulation of pinkish amorphous material with calcification and ossification, suggesting laryngeal polyp, amyloidosis, or tracheopathia chondro-osteoplastica. La-ryngeal polyp is less likely due to its appearance in fi-bre-optic laryngoscopy examination, and amyloidosis was ruled out by additional histological analysis. Thus tracheopathia chondro-osteoplastica is considered most likely. Postoperative aerodynamic study was normal and the patient no longer had complaint of hoarseness. Tra-

April28(Sun)




electromyography, denervated activities of right cricothy-roid muscle were identified five days after vocal fold palsy development. Vocal fold mobility and other symptoms were completely improved after a month. Vagus nerve has various functions including laryngeal sensation, au-ricle and external auditory canal sensation, and laryngeal movement. An understanding of the precise functions of involved nerve by HZ is important to diagnose, especially in vagus nerve due to its rarity.

» HNPX-04

» AIRWAY OBSTRUCTION IN INFANT CAUSED BY EPIgLOTTIC CYST - A CASE REPORT

DEP. OF OTORHINOLARYNGOLOGY-HEAD AND

NECK SURGERY, DR. SARDJITO HOSP., FACULTY

OF MEDICINE, PUBLIC HEALTH AND NURSING,

UNIVERSITAS GADJAH MADA

MUHAMMAD S. RISKI, GESIT G. PURNAMA, AGUS SURONO

Introduction: Epiglottic cyst is a rare cause of upper re-spiratory tract obstruction in neonates and infants. The small larynx and narrow airway of infants put them at high risk for obstruction. Case report: We reported a 2- month-old infant with stridor and dyspnea during the second month of life accompanied by feeding difficulties. Flexible laryngoscopy and a computed tomography (CT) scan showed a cystic mass on the epiglottis. The patient was successfully treated with mass extirpation under gen-eral anesthesia through tracheostomy. During follow-up, the cyst was not appeared up to 3 months after surgery and the upper airway is patent. Histopathological result revealed cystic lymphangioma with moderate dysplasia of the laryngeal mucosa. Conclusion: There was a patient with diagnose of epiglottic cyst that undergone mass ex-tirpation under general anesthesia through tracheostomy. Epiglottic cyst is a rare cause of upper airway obstruction that shows variety of symptoms. Epiglottic cyst should be considered in the differential diagnosis of an infant with stridor and clinicians should perform careful sur-gical planning. Keywords: Epiglottic cyst, infant, stridor

» HNPX-05

» A CASE OF NEgATIvE PRESSURE WOUND THERAPY IN NECROTIzINg FASCIITIS OF THE

cheopathia chondro-osteoplastica is a rare, benign disor-der characterised by numerous cartilagenous and bony submucosal nodules protruding into the tracheo-bron-chial lumen. The disease affects the anterior and lateral tracheal wall and occurs in patents over 50 years of age, with no gender predominance. There was several reports about growing subglottic mass which obstructed air-way and underwent tracheostomy. However, there was no case which presenting supraglottic spaces. This case is very difficult to confirm the definite diagnosis in the pathology. The most possible dianosis is either trache-opathia chondro-osteoplastica or amyloidosis. The amy-loidosis in the larynx has been reported through numeral studies, however, this patient is not clearly satisfied with the diagnositc criteria.Through this case, we considered that false vocal fold solid mass can be the tracheopathia chondro-osteoplastica, and cured by CO2 laser clearly. Further close follow-up would be needed.

» HNPX-03

» HERPES zOSTER OF ISOLATED vAgUS NERvE INvOLvEMENT



MEDICINE, DONGGUK UNIVERSITY

JUNG-WOO SHIN, JOO HYUN PARK, SEOK-WON PARK, BO HAE KIM

Herpes zoster(HZ) is caused by reactivation of varicel-la-zoster virus which establishes lifelong latency in the cranial nerve of dorsal root ganglia after primary in-fection. Although cranial nerve involvement of HZ is well known, isolated involvement of vagus nerve is rare. Therefore, we report a case of isolated herpes zoster of vagus nerve with a literature review. A 41-year old male patient having a history of diabetes mellitus presented with throat pain and fever that were not relieving by NSAIDs since two days ago. At presentation, multiple vesicles on right cavum concha and auricle were identi-fied. In addition, multiple ulcers on right supraglottis, the laryngeal surface of epiglottis and aryepiglottic fold, were observed. A day later, the patient complained aggra-vating hoarseness, and immobility of right vocal fold was identified on laryngoscopy. Although VZV DNA PCR-IgM and tzanck test were negative, we treated with anti-viral agent and steroid (40mg per day) for 7 days under suspicion of isolated vagus nerve involvement of HZ. On

April28(Sun)




aspect. A 71-year-old man with a solitary subcutaneous posterior neck mass visited our clinic. He was confirmed metastatic melanoma in lymph node through excisional biopsy. However, the primary site was not found with whole radiologic examinations. We report a very unique and rare entity with a brief literature review.

» HNPX-07

» A CASE OF KIMURAS DISEASE IN PAROTID gLAND IN PATIENT WITH POLYCYTHEMIA vERA




SCHOOL OF MEDICINE

HYE SOO KIM, SUN WOO KIM, JIN LEE, SANG HYUK LEE

Kimura's disease is a rare disease of unknown etiology, commonly presenting with slow-growing head and neck subcutaneous nodules. It primarily involves the head and neck region, presenting as deep subcutaneous masses and is often accompanied by regional lymphadenopathy and salivary gland involvement. Clinically it is often confused with parotid tumor or lymph node metastasis. It is diffi-cult to diagnose before surgery and fine needle aspiration cytology has only limited value. Even though this disease have not shown any malignant transformation, it is of-ten difficult to cope with because of its high recurrence rate. Surgery, steroids and radiotherapy have been used widely as first line recommendation, but none of them is standard procedure till now because of high recurrence rates. It was reported that rates of recurrence reached up to 62%. The authors have recently experienced a case of Kimura’s disease occurring in left parotid gland in 82 years old women with polycythemia vera, who had been treated with surgical excision, we report this case with a review of literatures.

» HNPX-08

» PRIMARY LARgE CELL NEUROENDOCRINE CARCINOMA OF THE PAROTID gLAND A CASE REPORT


HEAD AND NECK A CASE REPORT


HEAD AND NECK SURGERY, WONKWANG

UNIVERSITY HOSPITAL, WONKWANG UNIVERSITY


DONG-HWAN OH1, YOUNG-JU JIN1

Necrotizing fasciitis is a deep soft tissue infection that rapidly progresses along the fascia. It causes ischemia and necrosis of invaded tissues and causes extensive damage to surrounding skin, subcutaneous tissue, muscle and surrounding soft tissue. The treatment of necrotizing fas-ciitis is broad-spectrum antibiotics and incisional drain-age. Negative pressure wound treatment can remove tis-sue fluid or necrosis efficiently by applying continuous negative pressure to wound area. It is a method widely used in general surgery, plastic surgery, thoracic surgery, etc. Negative pressure wound treatment can reduce the number of treatments and reduce the fatigue of the med-ical staff and reduce the pain suffered by the patient. We report a case of wound healing successfully treated with negative pressure wound treatment for cervical necrotiz-ing fasciitis with a review of the literature.

» HNPX-06

» A CASE OF METASTATIC MALIgNANT MEL-ANOMA PRESENTINg AS SUBCUTANEOUS POSTERIOR NECK MASS


HEAD AND NECK SURGERY1 AND PATHOLOGY2,

VETERANS HEALTH SERVICE MEDICAL CENTER

SUNG HWAN LIM1, BEOM MO KOO1, MIN A KIM2, SEUNG WOO KIM1

Malignant melanoma can be classified as cutaneous and mucosal type.The former comprises more than 98% of all melanomas, and it is related to ultraviolet exposure, whereas the latter occupies only 1.3%. More than half of mucosal melanoma arises in head and neck and the sin-onasal tract is most predilection site. On the other hand, the metastatic melanoma of head and neck is lower in-cidence than primary lesion and the unknown primary site is about two to five percent. Moreover, the lymphatic metastasis to the posterior neck is a more unusual clinical

April28(Sun)




left 10th ribs in imaging studies, and the result of in-cisional biopsy revealed tongue metastasis of renal cell carcinoma. RCC metastasis to the tongue is extremely rare. Only 51 cases were reported worldwide from 1911 to 2017. According to reviews, There is no case of renal cell carcinoma metastatic to the tongue reported to date in Korea. So we report this case with a review of the lit-erature.

» HNPX-10

» A CASE OF ATYPICAL LIPOMATOUS TUMOR/WELL-DIFFERENTIATED LIPOSARCOMA ARIS-INg FROM TONgUE

1DEPARTMENT OF OTOLARYNGOLOGY, 2INSTITUTE OF HEALTH SCIENCES,



YOUNG CHUL KIM1, JUNG JE PARK1,2

Liposarcoma, first described by Virchow in 1857, is a common mesenchymal malignant tumor arising from the adipose tissue. The most common of all soft tissue sarco-mas, liposarcomas account for approximately 20% of all soft tissue sarcomas. However, it is rare in the head and neck, particularly in the oral cavity. Oral liposarcomas have been reported to occur mainly on the buccal mu-cosa, with other sites including the floor of the mouth, tongue, palate, and mandible. However, almost no cases of a liposarcoma located on the tongue have been report-ed in korea. To our knowledge, about 60 cases of liposar-coma of the tongue have been previously reported in En-glish language studies. We present a rare case of an atyp-ical lipomatous tumor/well-differentiated liposarcoma of the tongue that occurred in a 76-year-old male patient. Our patient underwent surgical excision. We also present a review of the current published data. At 4 months of follow-up, the patient remained free of disease.

» HNPX-11

» DUCHENNE MUSCULAR DYSTROPHY PA-TIENTS WITH MUCOEPIDERMOID CANCER OF PAROTID REPORT OF A CASE



INSTITUTE FOR MEDICAL SCIENCE,

CHONBUK NATIONAL UNIVERSITY-

CHONBUK NATIONAL UNIVERSITY HOSPITAL

JONG HWAN LEE1, SU GEUN KIM2, YONG TAE HONG3, KI HWAN HONG4

Primary large cell neuroendocrine carcinomas of the pa-rotid gland are exceptionally rare. We report the case of a 67-year-old man with large mass in the parotid area. On the enhanced MRI scan, a mass showing a lobulat-ed contour of about 4.2 * 2.5 * 3.7 cm was found in the inferior pole of the superficial lobe in the left parotid gland. Malignant tumors were found to be highly like-ly so total parotidectomy and MRND(Modified radical neck dissection) were performed together and biopsy was performed. The tumor was a large cell carcinoma with neuroendocrine features and positive immunostaining for neuroendocrine markers. Large cell neuroendocrine carcinoma of the salivary gland is a rare disease. Thus, we suspected a metastatic lesion of the parotid tumor and performed additional chest CT, but there was no specific finding. Therefore, a large cell neuroendocrine carcinoma was diagnosed in the parotid gland as a primary tumor.

» HNPX-09

» TONgUE METASTASIS FROM RENAL CELL CARCINOMA, A RARE CASE PRESENTATION




JI-SEOB YOO1, YEON-SEOK YOU2, YONG-TAE HONG3, KI-HWAN HONG4

Renal cell carcinoma is characterized by marked meta-static potential and is the third most common cancer of metastatic to the head and neck, following breast and lung cancer. We report a rare case of a patient with renal cell carcinoma metastatic to the tongue. A 72-year-old man visited our otorhinolaryngology clinic, complaining of tongue pain and ulcerative lesions occurred 3 weeks before. The patient was diagnosed with renal cell carcino-ma and received right radical nephrectomy in three years ago. Because the lesion was suspected to be malignant, hemiglossectomy was planned as an operative treatment. However, metastatic lesions were suspected on LUL and

April28(Sun)




» HNPX-12

» A CASE OF ONCOCYTIC PAPILLARY CYSTA-DENOMA OF THE PAROTID gLAND


HEAD AND NECK SURGERY1, PATHOLOGY2,

NATIONAL HEALTH INSURANCE

SERVICE ILSAN HOSPITAL

KYUIN LEE1, TAESEONG EO1, MI-KYUNG LEE2, HYANG AE SHIN1

Papillary cystadenoma is a rare salivary gland tumor, which is more common in minor salivary glands and ex-tremely rare in the major salivary glands. Cystadenoma is subdivided into papillary and mucinous types. The papillary type has well-defined unilocular or multilocular cysts, with intraluminal papillary projections. A 80-year-old male presented with a slow growing mass on the right cheek for 1 year. Fine-needle aspiration was performed to reveal oncocystic cells intermixed with many macro-phages. Under suspicion of a warthin’s tumor, partial su-perficial parotidectomy was performed. Histopathologic findings confirmed a oncocytic papillary cystadenoma. We discuss histopathological features of oncocytic papil-lary cystadenoma and review the literature.

» HNPX-13

» A CASE REPORT OF UNUSUALLY AggRES-SIvE PROgRESSION OF PAROTID MUCOEPI-DERMOID CARCINOMA


COLLEGE OF MEDICINE, KONYANG UNIVERSITY

MYEONG HEE KIM1, JONG JOONG CHOI1, HONG GEUN AHN1, JOONG SU PARK1,

YEON SOO KIM1, JOO HYUN KIM1

About 6% of the major and 19% of the minor salivary gland tumors is mucoepidermoid carcinoma (MEC). This tumor has been divided into low, intermediate and high grade type. The prognosis depends on the tumor’s grade and has marked difference between three types. 5 year survival rates ranged from 0 to 43% for patients with high grade tumors compare to 92 to 100% for patients with low grade tumors. A 51-year-old woman visited our


GEUN-JEON KIM, DONG HYUN LEE, SANG-YEON KIM, DONGIL SUN

Introduction Duchenne muscular dystrophy (DMD), a rare, progressive myopathy, is a recessive disorder caused by mutations on the short arm of the X chromosome. Most affected males have molecular deletions within the dystrophin gene, leading to disruption of dystrophin translation and subsequent muscle cell membrane de-fects. Recently, some authors have reported that DMD genes are related to neoplastic formation, but there have been no detailed clinical reports of parotid cancer as-sociated with DMD. Case presentation A 33-year-old man had facial swelling of the right parotid area since 2 months.Imaging of the head and neck along was done before the surgery, which showed 3*3cm sized lesion con-fined to the parotid deep lobe, seems to be a benign neo-plasm, such as, mixed tumor or Warthin tumor. And we checked sono-guided biopsy, which showed also benign nature. On exploration, the tumor had poorly defined margins with facial nerve, so we decided to confirm the frozen biopsy during the operation. As a result, tumor was confirmed as malignancy, we performed radical pa-rotidectomy including facial nerve, also nerve grafting with cervical flexus. After operation, he complained with bloody urine. His serum creatine kinase (CK) level had exceeded 20000IU/l , potassium level was extreme high (7.2mEq/l). His AST, ALT, and LDH levels were also el-evated. Genetic testing of the muscular dystrophy gene at the chromosome Xp21 site, affected in Duchenne dystro-phy, disclosed a characteristic deletion of exons 10 to 29. Histopathological examination of the operated specimen had showed features of low-grade MEC. Discussion & Conclusion Duchenne muscular dystrophy is ultimate-ly lethal disorder affecting striated muscle. Because sur-vival beyond the third decade of life is extremely rare, an increased risk of cancers commonly encountered in the older age groups cannot be excluded. Like this case, DMD patients may develop acute rhabdomyolysis after operation. Then muscle necrosis, gross elevation of se-rum creatine kinase, and myoglobinuria were occurred. Resulting hyperkalemia, metabolic acidosis and acute re-nal failure predispose to cardiac dysrhythmia. Although our findings do not demonstrate a relationship between Duchenne muscular dystrophy and parotid cancer, the present case report is the first to provide documentation of parotid cancer in a patient with DMD.

April28(Sun)




» HNPX-15

» A CASE OF CANCER CELL CONTAMINATION OF RECONSTRUCTION SITE




BYUNG-HYUN HAN, YONG-SEOK JO, TAEK-YOON CHEONG, JAE-KEUN CHO

Some surgeons change their equipment after the resection of malignant tissue to reduce the risk of cancer cell con-tamination. While this practice is conceptually attractive, there is little evidence that instruments act as mediators of cancer cell contamination in a clinical setting. We pres-ent a case of a 73-year-old male who had tongue cancer operation. We performed tongue wide excision and re-construction with anterolateral thigh free flap at the same time. Concurrent chemoradiation therapy (CCRT) was started at 6 weeks of operation. At 3 weeks after CCRT, ulceration tissue was developed in reconstructed tongue and we performed biopsy on the flap site. We decided re-operation because we suspected cancer cell contamina-tion on the flap site. Intra-operatively, all resection mar-gins were confirmed to be negative, and we finished sur-gery with primary closure. After 6 months of follow-up the patient is still disease free and there is no suspicion of recurrence until now. Many surgeons changed their equipment to mitigate the potential risks of mechanical tumor seeding of the wound and local tumor bed. But such efforts have no consensus of beliefs. So further stud-ies are needed to determine whether malignant cells are in fact detectable on instruments in a cancer resections.

» HNPX-16

» SMALL CELL NEUROENDOCRINE CARCINO-MA IN SUBLINgUAL gLAND CASE REPORT AND REvIEW



MEDICINE, YEUNGNAM UNIVERSITY1, REGIONAL

CENTER FOR RESPIRATORY DISEASE,

YEUNGNAM UNIVERSITY MEDICAL CENTER,

DAEGU, REPUBLIC OF KOREA2

clinic with painless parotid tumor. She did not drink and smoke, and had never had any disease history in the past. The tumor was predicted as a malignant tumor involving deep lobe of right parotid gland on CT, MRI. We did to-tal parotidectomy with modified radical neck dissection. Pathologic diagnosis was high grade MEC. The patient conducted PET-CT to identify metastasis, and there was no metastasis. She performed post-operative radiation therapy. In three months after radiotherapy, the right face paralysis had occurred. The facial nerve metastasis was suspected, so re-operation was performed. After one month of the surgery, lung metastasis was suspected and chemotherapy was performed. During chemotherapy, she visited our emergency center because of seizure like motion and decreased mentality. She diagnosed as brain metastasis on brain CT and MRI. She was performed stereotactic radiosurgery. Since the treatment with the ra-diosurgery, the patient has been doing chemotherapy for two months. We report a case of extremely rapid progres-sive high grade MEC treated with surgery and post-op-erative radiation/chemotherapy. Patients with high-grade tumors are at increased risk for treatment failure after surgery and postoperative radiation therapy. Investigative strategies to improve outcome should be considered for these patients.

» HNPX-14

» MALIgNANT MIxED TUMORS OF THE SAL-IvARY gLAND - A CLINICOPATHOLOgICAL STUDY




YEON-SEOK YOU, YONG TAE HONG, KI-HWAN HONG

Malignant mixed tumors of salivary gland origin are rare, accounting for less than 1% of overall tumors of the salivary glands. Malignant mixed tumors of the salivary gland are diverse and include three different subcategories of lesions: carcinosarcomas, carcinoma ex pleomorphic adenoma, and metastasizing pleomorphic adenomas. The malignant mixed tumors behave aggressively, with poor 5-year survival. The objective of this study was the clini-cal and pathological analysis of malignant mixed tumors treated surgically at the our department.

April28(Sun)




» HNPX-18

» A CASE OF CERvICO-FACIAL SUBCUTA-NEOUS EMPHYSEMA AFTER INFLATINg THE CHEEKS


GYEONGSANG NATIONAL UNIVERSITY SCHOOL

OF MEDICINE, GYEONGSANG NATIONAL

UNIVERSITY HOSPITAL

MIN JI KANG, HYUN WOO PARK

Cervicofacial subcutaneous emphysema(CSE) is a state of the caged in the subcutaneous layer, between muscles, fascial area and other deep interstitial locations at cer-vicofacial area. CSE usually occurs for trauma, surgery, dental procedure, infection, iatrogenic causes such as endotracheal intubation, and positive pressure ventila-tion. The common symptoms of CSE are facial swelling, crepitus on palpation, tenderness and pain. We report a 10-year-old boy with CSE following repeatedly inflating the cheeks, who presented with right facial swelling and crepitus on palpation. The patient was given prophylac-tic antibiotic and avoid inflating the cheeks. After weekly follow up appointments, gradually resolution of the em-physema in approximately three weeks.

» HNPX-19

» HAEMORRHAgIC TONgUE SWELLINg CAUSED BY vIBRIO vULNIFICUS




TAEK-YOON CHEONG, SOLLIP KIM, JAE-KEUN CHO

Vibrio vulnificus(V. vulnificus) is a gram negative bacilli, which can cause primary septicemia, soft tissue infection and gastroenteritis. Although the infection occurs rarely, it might results in fatal prognosis. Consumption of un-der-cooked seafood or exposure to seawater are common causes, and most cases presents in patients with immuno-compromised condition or chronic liver diseases. Com-bined antimicrobial therapy is essential for treatment, while surgical debridement can be performed to manage

Withdrawal

JOON-HEE KIM1, YOO SUN SONG1, TAE YEONG CHOI1, SOO YEON JO1,

HYUNG GYUN NA1, CHANG HOON BAE1, SI-YOUN SONG1, YONG-DAE KIM1,2,

YOON SEOK CHOI1

Small cell neuroendocrine carcinoma(SNEC) is a rare tumor. Most of this SNEC occurs in the lung, and the extra-pulmonary form accounts for only 0.1% to 0.4% of all cancers. Therefore, SNEC which originated in the sublingual gland is extremely rare and till now no case have been reported in the literature. And extra-pulmo-nary SNEC is highly malignant and poorly differentiated neuroendocrine tumor. Recently, we experienced a case of SNEC which was found in surgical specimen in the sub-lingual gland. The patient was treated with surgery only. There is no sign of recurrence since the operation. With a review of the literature, we reported a case of incidentally discovered SNEC in sublingual gland in a 94-year-old woman. The clinical presentation, imaging studies, and histopathological diagnosis of this tumor is discussed.

» HNPX-17

» A CASE OF ANgIOIMMUNOBLASTIC T-CELL LYMPHOMA INvOLvINg THE IPSILATERAL PA-ROTID AND LATERAL NECK

DEPARTMENT OF OTORHINOLARYNGOLOY-

HEAD AND NECK SURGERY1, AND PATHOLOGY2,

VETERANS HEALTH SERVICE MEDICAL CENTER

SEOK-JUNG HONG1, MI-JI LEE2, SEUNG-WOO KIM1

Angioimmunoblastic T-cell lymphoma (AITL) is a rare subtype of malignant lymphoma (ML), accounting for only 1 to 2% of all non-Hodgkin’s lymphoma (NHL). Although ML of parotid gland is rare, the majority are B-cell type. However, AITL occurring synchronously in the parotid gland and lateral neck has not been report-ed earlier. ATIL is classified as a high-grade malignancy with aggressive clinical feature, and the prognosis is worse than any other type of NHL. We recently encountered a 72-year-old man with multiple mass on parotid tail and lateral neck, and he was finally diagnosed as AITL. We report the unique and rare disease entity with a brief re-view of literature.

April28(Sun)




» HNPX-21

» A RARE CASE OF OROPHARYNx ACTINO-MYCOSIS




UNIV. GADJAH MADA

RIVANA L. SYAIFUL, ASHADI PRASETYO

Actinomycosis is a chronic granulomatous or suppura-tive infection caused by gram-positive anaerobic or mi-croaerophilic Actinomyces spp. which may involve only soft tissue, bone or both together. Diagnosis is often de-layed and is usually based on histopathology. This study reports a 11-year-old boy with an abrupt oral cavity mass after vomiting a week prior to visit. Since then patient was unable to eat and have difficulty speaking. The pa-tient has no past medical history of note. During phys-ical examination patient felt nauseous and the mass was spontaneously expelled during vomiting. The diagnosis was based on history and clinical evidence of the lesion confirmed by histopathological examination. The patient then referred to pediatric to screen for other mass and treated with oral ampicillin 250 mg 4 times a day and for 6 months with regular follow-up. Actinomycosis is a rare infection that can mimic malignancy. Oral mucous membrane is often the penetration site of Actinomyces. Finding of sulfur granules in histopathology is still the most reliable diagnostic aid. Adequate long-term antibi-otic therapy is essential to minimize damage.

» HNPX-22

» LARYNgEAL AMYLOIDOSIS WITH INvASIvE MYCOSIS- A RARE COMBINATION OF ENTI-TIES MASQUERADINg AS SUBgLOTTIC MA-LIgNANCY

1DEP. OF OTOLARYNGOLOGY, HEAD AND NECK

SURGERY⒥, DEP. OF PATHOLOGY2, ALL INDIA

INSTITUTE OF MEDICAL SCIENCES, JODHPUR

AMAN K. VERMA⒥, NITHIN P. NAIR⒥, SOURABHA K. PATRO⒥, AMIT GOYAL⒥,

POONAM ELHENCE2, SUDEEP KHERA2

necrotizing fasciitis. We recently experienced a case of V. vulnificus infection, presenting hemorrhagic tongue swelling, accompanied with cervical necrotizing fasciitis and septic shock. A 72-year old male with DM and heavy drinking history presented with sudden tongue swelling. Combined antibiotic therapy and surgery was done im-mediately to treat cervical necrotizing fasciitis. Pus cul-ture during the surgery revealed the V. vulnificus infec-tion later. Despite the treatment, the patient underwent septic condition and died. The presented case emphasizes the need to consider V. vulnificus infection in differential diagnosis with a patients with hemorrhagic oral or cervi-cal lesion.

» HNPX-20

» SINONASAL SCHWANNOMA - A RARE CASE REPORT

DEP. OF OTORHINOLARYNGOLOGY-HEAD AND



UNIVERSITAS GADJAH MADA

RIZKA FAKHRIANI, CAMELIA HERDINI

Introduction: Schwannomas are slow growing benign tumours arising from the nerve sheath. Sinonasal tract schwannomas are uncommon, representing less than 4% of head and neck schwannomas. Surgery is the treatment of choice and total excision is curative. Case report: We report a case of 25 years old woman who presented with progressive right nasal blockage since one years accom-panied with rhinorrhoea, recurrent epistaxis, and altered sense of smelling. CT- scan of sinonasal demonstrated mildly enhancing soft tissue density lesion on right na-sal cavity, extending into right maxillary sinus, and right ethmoid sinus. The biopsy with local anesthesia reported as schwannoma. The mass was removed successfully in general anesthesia with extirpation and lateral rhinoto-my approach without any postoperative complication. Histopathologic result confirmed schwannoma diagno-sis. Conclusion: Sinonasal scwhannoma is a rare benign tumour. The correct diagnosis is usually made with his-topathologic examination. It should be considered in the differential diagnosis of sinonasal mass lesions. Keywords: Scwhannoma, Lateral Rhinotomy, Sinonasal

April28(Sun)




» HNPX-24

» A CASE OF LARYNgOPHARYNgIT IS CAUSED BY CLINOSTOMUM COMPLANATUM IN KOREA


HEAD AND NECK SURGERY, SAMSUNG

CHANGWON HOSPITAL, SUNGKYUNKWAN

UNIVERSITY SCHOOL OF MEDICINE, CHANGWON

HANARO PARK

A 22-year-old Korean woman visited our outpatient department with complaints of left part of throat dis-comfort and pain, occurring 3 days after eating raw fish with chopped fish bone (segoshi). Laryngeal endoscopy revealed a slow-moving worm, about 5 mm in length, was found attached to the surface of the left aryepiglottic fold. The fluke was removed using forceps, under local anesthesia with 10% lidocaine spray. The worm was iden-tified to be Clinostomum complanatum. C. complana-tum infection in human is rare and is known to occur after eating raw fish, which is a secondary intermediate host. In humans, it is known that metacercariae enters the stomach and then migrates to the throat through the esophagus, and causing the laryngitis. The only treatment method is mechanical removal.

» HNPX-25

» COBLATION ASSISTED ADHESIOLYSIS- AN ALTERATE TO MORBID SURgERIES AND Ex-PENSIvE LASERS FOR PHARYNgEOLARYN-gEAL STRICTURE A CASE REPORT

DEPARTMENT OF OTORHINOLARYNGOLOGY1,

DEPARTMENT OF SURGICAL

GASTROENTEROLOGY2, AIIMS JODHPUR, INDIA

NITHIN PRAKASAN NAIR1, SOURABHA KUMAR PATRO1, VAIBHAV KUMAR VARSHEY2,

AMIT GOYAL1, DARWIN KAUSHAL1

Corrosive pharyngeal strictures are morbidities which may require multiple staged repair. Here we are reporting a 45 year old male with accidental corrosive acid poison-

Case Report: We report a case of a 35-year-old male, chronic smoker, presenting with stridor and progressive hoarseness for 1 month. Fiber-optic examination showed subglottic growth with significant luminal narrowing and thickening of bilateral vocal cords. CEMRI showed intense heterogeneously enhancing lesion involving sub-glottic region with significant luminal narrowing ex-tending into glottic space, bilateral true vocal cords, cri-coarytenoid joint, post-cricoid region, inferior aspect of right thyroid lamina and inferior fibers of strap muscles suggestive of malignancy. An emergency tracheostomy was done followed by DL biopsy. HPE report showed the presence of an amorphous congophilic extracellular hyaline material with apple green birefringence admixed with septate fungal colonies. No evidence of malignancy or dysplasia. Abdominal fat biopsy showed the presence of amyloid deposits. Conclusion: Amyloidosis is a rare disease which has a diverse presentation. In our case, pre-sented with stridor with cartilage destruction and extra laryngeal spread which is rare and surprising.

» HNPX-23

» A CASE OF vARICELLA zOSTER MENINgI-TIS WHICH MIMICS vIRAL PHARYNgITIS



UNIVERSITY MEDICAL SCHOOL AND CHONNAM

NATIONAL UNIVERSITY HOSPITAL, GWANGJU,

SOUTH KOREA

SE-HYUN JEONG, HYUNG CHAE YANG, JONG MIN PARK, SUNG HO YOON,

HYONG-HO CHO, YONG-BEOM CHO, CHUL HO JANG, SANG CHUL LIM

Varicella-zoster virus (VZV) meningitis can involve multiple cranial nerves and requires intensive antiviral treatment. It can cause various symptoms according to their involvement. When it involved cranial nerve X, it can mimic viral pharyngitis. However, the treatment for VSV infection should be more intensive than that of vi-ral pharyngitis. In this study, we present a patient who initially misdiagnosed as viral pharyngitis but eventually turn out to be viral meningitis on his CSF examination.

April28(Sun)




DIAR M. ARDANI, IRWAN KRISTYONO, MAGDA R. HUTAGALUNG

A 10-year-old male patient presented with Severe Late Crouzon Syndrome, with turri-brachycephaly, and se-vere exorbitism of both eyes, visual loss, beaked nose and maxilla hypoplasia. The head circumference was 54 cm and 90 precentile. Patient had a high arched palate, tonsil hypertrophy and type III malocclusion. From the multi-disciplinary meeting, in the first stage it was decided to first secure the airway with Tracheostomy then immedi-ately followed by Monobloc Advancement with External Frontofacial Distraction. Then in the second stage, after removal of the rigid external distractor, by 9 months after first surgery, the patient underwent a simultaneous proce-dures of Adenoidectomy, Conchotomy, and Septoplasty. Thus, after patient got stable in follow-up, Nasendoscopy and Tracheostomy devices was removed. After 11 months follow-up. visual function still not getting better. How-ever turri-brachycephaly, exorbitism of both eyes, beaked nose and maxilla hypoplasia, head circumference, arched palate, tonsil hypertrophy and the malocclusion were get-ting much reduced, and the patient getting happier and more active.

» HNPX-28

» SYNCHRONOUS PAPILLARY MICROCARCI-NOMA AND MALT LYMPHOMA OF THYROID gLAND WITHOUT HISTORY OF THYROIDITIS


YONSEI UNIVERSITY WONJU COLLEGE OF MEDICINE

HYUN JONG JEON, HA NEUL LEE, SUNG MIN HAN, CHUN HAN, JI HOON KIM

Primary thyroid lymphoma is a rare malignancy, ac-counting for 0.6~5% of all thyroid malignancies. Here, we report the case of a 60-year-old man referred to the ENT clinic, who developed 8 mm heterogenous thy-roid mass during regular checkup. Thyroid ultrasonog-raphy demonstrated increased growth of 6 mm in 1 year. Fine-needle aspirating cytology was reported as lympho-ma. PET scan showed no evidence of regional or dis-tant metastasis. The hemithyroidectomy was performed and the histological examination revealed synchronous MALT lymphoma (8 x 4 mm) and papillary microcarci-noma (3 x 2 mm) of the thyroid gland. The lesions were

ing presented with laryngopharyngeal strictures suffering for 2 months with difficulty in breathing, swallowing, phonation and sleep. He was on feeding jejunostomy and had attempted esophageal dilation once before presenting to us. We did an elective tracheostomy and endoscopic coblation assisted stricture adhesiolysis. As early as 5th postoperative day tracheostomy was decannulated, and the patient was able to swallow soft solids without ma-neuvers, liquids without nasal regurgitation, phonating with normal neck position and a good sleep with no re-currences in 12 months follow up. There was no recur-rent fibrosis at sites of adhesiolysis which is a worry of concern as per literature comparing to lasers.

» HNPX-26

» UNDERSTANDINg NECROTISINg PERIOR-BITAL CELLULITIS A CASE REPORT

DEPARTMENT OF PLASTICS AND

RECONSTRUCTIVE SURGERY, FLINDERS MEDICAL

CENTRE, SOUTH AUSTRALIA.

HSU PHIE CHONG, PETER RIDDELL

Periorbital cellulitis is an infectious process limited to the soft tissues of the eyelids that can occur as a consequence of periorbital trauma, secondary to distant haematoge-nous spread of bacteria or with no identifiable cause. We herein report two cases treated at Flinders Medical Centre, South Australia of spontaneous adult bilateral necrotising periorbital cellulitis. The aim of our report is to provide a summary on the etio-pathogenesis, focused anatomical understanding pertaining to eyelid vascular anatomy and management of disease process with the understanding of relevant differential diagnosis.

» HNPX-27

» SUCCESSFULLY TRACHEOSTOMY AND MONOBLOC ADvANCEMENT WITH ExTERNAL FRONTOFACIAL DISTRACTION FOLLOWED BY SIMULTANEOUS ADENOIDECTOMY, CON-CHOTOMY, AND SEPTOPLASTY IN SEvERE LATE CROUzON SYNDROME

DEP. OTORHINOLARYNGOLOGY HEAD AND

NECK SURGERY, FACULTY OF MEDICINE, UNIV.

AIRLANGGA

April28(Sun)




GOYANG, KOREA

SANG-WOO KIM, YUN-SUNG LIM, CHANG GUN CHO, BO HAE KIM

Objectives Hypopharyngeal perforation can lead to se-vere complications resulted by saliva leakage into the deep neck space. Since the prediction of hypopharyngeal perforation due to a foreign body such as fishbone, is difficult because of its rarity, attention should be taken when perforation is suspected. We diagnosed and treated two cases of hypopharyngeal perforation caused by fish-bone impaction and report these cases with a literature review. Clinical presentation Case 1 A 61-year old female patient presented the emergency department with throat pain that was developed after fish ingestion a few hours ago. Although high attenuated foreign material, such as fishbone, was identified on computed tomography, the removal of foreign body using an endoscopic gastroscopy failed because the foreign body was not identified during procedure despite repeated trials. Since throat pain grad-ually worsened and leukocytosis was progressing, remov-al using a transcervical approach was performed. During surgery, focal necrosis of inferior constrictor muscle was observed after the rotation of the pharynx, the fishbone was removed by suspension examination under external support with the finger. We repaired pyriform sinus using primary closure after debridement of necrosis, and the patient was discharged a week after surgery. Case 2. A 74-year old male patient presented with throat pain after eating fish from a day ago. Small sized fish bone was iden-tified at left pyriform sinus and removed under 70 angled rigid laryngoscope with angled forceps. Since fish bone was unexpectedly large over 4cm, computed tomography was conducted to evaluate perforation of pyriform sinus. Since computed tomography scan revealed multiple air bubbles in the deep neck space, repair of perforation was done by the external approach. Conclusion Suspicion of hypopharyngeal perforation and proper evaluation are important in cases with the ongoing symptoms or a large fish bone. In addition, removal by transcervical approach is necessary for patients with suspicious salivary leakage into the deep neck space or patients who failed endoscop-ic gastroscopy.

pathologically confined in the right lobe without invasive features. Therefore he did not undergo adjuvant chemo-therapy or radiation therapy and there was no evidence of recurrence 1 year after the operation. All of primary thyroid lymphoma cases are preceded by Hashimoto's thyroiditis in the previous literature. However, PTC and MALT lymphoma can exist concomitantly, without any history of Hashimoto's thyroiditis.

» HNPX-29

» METASTATIC SQUAMOUS CELL CARCINO-MA OF THYROID gLAND CASE SERIES





SU GEUN KIM1, JONG HWAN LEE2, CHA DONG YEO3, YONG TAE HONG4,

KI HWAN HONG5

Squamous cell carcinoma (SCC) of the thyroid gland is a rare carcinoma. This may indicate involvement of the primary SCC or secondary SCC of the gland. It can be either extension of SCC from an adjacent structure or metastasis from a distant SCC. The direct extension and metastatic SCC of the thyroid gland is more common than generally realized, occurring about 10 times more frequently than thyroid SCC. Primary SCC of the thy-roid constitutes less than 1 per cent of all primary thy-roid carcinomas. Nevertheless, the frequency of thyroid metastases is low and accounts for only 2-3% of all ma-lignant tumors of the thyroid gland. Among them SCC form only a small fraction. In our hospital, We have ex-perienced 5 cases of metastatic SCC. Among them, the primary site of tumor was esophagus in 2 cases and that of the rest was mouth floor, tongue, lung. So we report this case with review of literatures.

» HNPX-30

» TWO CASES OF HYPOPHARYNgEAL PER-FORATION CAUSED BY FISH BONE



MEDICINE, DONGGUK UNIVERSITY,

April28(Sun)



April 28(Sun) 윤리특강

» 13:30~14:00

» 삶과 죽음의 문제들: 미래사회에서 의사의 새로운 역할과 과제

(전남대 철학과)

김양현

오늘날 최첨단 의료기술은 삶과 죽음의 경계선을 모호하게 만들어버렸다. 우리는 새로운 의료적 환경에서 죽음의 과정을 시 초 분 단위로 낱낱이 쪼개서 관찰할 수 있는 새로운 차원을 경험하고 있다. 급속한 사회문화적․의료적 환경과 조건의 변화는 삶과 죽음의 문제를 둘러싼 의사들의 직업적 역할과 의무를 새롭게 반성하게 한다. 이에 변화된 환경과 조건을 바탕으로 미래사회에서 의사들의 새로운 역할과 과제를 제안해 보고자 한다.

윤리특강Room 3-3 (Diamond)좌장 : 임상철(전남의대)

April28(Sun)




» 14:00~14:30

» 임상윤리의 이론과 실제

(한양대 의료윤리학)

유상호

April28(Sun)




April26(Fri)~28(Sun)


April 26(Fri)~28(Sun) Index


[ AUTHOR'S INDEX ]

[ㄱ]김양현 403

[ㅇ]유상호 404

[A]ADHAM, MARLINDA 355AGUSTIN, BENJAMIN SAN 60, 65AHN, DONG BIN 230AHN, DONGBIN 310AHN, HEE KYUNG 74AHN, HONG GEUN 165, 396AHN, JAE-CHEUL 115AHN, JOONG HO 104, 106, 109AHN, JOONG HO 146, 147, 153, 158, 171, 234AHN, MIN HEE 254AHN, SANG HYEON 116, 282AHN, SEONG-KI 161AHN, SOON-HYUN 67, 80, 306, 382, 388AKYOL, MEHMET UMUT 218ALAM, LTCOL MOHAMMED IFTEKHARUL 171AL-AMIN, ALI ZAHEER 57AL-DILAIJAN, KHALID 113, 325AL-MASOUD, MAI 325AL-SWIAHB, JAMIL 154AN, SOO YOUN 321AN, SOO-YOUN 304AN, YONG-HWI 101, 271AN, YONGHWI 85AN, YUN SUK 364ARDANI, DIAR M. 401

[B]BAE, CHANG HOON 288, 398BAE, GYO HAN 328BAE, HO YOUNG 143BAE, JA-SUNG 192BAE, JUNG HO 329BAE, JUN-SANG 292BAE, KIHO 141

BAE, MI RYE 186, 280BAE, SEONG-CHEON 159BAE, SEONG-HOON 101BAE, WOO YONG 175BAE, WOO-KYUN 181BAEK, BYOUNG-JOON 126BAEK, CHUNG-HWAN 72, 75, 129, 130, 186BAEK, JIN HO 382BAEK, JUNG-HWAN 76BAEK, MOO-JIN 168BAEK, SEUNG KUK 189BAEK, SEUNG-HAK 347BAEK, SEUNG-KUK 221, 314BAIK, FRED M 79BAN, MYUNG JIN 184, 187BAN, MYUNG-JIN 311BANG, JOOIN 152BAXTER, MALCOLM 300BINMANIE, MANAL IBRAHIM 308BKTAN 287BLESS, DIANE M 76, 241BLEVINS, NIKOLAS H 366BOON, BARRIE TAN YAU 197, 334BROADHURST, MATTHEW STEPHEN 247BUANA, ADITYA W. 382BYEON, HYUNG KWON 189, 371BYUN, HA YOUNG 110BYUN, HA YOUNG 149BYUN, JAE YONG 150, 155, 156BYUN, JAE YONG 266BYUN, JUNHYOUNG 291BYUN, KWANG-HYUN 123BYUN, SUNG WAN 141, 143BYUN, YOUNGRO 372

[C]CARPENA, NATHANIEL 152CAYE-THOMASEN, PER 205CHA, EUN HYE 171, 317CHA, HYUN-KYUNG 374CHA, WONJAE 320, 377CHAE, HYUNKYU 168CHAE, SUNG WON 97, 98CHAE, SUNG-WON 103, 251





CHO, HYUNG-JU 116, 119, 283, 286, 289, 293, 296CHO, HYUN-JIN 326, 327CHO, ILYOUNG 113CHO, JAE-GU 230, 239, 314CHO, JAE-KEUN 378, 397, 398CHO, JIN HEE 291CHO, JUNG-HAE 231CHO, KWANG-JAE 66, 131, 190CHO, KYEONGWON 255CHO, KYONG JIN 292CHO, KYU SUP 211CHO, KYUNG-JA 186, 306, 313CHO, KYU-SUP 113CHO, KYU-SUP 125, 276, 329, 367CHO, MIN-KYU 125CHO, SANG-HEE 181CHO, SEOK HYUN 64, 149CHO, SUNG IL 150, 234CHO, SUNGBO 295CHO, SUNG-DONG 107CHO, SUNG-WOO 112CHO, SUNG-WOO 63, 117, 118, 281, 366CHO, WON KI 128, 375CHO, YANG-SUN 106, 258CHO, YANG-SUN 51, 147, 165CHO, YESUN 157CHO, YONG BEOM 164CHO, YONG BUM 177CHO, YONG TAE 271CHO, YONG-BEOM 400CHO, YONG-TAE 277CHO, YOUNG SANG 105, 106, 255CHO, YOUNG SANG 147CHO, YOUNG-SANG 256CHOE, GOUN 143CHOE, GOUN 94, 102CHOI, AE JIN 373CHOI, BO YOON 294CHOI, BYUNG YOON 197, 203, 342CHOI, BYUNG YOON 264CHOI, BYUNG-YOON 143CHOI, BYUNG-YOON 94, 102CHOI, EUN CHANG 225, 298, 380, 389CHOI, GIL SOON 122

CHAE, SUNGWON 200CHAI, MIN SUK 271CHAI, MIN SUK 386CHAN, AI CHEN 184CHAN, JASON 74, 358CHAN, OH 180CHAN, SONNY 366CHANG, HYO WON 180, 372CHANG, JAE WON 180, 184, 301, 375CHANG, JAE-IN 257CHANG, JAEWON 373CHANG, KI-HONG 245CHANG, KI-HONG 93CHANG, MUNMUNYOUNG 266CHANG, MUNYOUNG 168CHANG, MUNYOUNG 98, 100CHANG, SO-YOUNG 152CHANG, SO-YOUNG 95, 96CHANG, SUN O 248CHANG, YOUNG SOO 145CHANG, YOUNG-SOO 142, 158, 167, 170CHANG, YOUNG-SOO 269CHAO, WEI-CHIEH 335CHATURVEDI, PANKAJ 130CHAUKAR, DEVENDRA A 130CHAKRABARTY, SWAGNIK 130CHEN, CHRISTOPHER 110CHEN, CHUN-NAN 228, 359CHEN, TAO 362CHEON, YONGIL 261CHEON, YOUNG-IL 389CHEONG, TAEK YOON 132CHEONG, TAEK-YOON 329, 397, 398CHIANG, FENG YU 232CHIL, CHAN HEE 279, 290CHITSUTHIPAKORN, WIRACH 350CHO, BAEK HWAN 255CHO, CHANG GUN 402CHO, CHANG HYUN 142CHO, DEUKTAE 114, 118, 124CHO, DO-YEON 59, 206CHO, HYONG-HO 100CHO, HYONG-HO 153, 164, 400CHO, HYUNG JU 210





CHOI, WOO RI 277, 294CHOI, YEONJOO 104, 260, 261CHOI, YEONJOO 306, 309CHOI, YOON SEOK 230, 288, 398CHOI, YOUNG MI 100CHONG, HSU PHIE 326, 401CHOO, JAEGUL 252CHOO, OAK-SUNG 92, 108CHOO, YONG-BEOM 100CHOUNG, YUN HOON 258CHOUNG, YUN-HOON 108CHOUNG, YUN-HOON 92CHOW, OLIVER 315CHUN, MI SUN 141, 143CHUN, ROBERT 216CHUN, YOUNG-MYOUNG 159CHUNG, EUN-JAE 388CHUNG, IK-JOO 181CHUNG, JAE HO 110CHUNG, JAE HO 149CHUNG, JAE-HO 258CHUNG, JAIHO 270CHUNG, JONG WOO 104, 106, 109, 258, 260, 261, 364CHUNG, JONG WOO 146, 147, 153, 158, 163, 171CHUNG, MAN KI 79, 129, 130, 186, 298, 370CHUNG, MYUNG-HYUN 165CHUNG, SEUNG-KYU 120, 124CHUNG, SUNG MIN 383CHUNG, WON-HO 147, 165, 203CHUNG, WON-HO 255, 256CHUNG, WOON YOUNG 179CHUNG, YOO-SAM 119, 280CHUNG, YOUNG-JUN 123CINGI, CEMAL 62CONSTANTINIDIS, JANNIS 56CUKUROVA, IBRAHIM 351

[D]DCRUZ, ANIL K 130DESHMUKH, ANUJA 130DHONG, HUN-JONG 120, 124DO, SANG EUN 108DO, SUNG-IM 369DONG, SUNG HWA 150, 155, 156

CHOI, HONG-SHIK 320CHOI, HYE RANG 262CHOI, HYO GEUN 191CHOI, HYUN SEUNG 144CHOI, HYUNSU 291CHOI, ICK-SOO 329CHOI, IK JOON 229, 381CHOI, IN HAK 176CHOI, JAE YOUNG 343CHOI, JAE YOUNG 95, 106, 361CHOI, JEONG HWAN 139CHOI, JEONG-SEOK 372, 387CHOI, JI EUN 152, 154CHOI, JI EUN 96CHOI, JI HO 237, 283CHOI, JI YOON 325CHOI, JI YUN 90, 240, 326CHOI, JI-EUN 120, 124CHOI, JIN WOONG 137, 145CHOI, JIN WOONG 257CHOI, JINSIL 95CHOI, JIN-WOONG 343CHOI, JONG JOONG 165, 396CHOI, JONG-WOO 76CHOI, JUNE 103, 258, 269, 364CHOI, JUNE 142, 145, 159, 167, 168, 170, 318CHOI, KWAN WOO 298CHOI, KYOUNG RAI 328CHOI, KYU YOUNG 310CHOI, MI EUN 372CHOI, MIN-HO 174CHOI, MI-RA 286CHOI, MYOUNG-SU 188CHOI, NAYEON 307, 378CHOI, SEONG HYE 295CHOI, SEUNG-HO 128, 186, 187, 306, 308, 309, 313, 315, 375, 384CHOI, SUNG YONG 186CHOI, SUNG-WON 139, 166CHOI, SUNGWON 250, 261CHOI, SUNG-WON 267, 273CHOI, SUNG-WOOK 383CHOI, SUNGYONG 129, 130, 185CHOI, TAE YEONG 288, 398





HAN, BYUNG HYUN 132HAN, BYUNG-HYUN 378, 397HAN, CHUN 162, 401HAN, DOO HEE 118, 120, 124, 293HAN, GYU CHEOL 198HAN, GYU CHEOL 258HAN, HYE MIN 168HAN, JAE JOON 108, 264HAN, JAE SANG 139, 146, 154, 155HAN, JI HYE 325, 326HAN, JI-HYE 150, 321HAN, JU-HO 164HAN, JUNG JU 137, 138, 146, 149HAN, JUNG JU 268HAN, KYU-HEE 100HAN, KYUJIN 262HAN, KYUJIN 294HAN, KYUNG DO 109HAN, MIN KYUNG 119HAN, MUN SOO 142, 145, 167, 284HAN, SANG-YOON 118HAN, SEUNG HWAN 263HAN, SUN A 94HAN, SUNG MIN 177, 401HAN, SUNGJUN 299HAN, TAE SUN 155HAO, JIN 99HAO, SHENG-PO 68, 226HASAN, DEWAN MAHMUD 88HAYASHI, KEN 338HENDRIKS, THOMAS 128HENDRIKS, THOMAS 262HEO, JAE HYUNG 281HEO, SUNG JAE 282HERAWATI, SRI 382HERDINI, CAMELIA 316, 399HILAL, SAIMA 110HOLSINGER, CHRIS 219HOMMA, AKIHIRO 190HONG, CHANG EUI 144HONG, CHANG KI 166HONG, HANSOL 361HONG, HYUN JUN 68HONG, HYUNG SUN 169

DOWECK, ILANA 81DUFFY, BEN A 106DUMRONGPISUTIKUL, NETSIRI 192

[E]ELHENCE, POONAM 399EO, TAESEONG 396ERTUGAY, CIGDEM KALAYCIK 136EUN, KYOUNG MI 287EUN, YOUNG-GYU 188, 302, 373

[F]FAKHRIANI, RIZKA 399FAVA, MAURIZIO 298FIRMANSYAH, RIZKY 182FU, XINXING 99

[G]GALLAGHER, DANIEL J. 225GARG, APURVA 130GEE, HEON YUNG 95GI, JUNG YONG 365GIL, BU-KWAN 176GIM, HYUN GI 191GIM, TAE WOO 273GO, MIN CHUL 139GO, YOON YOUNG 251GOEL, ALEXANDER N. 365GOEPFERT, RYAN P 71GOH, EUI-KYUNG 273GOKCAN, KURSAT 223GOLUSINSKI, WOJCIECH 66GOLUSINSKI, WOJCIECH 73GONG, GYUNGYUP 313GOYAL, AMIT 399, 400GREEN, TANIA 316GUIO-AGUILAR, PEDRO 316GYANWALI, BIBEK 110

[H]HA, JONG GYUN 119HA, JONG-GYUN 116, 282, 286, 289, 293, 296HA, RYUN 142HAH, YOUNG MIN 265





HWANG, SUN JIN 284HWANG, YEON-SHIN 192, 319, 381HWANG, YONG SUNG 187HWANG, YU-JUNG 151HYUN, SE JIN 107HYUN, SE JIN 127

[I]IAREMENKO, ANDREI I. 67, 379IBRAHIM, MANAL 309IKEDA, RYOUKICHI 53IM, GI JUNG 168, 318, 340IM, GI JUNG 97, 98, 109IM, GI-JUNG 103IM, IL-GYE 318IM, MI AE 180IMAI, TAKAO 253IMAI, TAKAO 49ITO, TSUKASA 47ITO, YASUHIRO 219, 231

[J]JANG, CHUL HO 164, 400JANG, CHUL HO 250, 272JANG, HYUNSOOK 109JANG, JEON YEOB 371, 376JANG, JEONG HUN 108JANG, JEONG HUN 92JANG, PILKEUN 387JANG, SOO KYUNG 310JANG, TAE YOUNG 292, 297JANG, YONG JU 63, 119, 246, 277, 278, 280JARIN, PETER SIMON 59JEON, EUN HAE 172JEON, EUN-JU 148, 339JEON, EUN-JU 264JEON, HAN JAE 254JEON, HONG JIN 298JEON, HYUN JONG 401JEON, JAE YOUG 268JEON, JAE-MIN 251JEON, JEANHONG 263JEON, YUNG JIN 326, 327JEONG, DO YOON 150, 325, 326

HONG, HYUNG SUN 361HONG, KI HWAN 395, 402HONG, KI-HWAN 395, 397HONG, MIN PYO 115, 166HONG, MIN PYO 92, 263HONG, SANG DUK 120, 124, 208HONG, SEOK CHAN 168HONG, SEOK JIN 252HONG, SEOK JIN 392HONG, SEOK MIN 252HONG, SEOK MIN 339, 392HONG, SEOK-HO 390HONG, SEOK-JUNG 398HONG, SEUNG-NO 58, 285HONG, SUNG HWA 105HONG, SUNG KWANG 254HONG, SUNG KWANG 340HONG, SUNG-HWA 147HONG, SUNG-KWANG 164, 165HONG, YONG TAE 395, 397, 402HONG, YONG-TAE 395HONG, YUPYO 152, 326HONG, YU-PYO 392HONGJIAN, LIU 161HOUGAARD, DAN DUPONT 340HU, GUOHUA 362HU, HONG TAO 267HUA, LIN 99HUANG, SHENG-KAI 162HUH, GENE 306HUI, MICHELLE M.P. 390HULLAR, TIMOTHY E 253HUR, DONG GU 161HUR, DONG GU 251HUTAGALUNG, MAGDA R. 401HUYNH, B TAN 136HWANG, CHI SANG 115, 177, 329HWANG, CHIWOO 179HWANG, EUNA 196HWANG, EUNA 196HWANG, JAE WOONG 288, 367HWANG, JUN-EUL 181HWANG, JUNHO 323HWANG, PETER 366





JUN, BEOMCHO 53, 157JUN, JIN-SUN 282JUNG, AH RA 128, 308, 315, 384JUNG, DA JUNG 135, 160JUNG, EUN KYUNG 153, 181JUNG, GAON 108JUNG, HAK HYUN 168, 318JUNG, HAK HYUN 97, 98JUNG, HWI KYEONG 138JUNG, JAE YEUP 184JUNG, JAE YUN 152, 154JUNG, JAE YUN 96JUNG, JAEHWAN 250JUNG, JAE-UK 181JUNG, JAE-YEOP 126JUNG, JIN-SEI 101JUNG, JINSEI 203, 296JUNG, JINSEI 95, 106, 361JUNG, KWANG YOON 189JUNG, KWANG-YOON 314JUNG, SEON MIN 301JUNG, SEUNG-NAM 180, 301, 375JUNG, SOO YEON 383JUNG, SO-YOUNG 362JUNG, SUNG WOOK 364JUNG, TAE YOUNG 328JUNG, YONG GI 59JUNG, YONG WOO 347JUNG, YOUNG HO 127, 382, 388JUNG, YOUNG-DO 122JUNG, YUH-SEOG 357JYMIN 287

[K]K.F.CHEUNG, PHYLANNIE 390KANG, BYUNG CHUL 106KANG, BYUNG CHUL 317KANG, BYUNG-JUN 122, 279KANG, DAE WOONG 155KANG, DAE-WOONG 284KANG, HARAM 253KANG, HA-RAM 318KANG, HARAM 386KANG, HEE-JIN 115

JEONG, DO-YOON 321JEONG, HAN-SIN 74, 129, 130, 185, 186JEONG, HYEON-YEONG 294JEONG, IN SEONG 308JEONG, JIN HYEOK 110JEONG, JO-EUN 155JEONG, JONG IN 175JEONG, JUNHUI 144JEONG, KWANG WON 99JEONG, SE-HYUN 400JEONG, SUNG WOOK 341, 342JEONG, WOO-JIN 127, 382, 388JEONG, WOO-JIN 89JEONG, YE JI 363JEONG, YEONG-WOOK 324JEONG, YONG JUN 142, 145, 167, 284, 314JERONIMO, LEONITA PINTO 290JI, YONG BAE 191, 301JIN, HO JOON 135, 149JIN, HO-JOON 326JIN, HO-JUN 133JIN, HOKYUNG 130, 165, 307JIN, HONG RYUL 62JIN, HONGRYUL 90, 248JIN, SEONG-MIN 181JIN, SUNG MIN 178, 185, 305, 330JIN, SUNG-MIN 182, 369JIN, YOUNG-JU 394JO, ARA 279, 290JO, EU-RI 150JO, KYOO SANG 175JO, SOO YEON 288, 398JO, YONG SEOK 132JO, YONG TAE 386JO, YONG-SEOK 378, 397JOO, BYUNSUN 370JOO, JAE-WOO 314JOO, SOO HYUN 387JOO, YEON-HEE 326, 327JOO, YOUNG-HOON 79, 314JOU, SHENG-CHIA 136JU, YEO RIM 154JUN, BEOM CHO 258JUN, BEOM-CHO 245





KIM, BYUNG GUK 291KIM, BYUNGGUK 295KIM, CHANG HOI 122KIM, CHANG WOO 138KIM, CHANG-HEE 262KIM, CHANG-HOON 116, 119, 214, 283, 286, 289, 293, 296KIM, CHO HEE 374KIM, CHOUNG-SOO 392KIM, CHUL-HO 73, 371, 376, 388KIM, DA HEE 298, 380, 389KIM, DAE WOO 57, 121, 285, 287KIM, DAE-WOO 367KIM, DEOKSOO 273KIM, DO HOON 99KIM, DO HYUN 279, 366KIM, DO YEON 138KIM, DON HAN 278KIM, DONG EUN 175KIM, DONG HWAN 301KIM, DONG HYUN 101KIM, DONG HYUN 142, 328KIM, DONG YOUNG 283, 376KIM, DONG-HYUN 323KIM, DONGJO 138KIM, DONG-JO 323, 383KIM, DONG-KEE 152KIM, DONG-KEE 258, 362KIM, DONG-KYU 121, 287KIM, DONG-YOUNG 114, 118, 120, 124, 206, 285, 290, 293, 366KIM, DONGYOUNG 256KIM, DON-WON 166KIM, DOYEON 163, 384KIM, EUIJIN 295KIM, EUN JI 133KIM, EUN-HEE 292KIM, EUNHYE 186KIM, EUN-JI 133, 135KIM, GAEUN 253KIM, GEON WOO 138KIM, GEUNHYO 320KIM, GEUN-HYUNG 250KIM, GEUN-JEON 190, 192, 306, 312, 381, 396

KANG, HOU-YONG 362KANG, HYUN WOOK 179KANG, JAE-GOO 324KANG, JAE-YOON 145KANG, JAE-YOON 257KANG, JEONG WOOK 265KANG, JEONG WOOK 373KANG, JIN GU 361KANG, JIN WOOK 255KANG, JONG-SEOK 385KANG, JU-HEE 295KANG, MIN JI 133, 398KANG, MIN SEOK 298, 380KANG, MIN SUK 389KANG, MYEONG SIN 328KANG, MYUNG-KOO 138KANG, SEUNG HEON 377KANG, SEUNG-HEON 299KANG, SUNG HOON 178, 185, 330KANG, TAE KYU 93KANG, TONG HO 99KANG, WOO SEOK 104, 106, 261, 267, 268KANG, WOO SEOK 146, 147, 153, 158, 171KANG, YEA EUN 301KANG, YEON SHIN 101KANG, YOUNG 89KANG, YOUNG-HYE 387KANO, SATOSHI 190KARLE, WILLIAM E 181KASEMSUWAN, PANOTE 183KAUSHAL, DARWIN 400KHARDALI, MOHSEN HUSSAIN 149KHERA, SUDEEP 399KIL, BU-KWAN 122, 148KIM, BO HAE 393, 402KIM, BO YONG 185KIM, BO YOUNG 130KIM, BO-MUN 148, 279KIM, BONG JIK 137, 145, 202KIM, BONG-JIK 257KIM, BOO-YOUNG 295KIM, BO-RA 293KIM, BYEONG GON 150KIM, BYOUNGJAE 291





KIM, JEONG MI 372KIM, JEONG-WHUN 112KIM, JEONG-WHUN 117, 281, 346, 366, 367KIM, JEONGYUN 292KIM, JI HEUI 61, 119, 280, 294KIM, JI HOON 370, 401KIM, JI HYE 292KIM, JI HYUNG 166KIM, JI HYUNG 92, 263KIM, JI MIN 369, 374KIM, JI RYONG 175KIM, JI RYONG 273KIM, JI WON 242, 372, 387KIM, JI-A 377KIM, JIN HWAN 310KIM, JIN KOOK 294KIM, JIN PYEONG 129, 302, 311KIM, JIN SU 363KIM, JIN YOUP 121, 293KIM, JIN-KOOK 367KIM, JIN-SOOK 109KIM, JIN-SOOK 341KIM, JI-SUN 277, 323KIM, JI-SUN 93KIM, JONG SEUNG 125, 327KIM, JONG YANG 364KIM, JONG-SEUNG 327KIM, JOO HYUN 187, 396KIM, JOON-HEE 288, 398KIM, JOOYEON 122KIM, JOO-YEON 324KIM, JUNG JIN 155KIM, JUNG MIN 363KIM, JUNG SOO 282KIM, JUNG SUK 328KIM, JUNG WHOON 118KIM, KEON-HO 149KIM, KI NAM 169KIM, KI NAM 361KIM, KI-NAM 292, 297KIM, KUN YUNG 268KIM, KYU BO 58KIM, KYU SUNG 258KIM, KYU SUNG 49

KIM, GUI CHUL 372KIM, GUK BAE 75KIM, GYEONG BONG 255KIM, GYUTAE 157KIM, HAN SU 353KIM, HAN SU 383KIM, HANTAI 143KIM, HANTAI 92KIM, HEEJIN 392KIM, HEEJUNG 130, 307KIM, HEEJUNG 274KIM, HEE-YOUNG 272KIM, HEY-RIM 385KIM, HONG CHAN 164KIM, HONG JU 169KIM, HOSUNG 104, 106KIM, HWA-BIN 369, 389KIM, HYE SOO 305, 394KIM, HYE-SOO 369KIM, HYO YEOL 120, 124, 345KIM, HYO-JUN 311KIM, HYOUNG-MI 102KIM, HYOUNG-MI 163, 170KIM, HYUN JI 169, 172KIM, HYUN JI 361KIM, HYUN JIK 114, 118, 120, 124, 211, 249, 279, 290KIM, HYUN JUN 112KIM, HYUN JUN 283KIM, HYUNG GU 112KIM, HYUNG GU 117, 366KIM, HYUNG-BECK 134KIM, HYUNG-JIN 255KIM, HYUNG-JONG 164, 165, 246KIM, HYUNG-JONG 254KIM, HYUNG-SIK 150, 374KIM, HYUN-JIK 366KIM, HYUNJUNG 168, 189KIM, INON 166KIM, INON 92, 263KIM, JAE GU 178, 185, 330KIM, JAE HYUNG 189KIM, JAE SEUNG 186, 315KIM, JAE-WOOK 125, 311KIM, JEONG KYU 131





KIM, SO JEONG 329KIM, SO YOUNG 102KIM, SO YOUNG 163, 170KIM, SOJEONG 383KIM, SOLLIP 398KIM, SOO JIN 141, 143KIM, SOO WHAN 279, 291, 345, 366KIM, SOO-IN 286KIM, SU GEUN 132, 134, 327, 395, 402KIM, SU JIN 276, 329KIM, SU-GEUN 159KIM, SUK HWA 259KIM, SUN WOO 182, 305, 394KIM, SUN WOOK 298KIM, SUNG HEE 324KIM, SUNG HUHN 263, 264, 361KIM, SUNG HUHN 50KIM, SUNG HUHN 87KIM, SUNG KYUN 252KIM, SUNG KYUN 392KIM, SUNG WAN 113, 210, 215, 325KIM, SUNG WON 208, 279, 291, 300, 366KIM, SUNG-BAE 309KIM, SUNG-DONG 113KIM, SUNG-DONG 125, 276, 323, 329KIM, SUNG-HOON 292, 297KIM, SUNG-WAN 115, 284KIM, SUNGWUK 138KIM, SUNIK 149KIM, TAE HOON 176, 288, 291, 345, 367KIM, TAE HYUN 276KIM, TAE WOO 141KIM, TAE-HOON 188KIM, TAEHOON 281KIM, WON SHIK 306, 388KIM, YEE-HYUK 148KIM, YEHREE 104, 106KIM, YEHREE 146, 147, 153, 171, 317KIM, YEON SOO 388, 396KIM, YEONJI 323KIM, YI-KYUNG 255KIM, YONG BOK 392KIM, YONG HAN 313KIM, YONG MIN 281, 286

KIM, KYUBO 112KIM, KYUNG RAE 301KIM, KYUNG SOO 280KIM, KYUNG-SU 116KIM, KYU-SUNG 157, 169, 172KIM, KYU-SUNG 361KIM, MI KYUNG 102KIM, MI RA 180, 379KIM, MI-EUN 272KIM, MIN A 394KIM, MIN SIK 72KIM, MIN SUN 199KIM, MIN-BEOM 265KIM, MINBUM 199KIM, MINBUM 254KIM, MIN-KYUNG 112KIM, MIN-SIK 131, 190, 306, 312, 319, 383KIM, MINSIK 261KIM, MIN-SU 303KIM, MI-RA 381KIM, MYEONG HEE 165, 396KIM, NA HYUN 150KIM, SANG BIN 184KIM, SANG HOON 150, 155, 156KIM, SANG HOON 265KIM, SANG WOO 330KIM, SANG YEON 306KIM, SANG YOON 128, 180, 186, 187, 306, 308, 309, 313, 315, 372, 384KIM, SANG-BIN 126KIM, SANG-HOON 389KIM, SANGHUN 250KIM, SANG-HYUB 123KIM, SANG-WOO 402KIM, SANG-WOOK 327KIM, SANG-YEON 190, 192, 312, 319, 381, 396KIM, SE-HEON 66, 218, 298, 380, 389KIM, SEON IK 137, 146KIM, SEONG WHO 180KIM, SEON-LIN 125KIM, SEUNG HO 328KIM, SEUNG HYUN 99KIM, SEUNG WOO 394KIM, SEUNG-WOO 398





261, 267, 268, 364KWAK, MIN YOUNG 146, 147, 160, 317KWAK, SANG GYU 367KWAK, SANG HYUN 264KWATRA, DEVANSHU 141KWON, DONG-SOO 224KWON, HYUN-KEUN 369, 374, 389KWON, JAE HWAN 122KWON, JAE-HWAN 324KWON, JOONG KEUN 364KWON, KYUNG WON 324KWON, MIN-JO 147KWON, MINSU 127, 386KWON, OH EUN 113KWON, OH-EUN 115, 284KWON, SAM HYUN 125KWON, SAM-HYUN 327KWON, SEONG KEUN 286, 306, 374, 388KWON, SOON YOUNG 303KWON, SOON-BOK 189KWON, SOONBOK 320KWON, SOON-YOUNG 314KWON, TACK-KYUN 299, 352, 377, 388

[L]LAI, JEN TSUNG 201LAI, JEN-TSUNG 162LAY, CHASE 212LEE, BOK-SOON 371, 388LEE, BUM SANG 310LEE, BYEONG CHEOL 381LEE, BYUNGJOO 320LEE, BYUNG-JOO 81, 369, 374, 385, 389LEE, CHANG BAE 175LEE, CHANG HO 102LEE, CHANG HO 163, 170, 245LEE, CHANG YOON 321LEE, CHUL HEE 293LEE, DOH YOUNG 236LEE, DOH YOUNG 299, 377, 387LEE, DOHEE 152LEE, DO-HEE 326LEE, DONG CHANG 291LEE, DONG HOON 178, 181, 185, 330

KIM, YONG-DAE 288, 398KIM, YONG-MIN 367KIM, YONG-WAN 122KIM, YOUN WOO 330KIM, YOUNG CHUL 326, 395KIM, YOUNG HO 270, 274KIM, YOUNG HYO 58, 292, 295, 297KIM, YOUNG NAM 139KIM, YOUNG SEOK 127, 319, 382KIM, YOUNG-JUN 283KIM, YOUNG-MO 372, 387KIM, YU KEONG 274KIM, YUN HYE 187KIM, YUWON 298KO, JUNG MIN 107KO, JUNG-YON 365KO, YOUNG HYEH 370KO, YOUNG KYUNG 174KOH, EUN-KYOUNG 304KOH, TAE-KYUNG 189, 283KOH, YOON WOO 179, 228, 298, 379, 380, 389KOH, YOONWOO 84KOLEGOVA, TATIANA E. 379KONG, DOO-SIK 120, 124KONG, IL GYU 287KONG, SOOKEUN 250, 261KONG, SOO-KEUN 267, 273KONG, SOO-KEUN 54, 139, 166KONG, TAE HOON 162KONG, TAE HOON 255KOO, BEOM MO 394KOO, BON MIN 175KOO, BON SEOK 180, 301, 375KOO, HEEBEOM 363KOO, JA-WON 49, 196, 197KOO, JA-WON 94, 108, 264KOO, SOO-KWEON 189, 283KOUZAKI, HIDEAKI 348KRISTYONO, IRWAN 401KU, DOMINIC 315, 390KU, JA YOON 147, 294KU, MINHEE 370KURABI, ARWA 251KWAK, MIN YOUNG 104, 106, 259, 260,





LEE, HYUN-HO 318LEE, HYUN-JIN 161LEE, HYUN-JOO 369LEE, HYUNMIN 138LEE, HYUN-MIN 166LEE, HYUNMIN 250, 261LEE, HYUN-MIN 267LEE, HYUNWHA 385LEE, IL WOO 364LEE, ILWOO 138LEE, ILWOO 250, 261LEE, IL-WOO 267LEE, IL-WOO 47, 166, 385LEE, JAE HOON 328LEE, JAE IL 273LEE, JAE RYUNG 273LEE, JAE SEOK 311LEE, JAE YONG 283LEE, JAE-HUN 152LEE, JAMES 316LEE, JE YEON 104, 259LEE, JE YEON 147, 160LEE, JEE YEON 104, 106LEE, JEE YEON 153LEE, JEON MI 132LEE, JEONG HYUN 186, 294LEE, JIEUN 174LEE, JIN 182, 369, 394LEE, JIN-CHOON 217, 247, 374, 383, 385LEE, JI-SOO 165LEE, JI-UN 250LEE, JIVIANNE T. 365LEE, JONG BIN 165LEE, JONG DAE 52LEE, JONG HWAN 132, 134, 327, 395, 402LEE, JONG KYU 310LEE, JONG-GEUN 103LEE, JOOHYUNG 291, 326LEE, JOON KYOO 178, 181, 185, 330LEE, JOONG-HEON 174LEE, JU HYOUNG 142LEE, JUN HO 150, 151, 203, 319LEE, JUN HO 98, 107, 109, 258, 259, 260, 364LEE, JUN 269

LEE, DONG HYUN 306, 312, 396LEE, DONG JIN 310LEE, DONG KUN 129, 191, 377LEE, DONG KYU 119LEE, DONG WON 131LEE, DONG-CHANG 326LEE, DONG-HEE 156, 158LEE, DONG-HYUN 131, 190, 192, 381LEE, DONG-JOO 276LEE, EUN JUNG 132, 133, 134, 289LEE, EUN SOO 175LEE, EUN-JUNG 132, 133, 135, 159LEE, EUNKYU 130, 185LEE, EUNSOO 138LEE, GA YOUNG 376LEE, GEONHO 137, 145LEE, GIL JOON 310LEE, GILJOON 242LEE, GUK-HAENG 381LEE, HA NEUL 401LEE, HAE-JUNE 363LEE, HA-NA 321LEE, HANEUL 252LEE, HO SUN 363LEE, HO YUN 269LEE, HO YUN 55LEE, HO YUN 97LEE, HO-BYUNG 189, 283LEE, HOJUN 187LEE, HO-KI 270LEE, HONG-RAE 304LEE, HO-WON 282LEE, HOYOUNG 168, 176LEE, HWAN HO 256LEE, HYE 151LEE, HYE-SOOK 93LEE, HYO-JEONG 164, 165LEE, HYO-JEONG 254LEE, HYOUNG SHIN 82, 179, 300LEE, HYUN HO 376, 385LEE, HYUN JIN 148LEE, HYUN JIN 264LEE, HYUN MIN 238LEE, HYUN YONG 154





LEE, SANG-YEON 107, 260LEE, SANG-YOUP 102, 106, 108LEE, SANG-YOUP 143, 319LEE, SE HEE 97, 98LEE, SEOK YOON 273LEE, SEOK YUN 141LEE, SEOK-HWAN 139, 166LEE, SEOK-HWAN 267LEE, SEONHWA 363LEE, SEOUNG MIN 149LEE, SEULGI 145LEE, SEUNG HOON 210, 284, 285LEE, SEUNG HWAN 109, 110, 258LEE, SEUNG HWAN 149LEE, SEUNG JIN 320LEE, SEUNG-EUN 317LEE, SEUNGMIN 157LEE, SEUNG-WON 311, 353LEE, SEUNGWON 85, 217LEE, SO JEONG 141, 143LEE, SO-HEE 192LEE, SONGYI 390LEE, SO-YOON 179, 237LEE, TAE HONG 273LEE, WOO HYUN 271LEE, WOO HYUN 323LEE, YE CHAN 179LEE, YEO MYEONG 122LEE, YEONWOO 320LEE, YONG JIN 363LEE, YOON SE 372LEE, YOUNG CHAN 188, 302, 373LEE, YOUNG SUB 177, 329LEE, YU-MI 329LEONG, JAMES 316LI, HOK NAM 228, 231LI, YONGXIN 99LIM, CHWEE MING 356LIM, HYE RIN 177LIM, HYUN WOO 154LIM, HYUN WOO 364LIM, JAE YOL 298, 354, 380LIM, JAE-YOL 241, 320, 390LIM, JOO AE 263

LEE, JUNG JUN 112LEE, JUNG KYU 103LEE, JUNG WOO 113LEE, JUNG-WOO 385LEE, JUNG-YUP 265LEE, JUN-SIK 272LEE, JUN-YOUNG 274LEE, KANG DAE 300LEE, KANG-DAE 233LEE, KENNETH H 201LEE, KI JIN 328LEE, KI JUNG 288, 367LEE, KIJEONG 176, 291LEE, KUN HEE 113, 276LEE, KUN HEE 63LEE, KUN-HEE 115, 284LEE, KWANG SUN 159LEE, KYOGU 281LEE, KYUIN 144, 396LEE, KYUNGMIN 180LEE, KYU-YUP 135, 160, 202, 234, 317LEE, KYU-YUP 258LEE, MI-JI 398LEE, MI-KYUNG 396LEE, MIN JI 383LEE, MIN KYOUNG 294LEE, MIN KYU 142, 145LEE, MIN KYU 269LEE, MIN YOUNG 152, 154, 336LEE, MIN YOUNG 95, 96LEE, MINHYUNG 127, 377, 382LEE, MINSEOK 172LEE, MYUNG-CHUL 381LEE, MYUNG-JIN 317LEE, MYUNG-JUN 168LEE, SANG HAG 176, 288, 291, 367LEE, SANG HYUK 305, 354, 394LEE, SANG YEON 270, 274LEE, SANG-HOON 189, 283LEE, SANG-HYO 383LEE, SANG-HYUK 182, 369LEE, SANGMIN 361LEE, SANG-MYUNG 295LEE, SANGWOOK 309





MUN, SUE JEAN 293MUN, SUE-JEAN 125, 276

[N]NA, EUN JIN 298NA, HAN-SEUL 369, 377NA, HYUNG GYUN 288, 398NAIR, DEEPA 130NAIR, NITHIN P. 399NAIR, NITHIN PRAKASAN 400NAIR, SUDHIR 130NAM, DO HYUN 120NAM, DO-HYUN 124NAM, EUI-CHEOL 271NAM, GI-SUNG 106NAM, INN-CHUL 384NAM, JAE SUNG 116, 119, 289NAM, KUK JIN 145, 158NAM, KUK JIN 269NAM, SOON YUHL 128, 186, 187, 306, 308, 309, 313, 315, 384NAM, SUNG IL 141NAM, SUNG IL 273NAM, WOO JOO 305NAM, WOOJOO 182NG, JIA HUI 134NGUYEN, NGUYEN 157NICOLAI, PIERO 69, 227NOH, HAEMIN 294NOH, SEUNG-HO 369NOH, TAE-SOO 151NOH, WONJUN 172NOH, YANGSEOP 120, 124

[O]OH, CHAN 301OH, DONG HWAN 328OH, DONG-HWAN 394OH, HEONJEONG 114OH, HYEON SIK 101, 271OH, HYEON SIK 386OH, JAYOUNG 259OH, JEONG-HOON 50, 133, 212, 318OH, JEONG-HOON 93

LIM, KANG HYEON 145, 158LIM, KANG HYEON 269LIM, MI AE 301LIM, SANG CHUL 178, 181, 185, 330, 400LIM, SUNG HWAN 394LIM, YUN-SUNG 402LIN, CHE YI 229, 359LIN, YU-TSAI 356LIN1, HAIYUE 95LIU, LIHUA 180LIU, TIEN-CHEN 46, 162, 200LIU, YUHE 344LONGUR, ECEM SEVIM 136LOO, JENNY HOOI YIN 110LOUGHRAN, SEAN 232LOW, THOMAS PATRICK 70LYU, AH-RA 97

[M]MANI, NAVIN 233MCCAMLEY, CHERE 300MECO, CEM 207MERENSTEIN, DAVID 300MIN, HYE KYU 156MIN, HYUN JIN 280MIN, JIN-YOUNG 113, 115, 284, 325, 367MIN, JUNWON 129, 312MINN, YANG-KI 295MISCHOULON, DAVID 298MIYASHITA, TAKENORI 198MIZUMACHI, TAKATSUGU 190MO, JI-HUN 60, 123, 292, 367MOON, IL JOON 105, 106MOON, IL JOON 46, 165MOON, IL-JOON 147MOON, IN SEOK 51, 88, 197, 296MOON, IN SEOK 99, 258MOON, JEONG HWAN 129MOON, JI-SEUNG 283, 385MOON, SUNG HO 220MORITANI, SUEYOSHI 309MUN, SEOG-KYUN 168MUN, SEOG-KYUN 98, 100MUN, SUE JEAN 113





PARK, HONG JU 104, 106, 258, 259, 267, 268PARK, HONG JU 54, 146, 147, 153, 158, 160, 171, 248, 317PARK, HONG JU 87PARK, HUN YI 108PARK, HUN YI 143PARK, HUN YI 92PARK, HYE JIN 276PARK, HYE-JIN 267PARK, HYE-LIM 190PARK, HYUN WOO 133, 161, 398PARK, IL SEOK 392PARK, IL-SEOK 352PARK, ILYONG 96, 100PARK, JAE HONG 187PARK, JAE-HONG 311PARK, JAE-SUNG 366PARK, JEONG HYE 254PARK, JEONG JIN 282PARK, JEONG MI 149PARK, JI HOON 310PARK, JINHO 370PARK, JIN-SUNG 282PARK, JONG MIN 153, 400PARK, JONGWON 129, 130, 185, 186PARK, JOO HYUN 393PARK, JOONG SU 165, 396PARK, JUN WAN 141PARK, JUN WOO 104, 106PARK, JUN WOO 317PARK, JUNG JE 127, 220, 395PARK, JUNG JIN 119, 289PARK, JUNG MEE 135, 137, 138, 139, 146, 154, 155PARK, JUNG MEE 268PARK, JUNG-HOON 267, 268PARK, JUNG-JE 302PARK, JUN-HEE 321PARK, JUN-OOK 77, 84, 379, 381PARK, JUN-WOOK 245PARK, JUYEON 295PARK, KI-IK 292, 297PARK, KI-NAM 311PARK, KINAM 88PARK, KYOUNG HO 137, 138, 149

OH, JEONG-MIN 291OH, JIN SEOK 324OH, JOON 90OH, JUNGHO 300OH, KYUNG-HO 314OH, SE-JOON 139, 166OH, SEJOON 250, 261OH, SE-JOON 267, 273OH, SEUNG HA 106, 107, 259OH, SEUNG HA 150, 319OH, SEUNG JA 349OH, SEUNG RI 168OH, SEUNG-HA 107, 266OH, SEUNG-HA 151OH, SOO BIN 292OH, SUN JU 179OKUBO, KIMIHIRO 64, 206OLGUN, LEVENT 196ÖNERCI, METIN 346ONERCI, METIN 57OOI, SHIN YIN 183ORHAN, KADR SERKAN 47OROSCO, RYAN K 70OZ, FERHAN 217

[P]PAEK, SUN HA 366PAI, PRATHAMESH 130PAIK, SEUNG WON 329PAK, KWANG 251PANTVAIDYA, GAURI 130PARK, BYUNG-WHOO 168PARK, CHAN SOON 346PARK, CHUL WON 110PARK, CHUL WON 149PARK, DA-HEE 383PARK, DONG-JOON 177PARK, DO-YANG 112PARK, DO-YANG 283PARK, EUYHYUN 168, 318PARK, EUYHYUN 97, 98PARK, GEUN-HYUNG 189, 283PARK, HANARO 400PARK, HEON SOO 191





PATRO, SOURABHA KUMAR 84PAVAN, FIONA 300, 316PEDERSEN, ULRIK 48PERDANA, RIZKA F 382PIAO, XIAN-YU 98, 100, 266PLZAK, JAN 81PRASETYO, ASHADI 399PUNJ, PUVESH 326PURNAMA, GESIT G. 393

[Q]QIAN, YI 362

[R]RAH, YOON CHAN 142, 145, 158, 167, 168, 170, 318RAH, YOON CHAN 269RAHMAN, SHEIKH HASANUR 209RAWANGBAN, WORAWAT 183, 192RCKERN 287RHA, KI SANG 286, 375RHA, KI-SANG 281RHA, KOON HO 223RHEE, CHAE-SEO 112RHEE, CHAE-SEO 114, 117, 118, 120, 124, 174, 279, 285, 290, 293, 304, 366RHEE, JIHYE 258RHO, YOUNG-SOO 226RIDDELL, PETER 401RISKI, MUHAMMAD S. 393RO, JUNG- HOON 389ROH, HWAN JUNG 276ROH, HWAN-JUNG 113ROH, JIN 371ROH, JONG-LYEL 128, 186, 187, 306, 308, 309, 313, 315, 384RPSCHLEIMER 287RUSSELL, JON 70RYAN, ALLEN F 251RYU, CHANG HWAN 355RYU, JI-SEOB 159RYU, JUN SUN 311RYU, SOMI 327RYU, YOON-JONG 271

PARK, KYUNG SEOK 178, 185, 330PARK, MINA 151, 178PARK, MIN-HYUN 336PARK, MIN-HYUN 363PARK, MOO KYUN 107, 259PARK, MOO KYUN 150, 151, 178, 319, 334PARK, MOON SUH 150, 155, 156PARK, MOON SUH 266PARK, RICHARD CHAN WOO 78, 222PARK, SANG CHUL 296PARK, SANG YOO 162PARK, SANG-JOON 223PARK, SEOK-WON 330, 393PARK, SEONG KOOK 122PARK, SEONGBIN 142PARK, SEONGBIN 269PARK, SEUNG BIN 145PARK, SEUNG JIN 330PARK, SHI NAE 258, 268PARK, SHI NAE 87, 135, 139, 146, 154, 155, 201PARK, SO HYOUNG 376PARK, SO YOUNG 146PARK, SO YOUNG 268PARK, SOHYEON 150PARK, SONG I 256PARK, SOO KYOUNG 286PARK, SU YEON 105PARK, SU-KYOUNG 109PARK, SUNG JOON 376, 385, 386PARK, SUNG MIN 252PARK, SUNG MIN 392PARK, SUNJUNG 388PARK, TAE JUNG 328PARK, WON 387PARK, WOORI 129, 307, 378PARK, YEON KYOUNG 105PARK, YEONG JUN 379PARK, YONG-HO 137, 145, 235PARK, YONG-HO 97, 257PARK, YOUNG MIN 298, 380, 389PARK, YOUNG-HAK 376, 385, 386PARK, YOU-SOO 304PATRO, SOURABHA K. 399PATRO, SOURABHA KUMAR 400





SHIN, GEUN CHEOL 92, 263SHIN, HYANG AE 396SHIN, HYUN IL 264SHIN, HYUN-IL 135, 139SHIN, HYUN-SOO 390SHIN, JAE-MIN , 238SHIN, JAEYOUNG 281SHIN, JI-HYEON 325SHIN, JOONG BO 129SHIN, JUNG EUN 262SHIN, JUNG WOO 330SHIN, JUNG-WOO 393SHIN, KANG-JAE 312SHIN, MIN JUN 330SHIN, MYUNG-HEE 298SHIN, SEUNG-EHON 279SHIN, SEUNG-HEON 122, 176, 367SHIN, SEUNG-HO 141, 143SHIN, SUN AE 97SHIN, SUNG-CHAN 374, 385, 389SHIN, TAE HYEON 170SHIN, TAE HYUN 102SHIN, TAE HYUN 163SHIN, YOO SEOB 371, 376SHIN, YOO SEOB 89SHIN, YOU-REE 159SHINAE 278SHONG, MINHO 301SINGH, HARVINDER 116SIREGAR, SITI MASLIANA 324SNIDVONGS, KORNKIAT 350SO, YOON KYUNG 370SO, YOON-KYOUNG 378SOEKIN, SOEKIRMAN 204SOHN, HYUN GI 330SOHN, JIN HO 310SOHN, SEONYONG 98, 100SON, CHEOL-HUN 304SON, EUN JIN 166, 235SON, EUN JIN 92, 263SON, HEE YOUNG 304, 321, 377SON, IN KYUN 372SON, YEONGHOON 363SON, YOUNG-IK 129, 130, 186, 307, 370, 378

[S]SAFIULLAH, MD I 299SAIM, LOKMAN BIN 51, 334SALISBURY, KENNETH 366SANNIKORN, PHAKDEE 69, 72SCHINDLER, JOSHUA S 181SENVIRATNE, JANAKA 300SEO, HEE WON 110SEO, HYO-SEOK 369, 377SEO, JAE HYUN 258SEO, JAE-HYUN 253SEO, JAE-HYUN 314SEO, JI WON 106, 259SEO, JI WON 146, 147, 160, 317SEO, JIWON 104SEO, JIWON 158SEO, MIN YOUNG 284SEO, YOOJIN 374SEO, YOUNG JOON 162, 197SEO, YOUNG JOON 95, 252SEO, YOUN-TAE 176, 279SEO, YUJU 114, 120SEO, YUJU 98SEOK, JUNGIRL 374SEOL, HYE YOON 105SEONG, JEON 270SERESIRIKACHORN, KACHORN 351SEWANI, VICKY 315SEYEDABADI, MARYAM 315SHAIKH, HAMZAH KHALIL AL 154SHARMA, KUSHAL 97SHE, YUNYING 360SHIM, DAE BO 255SHIM, HOSUP 96SHIM, HYUN JOON 101, 271, 364SHIM, HYUN-JEONG 181SHIM, MI-RAN 192, 319, 381SHIM, WOO SUB 174SHIMIZU, TAKESHI 345, 349SHIN, BONG MIN 178, 185, 330SHIN, CHOL HO 313SHIN, CHOL 285SHIN, EUI-CHEOL 358SHIN, GEUN CHEOL 166





TONG, MICHAEL CHI FAI 46, 51TOPRANI, RAJENDRA B 69, 71TRAN, AN NGUYEN-THUY 383TSANG, RAYMOND KING YIN 357TSENG, WEN HSUAN 360TSUSHIMA, NAYUTA 190TURGUT, SUAT 213TWU, CHIH-WEN 61, 212

[V]VARSHEY, VAIBHAV KUMAR 400VENKATASUBRAMANINA, NARAYANASWAMY 110VERMA, AMAN K. 399

[W]WAHYUNI, ITA 303WALGER, MARTIN 239, 245, 235WANG, KEH-BIN 162WANG, MARILENE B. 365WANG, SOO-GEUN 247WANG, YING PIAO 214WANG, ZHAOYAN 52WANG, ZHE 267WANG5, SOOGEUN 320WHERLEY, JENNIFER P 181WIDURI, ASTI 117WON, CHEONG SE 170WON, CHEONGSE 102WON, HO-RYUN 180, 301, 371, 375WON, JINA 279, 290WON, SEONGJUN 302WON, TAE-BIN 112WON, TAE-BIN 117, 118, 207, 293, 366, 388WONG, DUNCAN KOON KIT 183WOO, HYUNJUN 260WOO, JEONG-SOO 222, 314WOO, JOO HYUN , 241WOO, SEUNG HOON 129, 311, 312WOODWORTH, BRADFORD A. 209WU, HSINGMEI 334WU, PEI-HSUAN 274WULANDARI, DIAN P. 182

SONG, CHAN IL 236SONG, CHAN IL 364SONG, CHANG MYEON 191, 301SONG, HO-YOUNG 267, 268SONG, JAE-JIN 197SONG, JAE-JIN 94, 264SONG, JAE-JUN 98, 103, 251SONG, MEE HYUN 106, 255SONG, SI-YOUN 288, 398SONG, YOO SUN 288, 398SONG, YOON JAE 114SONG, YOONJAE 124, 293SRISAWANGWONG, KES 192STIERNA, PONTUS 56SUDARMAN, KARTONO 182SUDHOFF, HOLGER 53SUH, JEE YOUNG 263SUH, JEFFREY D. 365SUH, JEFFREY DONGSUNG 213SUH, MICHELLE J 361SUH, MYUNG WHAN 106SUH, MYUNG-WHAN 107, 259SUH, MYUNG-WHAN 150, 151, 239SUK, JUN-GIRL 306SUN, DONG-IL 192, 319, 381SUN, DONGIL 396SUN, ZHE 104SUNG, EUI-SUK 374, 383, 385, 389SUNG, JAE MOON 138SUNG, MYUNG-WHUN 388SUNWOO, WOONGSANG 93SURONO, AGUS 393SUZUKI, TAKAYOSHI 190SWKIM 287SYAIFUL, RIVANA L. 399

[T]TAE, KYUNG 78, 191, 232, 301TAN, BARRIE YB 134TANAKA, SHUHO 208TANGJATURONRASME, NAPADON 183, 192, 222TEH, HUI MON 116, 184THAK, PYUNG GON 318THIBEAULT, SUSAN L 74, 216





YOO, JI-SEOB 133, 135, 395YOO, MYUNG HOON 135, 139, 158, 160, 236YOO, MYUNG HOON 258YOO, SEOK CHAN 273YOON, HO-YOUNG 314YOON, JOO-HEON 116, 119, 282, 286, 289, 293, 296YOON, JU HYUN 141, 143YOON, NARA 371YOON, SOYEON 254YOON, SUNG HO 400YOON, SUNG HWAN 267, 268YOON, SUNG-HO 272YOON, TAE MI 178, 181, 185, 330YOON, WAN-SOO 323YOON, YOU JIN 302YOON, YOUNG HOON 281YOSHIMOTO, SEIICHI 221YOU, SUNG-HYE 80YOU, YEON SEOK 133YOU, YEON-SEOK 132, 133, 135, 327, 395, 397YOUK, TAEMI 144YU, JYAE HYOUNG 254YU, MYEONG SANG 119, 280YUN, CHANG BIN 169YUN, JU HYUN 329YUN, MIYONG 373

[Z]ZHANG, XUELIANG 99ZHANG, YU-LIAN 174ZHAO, YU 204ZHONG, SHIXUN 362ZOU, QIJUANG 99

[X]XU, ZHENG-YAN 362

[Y]YADAV, MUKESH KUMAR 251YAKUNINA, NATALIA 271YAMAMOTO, NORIO 335YAMANAKA, TOSHIAKI 339YANAGI, KIYOSHI 56YANG, CHAN JOO 106YANG, CHAN JU 364YANG, HUN-MU 312YANG, HYUNG CHAE 177, 400YANG, JAEMOON 371YANG, KEUM-JIN 362YANG, SEUNG KOO 287, 382YANG, SUNGGU 172YANG, TSUNG-LIN 77, 358YE, BYUNG-SUK 101YE, MI-KYUNG 122, 176, 279YEH, TE-HUEI 61YENDRI, VEBY NOVRI 316YEO, CHA DONG 132, 134, 327, 402YEO, CHA-DONG 159YEO, NAM-KYOUNG 330YEO, SEONG CHUL 302YEO, SEUNG GEUN 150, 155, 156YEO, SEUNG GEUN 258, 265YEON, JI WOO 291YEON, SUN HEE 286YI, EUNYOUNG 97YI, GAWON 362YI, HANA 285YI, JONGSOOK 90, 248YI, KEUN IK 276YI, KEUN-IK 125, 323, 329YI, KUEN-IK 113YIGIDER, AYSE PELIN 136YIGIT, OZGUR 136YILMAZ, H.BAKI 213YOO, GWANG-HEE 126YOO, JAE-YEON 321YOO, JI SEOB 133YOO, JIHYE 362




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61 MSD

62 OTICOn KORea

63 Philips Korea

64 PHOnaK

65 POInTnIx

66 Ray medical

67 SaMaPHaRM

68 Sang-San

69 Schumitt Health Korea

70 SeaSun BIOMaTeRIaLS

71 Sejong Medical

72 Sivantos

73 SK chemicals

74 SLMeD

75 Sometech

76 STaRKey KORea

77 Stryker Korea

78 Thermo Fisher SCIenTIFIC

79 unIMeD PHaRMaCeuTICaLS

80 unIPHaRM KORea

81 unitron

82 univan

83 VFC (Vine Finacial Company)

84 Vitalaire Korea

85 WOOyang MeDICaL

86 yuHan CORPORaTIOn

87 yuyu Pharma




Exhibition제93차 대한이비인후과학회 학술대회2019년 춘계 대한이비인후과의사회 학술대회International Congress of ORL-HNS 2019

Convention Center (F3)Lobby

Registration Desk

Abstract Book

A : VFCB : 국민연금공단C : 건강보험심사평가원D : 국제백신연구소

A

B C D

Convention Centre (F1)Exhibition Hall

게

시

판

제한높이 (2.5 M)

커피 커피

리본커팅식(출입구)

제93차 대한이비인후과학회 학술대회2019년 춘계 대한이비인후과의사회 학술대회 Convention Center (F1)International Congress of ORL-HNS 2019 Exhibition Hall

후면

군자출판

닥터허브

VFC중앙메딕스

크리스탈옵틱

유한양행

한국애보트

알보젠

한화제약

유니메드

씨팝코리아

부스 크기3 * 2 * 2 (m)

기둥 간격7.5 m

안국약품

GSK

제일약품

대유메디칼

에스엘메드

3D메디비전

MSD

삼아제약

MDI

HDXWILL

동진국제엠비무역

현대약품

동아ST

제노레이

바이탈에어

CJ헬스케어

써모피셔

알피니언

메드스타

건인약품

이노트로닉

라이카코리아

루메니스

상산

레이썸텍

피셔앤파이클

포낙

AB 비트컴퓨터

히어링메딕스

유유제약

포유

메가메디칼오티콘코오롱칼자이스일성신약

한국유니팜

종근당

건양대병원

일동제약

대원제약

SK케미칼

한미약품

참메드

지엔히어링

광우메딕스

광우헬스케어

우양메디칼

히어라이프

스타키

메델코클리어

엠디팜

올림푸스

이니스트

슈미트

한미헬스

한국유나이티드

아주약품

유니트론

한림제약

시선바이오

필립스

오피테크

포인트닉스

다산

지반토스

동구바이오

지에스엠티

메드트로닉

대웅제약

보령제약인튜이티브부광약품스트라이커

유니반다이이찌의과

닥터킴

세종의학

3F

1F

Convention CenterLobby

Convention CenterExhibition Hall

제93차 대한이비인후과학회 학술대회 2019년 춘계 대한 ...

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