Min Woo Kim

Purpose: To identify anatomical and clinical predictors of tunneling time during transoral robotic thyroidectomy via the vestibular approach (TORTVA) and to clarify the potential utility of body habitus-related predictors for case selection. Methods: We retrospectively reviewed 33 consecutive patients who underwent TORTVA between October 2023 and December 2024. Tunneling time was defined as the interval from vestibular incision to completion of the subplatysmal tunnel. Preoperative sagittal neck computed tomography (CT) images were used to measure linear distances and angles between the mentum, hyoid bone, thyroid cartilage, thyroid isthmus, and sternal notch, as well as anterior neck soft tissue thickness. Clinicopathologic data and CT measurements were analyzed using univariate and multivariate linear regression. Results: The mean tunneling time was 25.3 min, with no significant difference observed between males (25.6 min) and females (25.2 min). In multivariate linear regression analysis, the skin-to-thyroid cartilage notch thickness (tST) (B=0.550, p =.024) and the mentum-to-thyroid cartilage notch distance (dMT) (B=0.347, p =.028) were significantly associated with tunneling time ( p =.006). Conclusion: Tunneling time was associated with skin thickness over the thyroid cartilage notch and the mentum-to–thyroid cartilage notch distance. These exploratory findings may inform future studies on patient selection and technical difficulty in TORTVA, particularly for surgeons early in the learning curve.

Background and Objectives The purpose of this study was to determine whether smartwatch (SW) data measured over several nights at home could effectively predict obstructive sleep apnea (OSA).Subjects and Method Patients suspected of having OSA and scheduled for polysomnography (PSG) were asked to wear a SW at home for 7 nights before undergoing PSG. After obtaining the SW data, it was compared and analyzed with the PSG.Results A total 59 people including 42 OSA patients and 17 normal control were included in the study. The sensitivity and specificity for predicting apnea-hypopnea index (AHI) ≥5/h using the SW lowest oxygen saturation of 85% were 85.7% and 70.6%. The area under curve (AUC) for the receiver operating characteristic (ROC) curve was 0.901 (p<0.001). The sensitivity and specificity for predicting AHI ≥15/h using the SW lowest oxygen saturation of 82% were 80.6% and 67.9%. The AUC for the ROC curve was 0.866 (p<0.001).Conclusion This study showed that the OSA can be predicted fairly accurately using data obtained from wearing a SW for several nights in an environment similar to daily life rather than a hospital laboratory.

Background and Objectives The aim of this study was to confirm the effect of intralesional triamcinolone acetonide injections (TRIAM) to treat granulomatous tissue surrounding the tracheostomy stoma.Subjects and Method We reviewed and documented the medical charts of 20 patients who were administered with TRIAM to treat granulomatous tissue surrounding the tracheostomy stoma from January 2018 to June 2019 were. The surface area of the granulomatous tissue was measured using Image J. The differences between the area of the granulomatous tissue after conventional treatment and after TRIAM on the same patient were compared.Results A total of 20 patients consisting of 12 males and 8 females were included, with the patients’ average age being 60.0±14.3 years. The initial surface area of granulation tissue was 1.266±0.449 cm2, and 1.243±0.432 cm2 after conventional treatment, showing no statistically significant difference in the tissue area (p=0.143). The pre-injection surface area of granulation tissue was 1.243±0.432 cm2, and the area on the 7th day after the third injection was 0.477±0.217 cm2, showing a significant difference (p<0.001).Conclusion Compared to the conventional treatment, the surface area of granulomatous tissue surrounding the tracheostomy stoma significantly decreased after being treating with TRIAM. This finding suggests the effectiveness of TRIAM as a treatment of granulomatous tissue surrounding the tracheostomy stoma without complications such as bleeding.

Background and Objectives The aim of this study was to investigate the compliance and treatment effects of both rapid eye movement sleep related obstructive sleep apnea (REM_ OSA) and non-stage specific OSA (NS_OSA) patients prescribed with positive airway pressure (PAP) therapy.Subjects and Method Medical records of 223 patients diagnosed with OSA from July 2021 to March 2023 were retrospectively analyzed. Six-month PAP compliance, symptoms questionnaires were compared for 60 patients in the REM_OSA group and 163 in the NS_OSA group.Results For patients in mild NS_OSA, mild REM_OSA, moderate NS_OSA, moderate REM_ OSA, severe NS_OSA, and severe REM_OSA groups, the compliance of six-month PAP was 50.0%, 33.3% (p=0.467), 69.6%, 58.3% (p>0.999), 70.7%, and 0% (p=0.023), respectively. In the NS_OSA group, PAP led to significant daytime sleepiness score improvement (7.3±3.4 to 5.7±3.6, p=0.022). In contrast, the scores for the REM_OSA group changed insignificantly (8.4±4.7 to 6.8±2.9, p=0.332).Conclusion This study revealed that PAP therapy compliance of the REM_OSA group was not lower than that of the NS_OSA group, except for the severe subgroup. However, REM_OSA was found to be less effective in improving daytime sleepiness symptoms than NS_OSA after PAP therapy.

Eosinophilic otitis media (EOM) differs from classic chronic otitis media as it is a refractory disease with the accumulation of eosinophils in thick mucinous middle ear effusion and mucosa. A 66-year-old male with a history of asthma, chronic sinusitis with polyposis, nasal polyposis, and multiple sets of ventilation tubes was presented to our center for the management of hearing loss and otorrhea. He had a history of consistent otorrhea and hearing loss even with the ventilation tube insertions and medical treatment. Both systemic and intratympanic steroid was administered, but the effect was insignificant and other systemic adverse effects occurred. Finally, the otologic symptoms including hearing loss and otorrhea improved after being given a Dupilumab injection. This case report discusses Dupilumab treatment resulting in remission in a patient suffering from refractory EOM.

Background and Objectives Obstructive sleep apnea (OSA) is associated with various health risks, including hypertension, cerebrovascular disease, myocardial infarction, diabetes, cognitive impairment, and all-cause mortality. While overnight polysomnography (PSG) is the gold standard for diagnosing OSA, it is costly and time-consuming. The STOP-Bang questionnaire is a convenient tool for OSA screening, but its high sensitivity comes at the expense of low specificity. The purpose of this study was to investigate the usefulness of combining the STOP-Bang questionnaire and a smartwatch capable of measuring oxygen saturation in screening for OSA.Subjects and Method Of the patients scheduled for PSG due to OSA, 109 patients voluntarily participated in the study by filling out a STOP-Bang questionnaire during their first visit and wearing a smartwatch during PSG.Results There were 80 males and 29 females, with the patients’ mean age of 45±13.3 years. Based on the apnea-hypopnea index (AHI), 19 patients (17.4%) were normal, 28 (25.7%) had mild OSA, 23 (21.1%) had moderate OSA, and 39 (35.8%) had severe OSA. When using the AHI threshold of AHI ≥15/h, the STOP-Bang alone showed sensitivity of 85.5% and specificity of 61.7%. Combining the STOP-Bang questionnaire with a smartwatch resulted in a slight decrease in sensitivity and a significant increase in specificity, yielding the values of 80.5% and 84.4%, respectively.Conclusion A two-step approach using the STOP-Bang and a smartwatch was implemented to enhance the diagnostic accuracy of screening OSA.

Background and Objectives Obstructive sleep apnea (OSA) is a complex sleep-related respiratory disorder with various pathophysiology and clinical manifestations. Diagnosis and treatment considering only the number of respiratory events, such as sleep duration, may have limitations. The purpose of this study is to analyze the clinical and polysomnography (PSG) characteristics of patients with severe OSA in whom slow wave sleep (SWS) was well-maintained.Subjects and Method This study retrospectively analyzed 203 patients who underwent PSG due to suspected OSA. Severe OSA patients were classified into a SWS maintained group (SWS≥15%) and a SWS reduced group (SWS<15%), and their clinical records, PSG results, and heart rate variability (HRV) were compared.Results The SWS maintained group (n=27), compared to the SWS reduced group (n=58), had a significantly longer total sleep time (p=0.027) and lower wake after sleep onset (p=0.001), rapid eye movoement (REM) latency (p=0.007), non-supine apnea-hypopnea index (AHI, p=0.006), non-REM AHI (p<0.001), arousal index (p<0.001) and Epworth Sleepiness Scale (p=0.048). In addition, the SWS maintained group had a significantly low value in very low frequency in HRV than that of the SWS reduced group (p=0.046).Conclusion The SWS maintained group in the severe OSA showed better PSG and HRV results and reduced daytime sleepiness than those of the SWS reduced group.

Background and Objectives: Considering the prevalence and health effects of obstructive sleep apnea (OSA), early diagnosis and proper treatment are essential. Polysomnography (PSG) has limitations in diagnosing or tracking large-scale OSA patients. Smartwatches (SWs) can be equipped with a photoplethysmograph (PPG) that can indirectly measure heart rate and blood oxygen saturation by detecting the difference of light absorption through blood. The purpose of this study is to compare oxygen saturation parameters of PPG-based SWs with those of PSG to determine the diagnostic accuracy for OSA.Methods: After obtaining voluntary consent from patients who were scheduled to undergo PSG in a sleep clinic due to suspected OSA, they were randomly assigned to wear a Galaxy watch4 (GW) or Apple watch7 (AW) on their wrist. The agreement rates between the oxygen saturation parameters of the two SW types and PSG were evaluated. The accuracy, sensitivity, and specificity of the oxygen saturation parameters for diagnosis of OSA (apnea-hypopnea index [AHI] ≥5/h) were compared between the two types of SW.Results: A total of 133 patients underwent PSG while wearing an SW. Including duplicates, 109 patients wearing a GW and 69 wearing an AW were included. The diagnostic accuracy of AHI ≥5/h according to oxygen saturation time measured by a GW was less than 90%, the respective sensitivity and specificity were 82.9% and 75.8%. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was 0.807 (p<0.001). Using the lowest oxygen saturation value of GW, the sensitivity was 81.6%, the specificity was 69.7%, and the AUC of the ROC was 0.849 (p<0.001). The diagnostic accuracy of AHI ≥5/h according to the average oxygen saturation of AW, and the sensitivity and specificity were 75.6% and 70.8%, respectively. The AUC of this ROC curve was 0.757 (p<0.001). Using the lowest oxygen saturation value of AW, the sensitivity was 71.1%, the specificity was 62.5%, and the AUC of the ROC was 0.705 (p=0.005).Conclusion: This study found that the two types of SW showed considerable accuracy in diagnosing OSA, but the accuracy decreased as the severity of OSA increased.

BACKGROUND: We aimed to analyze the patient characteristics in accordance with white matter lesions and confirm whether white matter lesions affect final treatment outcomes in idiopathic sudden sensorineural hearing loss. METHODS: Medical records of 126 patients treated for unilateral idiopathic sudden sensorineural hearing loss and who underwent magnetic resonance imaging of the brain at an otology clinic in a university hospital from 2013 to June 2019 were reviewed. The Fazekas scale was used to evaluate the severity of white matter lesions. Complete recovery was defined if final hearing at 3 months did not exceed 25 dB. RESULTS: Overall, 107 patients were enrolled in this study. A score of 0 on the Fazekas scale was most frequent (n=78, 72.9%), followed by 1 (n=17, 15.9%), and 2 (n=12, 11.2%). Prevalence of diabetes (P=.032) and/or hypertension (P=.006) and distribution of age (P <.001) were different according to Fazekas scale scores. Hearing level in the affected side was significantly different between those with scores of 1 and 2 (P=.009). Contralateral hearing thresholds were not different according to Fazekas scale scores, but hearing on the contralateral side was significantly poorer in patients with hypertension than those without hypertension (P < .001). Regression analysis revealed that Fazekas scale score and initial hearing thresholds of the affected side were significant prognostic factors for complete recovery. CONCLUSION: Although the prevalence of white matter lesions in idiopathic sudden sensorineural hearing loss was not high, severe white matter lesions and accompanying cardiovascular risk factors may increase the possibility of initially worse hearing and decrease response to treatment in idiopathic sudden sensorineural hearing loss. Therefore, it might be important to control cardiovascular abnormalities in idiopathic sudden sensorineural hearing loss to achieve a better prognosis. Cite this article as: Shin S, Wan Byun S, Jin Kim S, Woo Kim M, Kyu Yu I, Yun Lee H. Clinical significance of white matter lesions in idiopathic sudden sensorineural hearing loss. J Int Adv Otol. 2022;18(2):100-105.

임상이비인후과(Journal of Clinical Otolaryngology Head and Neck Surgery)