성대마비와 양성 성대점막질환의 음향학적 특성비교

공일승,조영주,이명희,김종승,양윤수,홍기환,Kong, Il-Seung,Cho, Young-Ju,Lee, Myung-Hee,Kim, Jong-Seung,Yang, Yun-Su,Hong, Ki-Hwan 대한후두음성언어의학회 2007 대한후두음성언어의학회지 Vol.18 No.2

This study aims to analyze the voices of the patients with voice disorders including vocal fold paralysis, vocal fold cyst and vocal nodule/polyp in the aspect of acoustic phonetics. This study intends to collect subsidiary acoustic data in order to make a speech treatment and an standardization of vocal disorders. Subjects and Methods: The subjects of this study were 64 adult patients who underwent indirect laryngoscopy and laryngostroboscopy, and were diagnosed as vocal fold paralysis, vocal fold cyst or vocal nodule/polyp. Experimental group consisted of 20 patients who were diagnosed as vocal fold paralysis, 21 patients who were diagnosed as vocal fold cyst and had the average age of 42.0 $({\pm}10.03)$ ; and 23 patients who were diagnosed as vocal nodule/polyp and had the average age of 40.9 $({\pm}13.75)$. For the methodology of this study, the patients listed above were asked to sit in a comfortable position at intervals of 10cm apart from the patient's mouth and a microphone, and subsequently to phonate a vowel sound /e/ for the maximum phonation time with natural tone and vocal volume then the sound was directly inputted on a computer. During recording, sampling rate was set to 44,100Hz and the 1-second area corresponding to stable zone except the first and the last stage of waveform of the vowel sound /e/ vocalized by the individual patients was analyzed. Results: First, there was no statistically significant difference in jitter and shimmer between vocal fold paralysis and vocal fold cyst, while there was highly statistically significant difference in them between vocal fold paralysis and vocal nodule/polyp. Second, looking into the mean values obtained from NNE, HNR and SNR results associated with noise ratio, the disease showing the most abnormal characteristics was vocal fold paralysis, followed by cyst and nodule/polyp in order. For NNE, there was statistically significant difference between vocal nodule/polyp, and cyst or paralysis. In other words, it was found that the NNE of vocal nodule/polyp was weaker than that of cyst or paralysis. Similarly, HNR and SNR also showed the same characteristics; there was statistically significant difference between vocal fold paralysis and vocal fold cyst or nodule/polyp, and HNR and SNR values of vocal fold paralysis were lower than those of vocal fold cyst or nodule/polyp. Conclusion: For vocal fold paralysis, the abnormal values of acoustic parameters associated with frequency, amplitude and noise ratio were statistically significantly higher than those of vocal fold cyst and nodule/polyp. This finding suggests that the voices of the patients with vocal fold paralysis are the most severely injured due to less stability of vocal fold movement, asymmetry and incomplete glottic closure. In addition, there was no statistically significant difference in the acoustic parameters of tremor among vocal fold paralysis, vocal fold cyst and vocal nodule/polyp. Further studies need to ascertain reasonable acoustic parameters with various vocal disorders as well as to clarify the correlation between acoustics-based objective tools and subjective evaluations.

비인강암의 치료방법에서 Docetaxel과 Platinum을 이용한 유도항암요법의 효과

공일승,양윤수,최동일,권삼현,홍기환 대한이비인후과학회 2008 대한이비인후과학회지 두경부외과학 Vol.51 No.1

The aim of this study was to determine the efficacy of induction chemotherapy with docetaxel and platinum in patients with nasopharyngeal carcinoma. Subjects and Method:The medical records of 52 patients, who were diagnosed with NPC at our department from January 1995 to December 2005, were reviewed and retrospectively analyzed. Patients were divided into three groups according to treatment methods. Twenty-eight cases treated with induction chemotherapy consisted of docetaxel, platinum and RT, 17 cases treated with induction chemotherapy consisted of 5-FU, platinum and RT, and 7 cases were treated with RT only. A total of 114 chemotherapy cycles were administered to patients and most received 2 cycles. Results:The T stage distribution at the time of diagnosis was 48%, 14%, 15%, and 23% for T1, T2, T3 and T4, respectively. According to the WHO classification, the type I included 11 cases, type II 2cases, and type III 39 cases. The overall 5-year survival rate was 60.6%. According to the treatment modality, only the RT group was 42.9%. In the chemoradiotherapy group, the 5-year survival rates of 5-FU and platinum combination group and docetaxel and platinum combination group were 47.1% and 78.8%, respectively. There was significant difference in survival (p=0.037). There was no difference in sex, age, and N stage with regards to the 5-year survival rate. Conclusion:Although no valid conclusions could be drawn because of the small number of patients examined in the present study, we found that induction chemotherapy consists of docetaxel and that platinum may improve the outcome of patients with NPC. (Korean J Otorhinolaryngol-Head Neck Surg 2008;51:58-63)

편도적출술이 구강 및 비강 음향스팩트럼에 미치는 영향

최동일,공일승,이은정,소상수,양윤수,홍기환,Choi, Dong-Il,Kong, Il-Seung,Lee, Eun-Jung,So, Sang-Soo,Yang, Yoon-Soo,Hong, Ki-Hwan 대한후두음성언어의학회 2007 대한후두음성언어의학회지 Vol.18 No.1

Background and Objectives: It has been suggested that tonsillectomy possibly causes changes of voice because the morphology of the vocal tract is altered. This may cause serious problems for professional voice users. Materials and Method: Subjects were 26 patients. The oral and nasal sound spectrum of oral vowel /a/, /e/ and /i/ were measured before and after tonsillectomy. The formant frequencies and intensities for oral and nasal spectra were compared. The nasality and fundamental frequencies for oral vowel were measured. Results: The first formant frequencies for oral spectra of all vowels were not changed after surgery, but the second formant frequencies were increased significantly after surgery in the vowel /e/ and /i/. The first and second formant intensities for oral spectra were increased significantly after surgery in the all vowels. The first and second formant frequencies for nasal spectra of all vowels were not changed after surgery, but their intensities for nasal spectra were increased after surgery. The nasalities for oral vowel were not changed after surgery. Conclusion : Tonsillectomy appeared to change the spectral features of oral and nasal components of oral vowel, especially spectral intensities.

갑상선 수술에서 비 회귀성 하후두 신경: 술 전 경부 CT의 유용성 및 임상적 고찰

이은정,공일승,조영주,유순호,이경석,이종민,김연우,양윤수,홍기환 대한이비인후과학회 2009 대한이비인후과학회지 두경부외과학 Vol.52 No.10

Background and Objectives The non-recurrent inferior laryngeal nerve (NRILN) represents a risk factor for nerve injury during thyroid surgery. The intraoperative identification and preservation of NRILN may be an extremely challenging procedure. It is associated with the developmentally absence of the brachiocephalic trunk and the presence of an aberrant subclavian artery, the so called “arteria lusoria”. The aim of this study is to investigate its prevalence and to verify the availability of preoperative neck CT in the research of NRILN by means of identification of arterial abnormalities and impact on NRILN morbidity. Subjects and Method Between January 1997 and July 2008, 1,639 patients underwent thyroid surgery. Of these cases, 1,469 cases (89.6%) were checked preoperative neck CT. Results Patients with preoperative neck CT, 10 cases (0.61%) show the absence of the brachiocephalic trunk and the retroesophageal aberrant right subclavian artery that arising directly form the aortic arch. Of these 10 cases, 9 cases (0.55%) NRILNs on the right side were exposed per-operatively. 7 cases were revealed high type (type I) of NRILN and 2 cases were low type (type II). There were no clinical symptoms such as dysphagia or dyspnea. The other 1 case was performed only left thyroidectomy, so we couldn’t identify the NRILN. In all cases, No vocal cord paralysis was observed. Conclusion Preoperative neck CT could correctly identify NRILN, allowing earlier nerve identification and subsequently reduce the risk of accidental nerve damages.

갑상선 전절제술 후 1시간에 측정한 혈청 부갑상선호르몬의 유용성

양윤수,이은정,소상수,최동일,공일승,홍기환 대한이비인후과학회 2007 대한이비인후과학회지 두경부외과학 Vol.50 No.11

Background and Objectives:Hypocalcemia is the most frequent complication following total thyroidectomy. This prospective study examines the predictive value of parathyroid hormone (PTH) levels measured 1 hour after surgery. Materials and Method:Twenty-four patients underwent total or near-total thyroidectomy for benign or malignant thyroid tumor in one year. Serum calcium and PTH levels were measured preoperatively and at 1 hour after surgery. Results:Al patients were clasified into three groups acording to hypocalcemic symptoms and postoperative serum calcium levels. A total of 6 (25% ) patients were found with hypocalcemia, as demonstrated by clinical and laboratory findings. PTH levels at 1 hour were below normal level (100% ) for 6 of the 6 symptomatic hypocalcemia patients, 5 (45% ) of the 11 biochemical hypocalcemia patients, and in 1 (14% ) of 7 normocalcemic patients (p= 0.002). The sensitivity and specificity of postoperative 1 hour PTH asesment to predict symp-tomatic hypocalcemia were 100% and 66%. The positive and negative predictive rate of postoperative 1 hour PTH assesment to predict symptomatic hypocalcemia were 50% and 10%. Conclusion:of transient hypocalcemia after bilateral thyroid surgery. Low PTH level at 1 hour after surgery is therefore a feasible predictor of postoperative symptomatic hypocalcemia and permanent hypoparathyroidism. (Korean J Otorhinolaryngol-Head Neck Surg 2007 ;50 :1012-6)

수술적으로 치료한 원발성 부갑상선 기능항진증을 동반한 부갑상선종의 임상적 고찰

유순호(Sun Ho Lyu),이경석(Kyung Seok Lee),조영주(Young Ju Cho),공일승(Il Seong Kong),이은정(Eun Jung Lee),양윤수(Yun Su Yang),홍기환(Ki Hwan Hong) 대한두경부종양학회 2010 대한두경부 종양학회지 Vol.26 No.1

Background and Objectives :Parathyroid adenoma is a rare disease in Korea, but the incidence of para-thyroid adenoma has gradually increased due to generalized measurement of serum calcium and imaging study according to wide spread public health screening program. In previous researches, the analysis of clinical aspects were insufficient due to a few cases. The purpose of this study was to assess the clinical analysis of surgically treated parathyroid adenoma with hyperparathyroidism. Methods :We reviewed the medical re-cords of nineteen cases of parathyroid adenoma with hyperparathyroidism. Initial symptom to visit hospital, hypercalcemia associated medical symptom, surgical outcome and complication were investigated. Serum total calcium, parathyroid hormone, phosphate, alkaline phosphatase were checked before and after surgery. Imaging study was performed with combination of radionuclide parathyroid scan, ultrasonography and neck CT scan. Results :The initial symptoms were no symptom(6/19), pelvic pain(5/19), muscular weakness (3/19), bone pain(3/19) and palpable neck mass(2/19) in order of frequency. Serum total calcium, parathyroid hormone decreased and phosphate increased after surgery than before surgery statistically significantly. Sensi-tivities of parathyroid scan, neck ultrasonography and neck CT as preoperative localization test were 88.2%, 72.7%, 73.3% each. The most common postoperative complication was transient hypocalcemia(9/19). Con-clusion :Similar to previous study, parathyroid adenomas have numerous clinical features and surgical treat-ment via unilateral approach with preoperatively localized single parathyroid adenoma was successful. In our study, parathyroid adenoma was predominantly detected by elevated serum calcium level with no clinical symp-tom so we need to evaluate parathyroid adenoma, if serum calcium elevated.