A Case of Dural Arteriovenous Fistula with Multitudinous Feeders Treated by Transvenous Embolization / 대한이비인후과학회지

Dural arteriovenous fistula (DAVF) is an uncommon condition. However, it is important for otologists because it is the most common cause of pulsatile tinnitus and may also present with intracranial hemorrhage and neurological disturbance. Many therapeutic approaches, such as surgery and endovascular techniques, have been proposed to obliterate the lesions. Surgery may be accompanied by massive blood loss. Transarterial embolization seldom obliterates transverse-sigmoid sinus DAVFs completely and permanently. In recent years, several authors have reported the effect of transvenous embolization of transverse-sigmoid sinus DAVFs in English literature. We recently experienced a case of sigmoid DAVF treated by transvenous embolization and report it with a review of the literature.

Immunohistochemical Study on bcl-2, c-myc, EGFR as Predictable Factor for Radiosensitivity in Early Glottic Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The radiotherapy or surgery is the main treatment modality for early glottic cancer. The advantage of radiotherapy is the preservation of good voice quality after treatment but the main problem is increased complications in the salvage surgery when local control fails. So, it is important to predict the success of radiotherapy. The purpose of this study is to find predictable factors of the radiosensitivity in the early glottic cancer. MATERIALS AND METHOD: Immunohistochemical staining was performed on the paraffin sections of the biopsy specimens of 57 patients with early glottic cancer who had undertaken radiotherapy treatments in Chonnam National University Hospital from January 1988 to October 1998. Primary antibodies were the anti-bcl-2 monoclonal antibody, the anti-c-myc monoclonal antibody, and the anti-EGFR monoclonal antibodies. The relation between the local control outcome after radiotherapy and the result of immunostaining was analyzed by the chi-square and the Fisher's exact test. RESULTS: Positive expression of bcl-2 was 21.1% in the local controlled group and 12.3% in the uncontrolled group. There was no statistical significance between two groups. The expression rate of c-myc was statistically higher in the controlled group (36.8%) than in the uncontrolled group (7.0%) (p=0.025). Expression of EGFR was 57.9% in the controlled group and 22.5% in the uncontolled group. However, there was no statistical significance between two groups. CONCLUSION: The relation between the positive c-myc expression and the radiosensitivity suggests that c-myc might be a predictable factor of the radiosensitivity in early glottic cancer.

Studies on Relationships between Inflammatory Cell, Cytokines and Clinical Features in Pediatric Otitis Media with Effusion / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Retension of inflammatory cells and cytokines in the middle ear cleft can result in ongoing chronic otitis media with effusion. This study aims to investigate the role of these inflammatory cells and cytokines in the middle ear effusion (MEE) of children with otitis media with effusion. MATERIALS AND METHOD: We analyzed 46 pediatric middle ear effusion samples for IL-6, IL-10, TNF-alpha and inflammatory cells and tried to elucidate the relationship between the concentration of these cytokines, inflammatory cells and clinical features. RESULTS: 1) The concentration of TNF-alphain MEE from children younger than 2 years was significantly higher than the levels of children older than 2 years (p<0.05). 2) The concentration of TNF-alpha in MEE of preoperative medication group was significantly lower than the levels of non-medication group (p<0.05). 3) The concentration of IL-6 in MEE of the ears with hearing threshold poorer than 35 dB was significantly higher than the levels of the ears with hearing threshold better than 35 dB (p<0.05). CONCLUSION: The results showed that TNF-alpha and IL-6 are intimately involved in the inflammatory cascade of the middle ear and suggest regulation of these cytokines as possible sites of future therapeutic intervention in otitis media with effusion.

Treatment of Methicillin-Resistant Staphylococcus Aureus(MRSA) Otorrhea in Pediatric Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Recently, incidence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infection has been increasing. There are problems with children with MRSA otorrhea in visiting otolaryngology clinics, since systemic vancomycin or teicoplanin injection can cause systemic side effects in children and admission and medical costs are higher. In this study, we used the conventional antibiotics orally and topically for the treatment of otorrhea by MRSA infection to compare the therapeutic effects of conventional antibiotics with the systemic vancomycin or teicoplanin. The author also tried to determine the timing of systemic vancomycin injection for the control of MRSA otorrhea. MATERIALS AND METHOD: Twenty-eight pediatric patients with MRSA otorrhea were treated with either conventional antibiotics (20 patients) topically and orally or systemic vancomycin or teicoplanin injection (8 patients). The use of vancomycin or teicoplanin injection was indicated when otorrhea didn't stop despite of 3-4 weeks of conventional treatment and when referred from local clinics, and in case of cholesteatoma, when it came as a result of complication of middle ear disease. RESULTS: The average therapeutic period for the conventionally treated group was 24.7 days. On the other hand, the average period was 12.3 days and 9.8 days for the systemic vancomycin and teicoplanin injection group, respectively. CONCLUSION: The conventional antibiotics treatment, topically or orally applied for the treatment of MRSA otorrhea in children, has advantages in relation to time and economy, although the average therapeutic period was longer than the treatment with systemic vancomycin or teicoplanin injection. The author suggests the usage of conventional antibiotics for 3 weeks prior to the use of systemic vancomycin injection.

Prognostic Significance of the Microvessel Density in Nasopharyngeal Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The nasopharyngeal cancer (NPC) of nasopharyngeal neoplasms is a rare disease with a relatively poor prognosis, because they tend to be diagnosed in the far advanced stage. Therefore, radiotherapy had been the treatment of choice. Angiogenesis is a crucial step in the tumor growth and progression. The authors attempted to investigate the prognostic value of the microvessel density in NPC. SUBJECTS AND METHOD: We analyzed tumor tissues from 57 cases of paraffin block specimens which had been diagnosed with NPC and treated at Chonnam National University Hospital. The anti-human von Willebrand factor antibody was used to determine the microvessel density (MVD). RESULTS: The MVD was 48.5 in the early stage (stage I and II) and 51.2 in the advanced stage (stage III and IV), which were not statistically significant (p=0.057). The MVD was 55.3 in type I, 54.4 in type II, and 41.8 in type III, and there were no statistical significance between these values (p=0.36). The MVD was not statistically significant between T and N stages (p=0.26, 0.42). There was no significance between the MVD and the survival rates (p>0.05). CONCLUSION: The results suggest that the MVD was not a prognostic significance in NPC.

Usefulness of Flexible Bronchoscopy in the Diagnosis of Tracheobronchial Foreign Bodies in Children / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Diagnosis of foreign body aspiration in children has not been satisfactory, although many methods have included history, physical examination, radiographic findings, computed tomography, magnetic resonance imaging, and lung scan. Therefore, a simple and definitive method is needed and we have studied the usefulness of flexible bronchoscopy in the diagnosis of tracheobronchial foreign bodies in children. MATERIALS AND METHOD: A retrospective review was undertaken of 67 cases referred with suspicion of foreign body aspiration. The age of patients ranged from 3 months to 192 months, with a mean age of 33.5 months. Flexible bronchoscopy was performed in 37 cases with topical-local anesthesia, because the evidence of tracheobronchial foreign body aspiration was not conclusive. RESULTS: We detected foreign bodies in 72.9% (27) and secretion suggesting foreign bodies in 18.9% (7). All of 34 children who were suspicious of having foreign bodies underwent rigid bronchoscopy and 32 had foreign bodies. Three children who had normal flexible bronchoscopic examination were discharged after improvement by medical treatment. There were no complications except transient cyanosis. CONCLUSION: We suggest that the diagnostic use of the pediatric flexible bronchoscope is safe, definitive, and cost-effective method for the identification of patients with tracheobronchial foreign bodies.

A Case of Acute Myelogenous Leukemia Recurred in Both Temporal Bone after Complete Remission / 대한이비인후과학회지

The clinical manifestations of leukemic patients who have temporal bone infiltration are acute mastoiditis, hearing impairment, tinnitus, dizziness, otorrhea, retro-auricular mass and facial nerve palsy. Otologic manifestations of leukemic patients have also been reported several times. However, reports about temporal bone infiltration by leukemic cells after complete remission have been rare, and there have not yet been any reports about both temporal bone infiltration that has been confirmed by mastoid biopsy after remission. We recently experienced a case of recurring acute myelogenous leukemia in both temporal bones after a complete remission and report it with a review of the literature.

A Case of Primary Tuberculous Otitis Media with Lateral SinusThrombosis and Subperiosteal Abscess / 대한이비인후과학회지

Tuberculosis of the middle ear is a disease rarely encountered in recent years. Because what used to be the typical clinical signs of this disease have been changed in recent years and the index of suspicion being low, there is frequently a considerable delay prior to diagnosis. This can lead to irreversible complications. A case of tuberculous otitis media complicated with lateral sinus thrombosis and subperiosteal abscess is reported with review of the literature, emphasizing the fact that this entity must be considered in the differential diagnosis of persistent suppurative otitis media.

The Effect of Air in a Sauna on Nasal Mucociliary Function / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There has been many attempts to find out the changes in the nasal mucociliary transport function under various conditions. In this study, we intended to determine if air in a sauna exerts any beneficial effect on the nasal mucociliary function using the saccharin method, which is regarded as the proper screening test for nasal mucociliary function. MATERIALS AND METHODS: Normal healthy adults (16 men, 15 women) aged from 18 to 22 volunteered for this study. We measured each saccharin transit time (STT) twice, inside a room (25degreesC, 85%), a dry sauna (70degreesC, 85%), and a wet sauna (70degreesC, 100%), respectively. RESULTS: The average STT was 7.98+/-2.95 minutes at the room, 8.47+/-1.71 at the dry sauna, and 7.59+/-2.95 at the wet sauna. There was no meaningful relationships of STT among each condition (p=0.157). CONCLUSION: Air in a sauna has neither any beneficial effect on the nasal mucociliary function nor any harmful effect on it.