Bacteriology of Chronic Otitis Media: Changing of Detection Rate of Methicillin-Resistant Staphylococcus Aureus and Pseudomonas Aeruginosa / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Chronic suppurative otitis media is one of the most common diseases in the otologic field. Along with development and widespread use of antibiotics, the kinds of pathogenic microorganisms and their resistance to antibiotics have been changed. It is thus significant to know the current trend of species and resistance rates of pathogens for choosing appropriate antibiotics. To investigate the current bacteriology of chronic suppurative otitis media and compare the current results with previous results. SUBJECTS AND METHOD: A retrospective study about chronic otitis media patients with otorrhea was performed from Jan, 2000 to Dec, 2005. RESULTS: The most commonly identified pathogenic bacterium was methicillin-resistant Staphylococcus aureus (MRSA). The next frequent pathogenic organisms were Pseudomonas, Coagulase (-) Staphylococcus (CNS) and methicillin-sensitive Staphylococcus aureus (MSSA). CONCLUSION: There was difference between the results of the present study and previous results regarding pathogenic organisms and antibiotics-sensitivity. Continuous and periodic surveillance about pathogens and antibiotics resistance is necessary to guide appropriate antibacterial therapy.

Relationship between Symptom Scores and Quality of Life before and after Endoscopic Sinus Surgery: Comparison between RSDI and SF-36v2(TM) Questionnaire / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In recent years, the emphasis on medical care has shifted from symptom scores and objective test results to the patient-centered assesment of effect of disease or response to treatment. So, we compared, before and after endoscopic sinus surgery (ESS), the relationship between 7 nasal symptom scores and quality of life scores measured with RSDI and the SF-36v2(TM) questionnaires, which have been verified by many articles. SUBJECTS AND METHOD: Subjects were 50 patients diagnosed as chronic sinusitis and who underwent ESS from November 2005 to Oct 2006. Patients filled out two questionnaires and checked a visual analogue scale at admission for surgery, and at 2, 4, 8 and 32 weeks postoperatively. Two questionnaires are the Rhinosinusitis Disability Index (RSDI) questionnaire, the SF-36v2(TM) questionnaire, and the visual analogue scale (VAS) is composed of nasal obstruction, rhinorrhea, postnasal drip, sneezing, cough, headache and facial pain. So, we compared each score of the SF-36v2(TM) (PCS and MCS) and RSDI with symptom scores of VAS. RESULTS: In comparing the scores of the RSDI with the symptom scores of VAS, statistically significant relationship was noted with respect to nasal obstruction, headache, and rhinorrhea continuously. But in comparing the scores of the SF-36v2(TM) (PCS and MCS) with the symptom scores of VAS, no statistically significant relationships was observed. CONCLUSION: With respect to the relationship between the quality of life after ESS and symptom severity, RSDI was found to be more effective than SF-36v2(TM). However, because results showed up differently in the two different kinds of questionnaire, it is important that we should use several different verified questionnaires in order to assess patient-centred response to ESS.

Comparison of Facial Nerve Paralysis in Adults and Children

PURPOSE: Facial nerve injury can occur in the regions ranging from the cerebral cortex to the motor end plate in the face, and from many causes including trauma, viral infection, and idiopathic factors. Facial nerve paralysis in children, however, may differ from that in adults. We, therefore, evaluated its etiology and recovery rate in children and adults. MATERIALS AND METHODS: We retrospectively evaluated the records of 975 patients, ranging in age from 0 to 88 years, who displayed facial palsy at Kyung Hee Medical Center between January 1986 and July 2005. RESULTS: The most frequent causes of facial palsy in adults were Bell's palsy (54.9%), infection (26.8%), trauma (5.9%), iatrogenic (2.0%), and tumors (1.8%), whereas the most frequent causes of facial palsy in children were Bell's palsy (66.2%), infection (14.6%), trauma (13.4%), birth trauma (3.2%), and leukemia (1.3%). Recovery rates in adults were 91.4% for Bell's palsy, 89.0% for infection, and 64.3% for trauma, whereas recovery rates in children were 93.1% for Bell's palsy, 90.9% for infection, and 42.9% for trauma. CONCLUSION: These results show that causes of facial palsy are similar in adults and children, and recovery rates in adults and children are not significantly different.

Clinical Analysis of Facial Palsy in Children / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Facial palsy in children is uncommon, but not rare. Most patients with facial palsy are idiopathic, as in Bell's palsy. Nevertheless, other more serious causes should be carefully excluded before Bell's palsy is diagnosed. We tried to characterize the causes, treatment methods, and the recovery rate of facial palsy in children. SUBJCETS AND METHOD: Between January 1986 and July 2005, we examined 157 patients who presented with facial palsy in Kyunghee University Hospital. The patients' ages ranged from 0 to 15. RESULTS: The highest age groups were children in their school period. The causes of facial palsy in children were in the order of following frequences : Bell's palsy (66.2%), infection (14.6%), trauma (13.4%), birth trauma (3.2%), leukemia (1.3%), facial burn (0.6%), iatrogenic (0.6%). Treatment methods according to causes were steroid, antiviral, antibiotics, acupuncture, myringotomy, facial nerve decompression, and nerve graft. The recovery rate was 93.1% in Bell's palsy, 100% in birth trauma, 100% in acute otitis media, 83.3% in herpes zoster oticus, 33.3% in temporal bone fracture, and 50% in cerebral contusion. CONCLUSION: Facial palsy in children results from variable causes in the order of Bell's palsy (66.2%), infection (14.6%), trauma (13.4%), birth trauma (3.2%), leukemia (1.3%), facial burn (0.6%), and iatrogenic (0.6%). There were variable treatment methods according to different causes and many of the children had acupuncture. Facial palsy caused by birth trauma and acute otitis media had satisfactory recovery rates in all cases, whereas Bell's palsy patients showed 93.1% satisfactory recovery and trauma patients 33.3%.

Local Immunity of Pediatric Adenoid with Allergic Rhinitis & Sinusitis

BACKGROUND: Chronic rhino-sinusitis and persistent allergic rhinitis is often cited as risk factor for developing adenoid hypertrophy or adenoiditis, but this relationship has not been studied extensively. In this study, we evaluated the mucosal barrier, squamous changes of ciliated epithelium, IgA secretion and BCL-6 expression in adenoids, and adenoid size. METHODS: Six children with allergic rhinitis and sinusitis, nine children with only allergic rhinitis, nine children with only sinusitis and six children without any history of allergic rhinitis and sinusitis were enrolled. H-E stain of adenoid for squamous metaplasia, immunohistochemical study of adenoid for IgA and BCL-6, cytokeratin stain for evaluation of mucosal barrier and lateral view X-ray for adenoid size were performed. ANOVA test was used in the analysis and data showing p value of less than 0.05 were considered significant. RESULTS: The number of ciliated cells had tendency to be decreased and squamous metaplasia had tendency to be increased in three experimental groups (p>0.05). Deterioration of mucosal barrier had tendency to be detected in three experimental groups than control group (p>0.05). BCL-6 had tendency to be increased and IgA secretion had tendency to be decreased in three experimental groups (p>0.05). There is no difference in adenoid size between three experimental groups and control group. CONCLUSION: Despite the expectation that adenoid would be affectecd by allergic rhinitis and rhino-sinusitis, we found no evidence for influence of adenoid immunity.

Usefulness of Botulinum Toxin Injection in Rehabilitation of Facial Paralysis: Improving Mouth Angle Asymmetry / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A number of surgical procedures exist to improve facial symmetry for patients with facial paralysis. Whereas static symmetry is often improved, dynamic asymmetry frequently persists because of the imbalance of complex coordinated movements of facial expression. The paralyzed face is often distorted by the excessive pull of the normal contralateral face during emotional expression. We report the use of botulinum toxin in patients with facial paralysis to improve lower facial asymmetry by limiting the excessive pull of contralateral face. SUBJECTS AND METHOD: Ten adult patients with unilateral facial paralysis were included in this study. Patients had injections at contralateral facial muscle which were zygomaticus major, levator labii superioris and depressor angularis orii. The effectiveness of the botulinum toxin injections on facial symmerty and patient appreciation of this were assessed by measuring the level difference of both mouth angles and difference in the distance from the midline to both mouth angles before and 1 month after injection. Also patients were asked to fill up the questionnaire about the magnitude of effect and any related side effects of injection at 1 month follow up. RESULTS: Botox injection decreased the level difference of both mouth angle and difference of distance from midline to both mouth angles in patients with unilateral facial paralysis at full-denture smiling. Five of ten patients were reported as moderate to marked improvement in expressive facial asymmetry after botulinum toxin injection into normal lower face. CONCLUSION: Botulinum toxin injection is a useful ancillary technique for improving dynamic facial asymmetry of the paralyzed face.