Long-Term Outcome of the Voice Rehabilitation after Total Laryngectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The voice rehabilitation following total laryngectomy is very important for the quality of life of patients who are cured by cancer treatment. The purpose of this study is to investigate the success rate and complications of various procedures used in our clinics and to evaluate various factors that can affect the success rate of the voice rehabilitation. SUBJECTS AND METHOD: From March 1993 to November 2002, 77 medical charts of the patients who underwent total laryngectomy were reviewed retrospectively to determine the immediate and long-term success rates of voice rehabilitation. The statistic correlation between the variables (age, tumor stage, tumor site, radiotherapy) and the success rate was analysed. RESULTS: Good vocalization was achieved in 90.5% of patients after Provox insertion, 81% after Amatsu procedure, while esophageal voice was acquired by 11.1%. The long-term success rate in 39 patients was 75% in Provox group, 81.8% in Amatsu group and 30.5% in esophageal voice group. There were no statistically significant correlation between the variables and the success rate of vocie rehabilitation. CONCLUSION: The result of this study suggested that tracheoesophageal puncture with Provox prosthesis and Amatsu operation are very effective procedures for the long term voice rehabilitation following total laryngectomy.

A Case Report of Pleomorphic Adenoma in Maxillary Sinus / 대한이비인후과학회지

Pleomorphic adenoma is the most common benign tumor of the salivary gland. It occurs mainly in the major salivary gland, but it can be originated from any minor salivary glands and upper airway. Pleomorphic adenoma arising in the maxillary sinus is extremely rare. Recently, we have experienced a huge pleomorphic adenoma originated in the maxillary sinus. The patient was 64 years old woman and the tumor in the left maxillary sinus extended to the infratemporal fossa, pterygopalatine fossa, and parapharyngeal space through destructed maxillary sinus bony wall. Surgical resection was performed via midfacial degloving approach and the result of surgery was successful. We report this case with the review of literature.

Morphophysiology of Primary Vestibular Afferents Recorded from an in vitro Preparation of Mouse Inner Ear / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We are developing an in vitro preparation of the mouse inner ear so as to study morphophysiologic character of primary vestibular afferents and synaptic transmission within the vestibular epithelium. MATERIALS AND METHOD: We have intra-axonally recorded from over 300 ampullary fibers, close to the base of their respective anterior and lateral crista (<500 micrometer from hair cell/afferent nerve synapse), and labelled as a sub-set of these with biocytin (n=71). Discharge activity can be classified as regular or irregular based on the variation of the interspike interval (coefficient of variation). Using a micropusher to indent exposed windows of membranous labyrinth, we have characterized the response properties of both anterior and horizontal canal afferents. We studied afferent activity in response to sinusoidal indentations of anterior and horizontal membranous canal. RESULTS: The majority of labelled units were dimorphic (56 out of 71), having both calyx and bouton terminals and there was no labelled bouton terminal. Whether action potentials (Aps) were spontaneous or elicited with current, a heterogeneity of discharge activity was observed and these were similar to those previously reported in in vivo recordings from other mammalian species. In recordings over a range of frequencies from 0.01 to 10.0Hz, afferents responded with sinusoidal changes at discharge rates and modulation of membrane potential in a predictable manner. The phase response of the afferent discharge was characterized by frequency-dependent shifts in peak activity. The peak activity of anterior canal was in advance of the maximum indentation (180dgrees out of phase), with largest phase leads at 0.01 Hz (59.2+/-14.1dgrees) and the smallest phase leads occurring at 1.0 Hz (13.4+/-9.3dgrees), while maximum indentation was in advance of the peak activity at 10.0 Hz (-17.6+/-9.1dgrees). These phase shifts were similar to those reported in in vivo recordings from mammals, despite our use of artificial rather than natural rotational stimuli. CONCLUSION: We developed an in-vitro mouse model to study morphophysiologic characteristics of primary vestibular afferent nerve and synaptic transmission.

Effect of Electrical Stimulation on Vestibular Compensation in the Unilateral Labyrinthectomized Rats / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The effect of electrical stimulation (ES) on vestibular compensation was investigated for 28 days after unilateral labyrinthectomy (Lx) in 24 rats. MATERIALS AND METHOD: The rats were divided into 4 groups and were treated as follows: A) Lx only, B) Lx with ES (0.6 mA) for 2 days, C) Lx with ES (0.6 mA) for 7 days, D) Lx with ES (1.2 mA) for 2 days. ES with pulse wave (10 Hz) was applied to temporal portion bilaterally (8 hr/day). Cathodal currents were transmitted to the electrode on the destructive side, anodal to that on the intact side. Postoperatively, spontaneous nystagmus (SN) was recorded with the video camera and yaw and roll head tilt (YHT, RHT) were measured using photo images. Horizontal vestibulo-ocular reflex (VOR) was evaluated at various frequencies (0.05, 0.1, 0.5, 1, 2, 3 Hz with peak angular velocity of 40degrees/sec) with the magnetic search coil system. Locomotor movement was monitored with a video camera. RESULTS: The ES groups showed faster compensation in SN, YHT, and RHT than the Lx group. At 3 days after Lx, the ES groups showed significant improvement in the gain over the whole frequency and asymmetry at low frequency compared to that of the Lx group. But the ES group had no effect on compensation of gain and asymmetry on and after 7 days of post-labyrinthectomy. There was no significant difference in vestibular compensation with respect to duration and intensity of ES. ES had no significant effect on the mean velocity and mean deviation of locomotor movements. CONCLUSION: These results suggest that ES has a favorable effect on the suppression of early static symptoms but has no effect on the compensation of dynamic symptoms after the recovery of resting discharge of the vestibular nuclei neurons.

The Effect of Administration of Cyclosporin A in Lipopolysaccharide Induced Otitis Media Model / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It has been known that immune reaction plays important roles in the pathogenesis of otitis media with effusion (OME). However, the immunologic mechanisms of OME have not been well defined yet. We investigated the changes of middle ear mucosal inflammation induced by lipopolysaccharide (LPS) following administration of immunosuppressive agent, Cyclosporin A (CsA) in experimental animals. MATERIALS AND METHOD: 35 mul LPS was injected into the middle ears of 30 rats. These rats were divided into groups of 10, each receiving CsA, Dexamethasone, and no treatment, respectively, daily. Five rats from each group were sacrificed at day 2 and 6 after the injection of LPS. RESULTS: Both the CsA-treated and the steroid-treated groups showed lesser inflammatory changes than the untreated groups, however, there were no significant differences between the CsA-treated and the steroid-treated groups. Both on day 2 & day 6, the CsA-treated group showed a decrease of mucosal metaplasia and secretory epithelium, compared with the untreated and steroid-treated group. CONCLUSION: The results suggest that CsA may be effective in decreasing inflammation with particular significance in mucosal mataplasia and the secretion of effusion in OME.

The Expression of Bcl-xL and Bax in Nasal Polyps / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The etiology and the pathophysiology of nasal polyps are still not definitely known and recently, it is suggested that inflammatory responses involving eosinophils may play a major role. The process of the infiltration of eosinophils in tissues is explained by the increase of the movement of eosinophils to the inflammatory area and the delay of apoptosis which results in the longer survival of eosinophils. Recently, there have been studies showing how eosinophils extracted from blood expressed their anti-apoptotic Bcl-xL genes and pro-apoptotic Bax genes when put in a delayed apoptotic condition. The purpose of this study is to investigate Bcl-xL and Bax expressions of eosinophils in nasal polyps and how allergic rhinitis affect their expressions. MATERIALS AND METHOD: Nasal polyps were obtained from patients with chronic paranasal sinusitis (30 cases) and nasal polyps were divided into two groups, one obtained from the patient with allergic rhinitis (15 cases) and the other obtained from the patient without allergic rhinitis (15 cases). The normal control group consisted of 5 cases of normal nasal mucosa in the inferior turbinate. The immunohistochemical stain was used to detect eosinophils and the cells expressing Bcl-xL and Bax. RESULTS: In nasal polyps, a significant statistical correlation between eosinophil numbers and Bcl-xL positive cell numbers was detected. But there was no correlation between them in the normal control. The Bax positive cell numbers had a correlation to eosinophil numbers in both the normal control and nasal polyps. And allergic rhinitis did not affect the expression of Bcl-xL and Bax of eosinophils in nasal polyps. CONCLUSION: The authors propose that in eosinophils of nasal polyps, Bcl-xL plays an important role in delayed apoptosis and allergic rhinitis has no effect on the expression of Bcl-xL and Bax.

Typing of Human Leukocyte Antigen in Patients with Inner Ear Disorders-Preliminary Report / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It has been well known that a number of autoimmune diseases are associated with certain types of human leukocyte antigen (HLA). The pathogenesis of inner ear disorders including Meniere's disease, idiopathic progressive sensorineural hearing loss, sudden sensorineural hearing loss and otosclerosis has not been clearly understood; however it is thought that some of the disorders are related to abnormal immune response, especially autoimmunity. This study was performed to investigate the association between HLA gene and inner ear disorders in Korean and confirm that some of inner ear disorders are mediated by abnormal immune response. MATERIALS AND METHODS: For 29 patients with inner ear disorders and 20 healthy persons without any ear disorders, we performed serologic tests for the typing of HLA-A and HLA-B, and reverse dot hybridization for the typing of HLA-DR. In addition, we also carried out both immunologic screening tests and Western blotting immunoassay against cow's inner ear proteins. RESULT: (1) The frequencies of HLA-A26, HLA-B61, HLA-B62, and HLA-DRB1*04 are significantly increased in the progressive idiopathic sensorineural hearing loss. (2) HLA-DRB1*04 is associated with Meniere's disease. (3) Both HLA-A26 and HLA-B61 are associated with the sudden sensorineural hearing loss. CONCLUSION: Several types of HLA genes were shown to be significantly associated with inner ear disorders despite the small sample size. The results suggest that several specific HLA gene products may confer susceptibility to inner ear diseases.

Sinonasal Infections in Immunocompromised Patients Undergoing Bone Marrow Transplantation / 대한이비인후과학회지

BACKGROUND: Sinonasal infection is potentially a fatal disease in the immunocompromised patients who are undergoing bone marrow transplantation(BMT). OBJECTIVES: The aim of this study is to determine the incidence, symptoms and signs, risk factors, treatment modalities and the prognostic factors of the sinonasal infections in the immunocompromised BMT patients. MATERIALS AND METHODS: We reviewed the records of 235 patients who had received bone marrow transplantation in St. Mary's hospital from December 1983 to August 1995 to determine the clinical features of sinonasal infections in these patients. RESULTS: Forty six patients(19.6%) were affected by sinonasal infections. In 40 patients(17.0%) the infection occurred before BMT. In 11 patients(4.7%), the infection occurred after BMT. Five out of 11 patients(2.1%) had previous sinonasal infections. The most common symptoms and signs were fever and rhinorrhea. Fourteen patients had no discernible symptoms or signs that suggested the presence of sinonasal infection. In our study, patients with previous history of sinonasal infection were more likely to be infected again after BMT. Medical treatment with broad-spectrum antibiotics is the initial treatment modality and surgical treatment is indicated in intractable cases. CONCLUSIONS: The immunocompromised BMT patients have high incidence of serious sinonasal infections than normal immunocompetent persons. Early detection and aggressive combined treatment with medical and surgical modalities are essential for the treatment of sinonasal infections in the BMT patients.