Multicenter study on the treatment pattern of Meniere'sdisease in Korea

BACKGROUND AND OBJECTIVES: It is hard to determine the efficacy of several treatment options of Meniere's disease since dynamic course of the disease and diverse rate of recurrence. Few modalities are regarded as 'effective' in the viewpoint of evidence based medicine. Study was conducted to know the current status of treatment options for Meniere's disease. MATERIALS AND METHODS: A multicenter survey was conducted using questionnaires to collect information on current status of treatment patterns in Meniere's disease. The questionnaire answered by neurotologic surgeons working at 12 institutes in Korea was analyzed. RESULTS: Low salt diet was always instructed to their patients, but 8 out of 12 responders (67%) did not emphasis on the amount of dietary salt. Duration of pharmacotherapy was ranged from 3 to 12 months. Intratympanic steroid injection was performed in 8 institutes (67%). Every institute agreed on the role of intratympanic gentamicin application. Treatment options for intractable patients were asked. Endolymphatic sac surgery, intratympanic steroid, Meniette device and intratympanic aminoglycoside injection were answered in patients who hope to preserve residual hearing. On the contrary, in patients without serviceable hearing, intratympanic jnjection of aminoglycosides (9/12, 75%) dominated as the next treatment option. CONCLUSIONS: Most institutes provide similar patterns of practice in medical treatment. The application of intratympanic aminoglycoside is also agreed in intractable patients without serviceable hearing. However, thoughts about the role and detailed methods of the surgical and adjunctive treatment options were not agreed, especially in intractable patients with good hearing. Further clinical studies and discussions would be necessary to provide consensus for the best treatment of Meniere's disease in Korea.

Long-Term Follow-Up of Immunotherapy in Allergic Rhinitis to House Dust Mite / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study was to evaluate the long-term effect of immunotherapy on the allergic rhinitis patients to house dust mite (HDM) patients. SUBJECTS AND METHOD: Sixty-five patients were treated for allergic rhinitis in the allergy clinic. Every patient underwent immunotherapy for 3 to 5 years and did not receive any additional treatments after the completion of the initial one. The survey on the symptom improvement and the patients' satisfaction was carried out 3 and 10 years after the immunotherapy treatment. The results of skin prick test for each individual were analyzed before, 3 and 10 years after the immunotherapy, respectively. RESULTS: Overall symptom improvement surveyed 10 years after the immunotherapy decreased compared with that taken after 3 years of the treatment (p<0.05). In particular, symptom improvements on sneezing, itching sensation, and rhinorrhea was significantly decreased after 10 years (p<0.05). Patients' satisfaction level was 64.6% after 3 years and 49.2% after 10 years of the immunotherapy treatment. Skin prick test reactivity was significantly decreased after 3 years of the treatment compared to before the treatment. Although skin prick test reactivity measured in 10 years after immunotherapy increased compared with that measured in 3 years after, there was little statistical significance when compared with the reactivity before the treatment. CONCLUSION: The immunotherapy has long term efficacy on allergic rhinitis to HDM. However, the efficacy decreased after the discontinuance of the immunotherapy treatment.

Bacteriology of Tonsillar Cores in Obstructive Tonsillar Hypertrophy and Recurrent Tonsillitis Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study was to find whether bacteriological characteristics can affect the size and recurrent infections of the tonsil by comparing the type and number of bacteria located in the core of palatine tonsil in obstructive tonsillar hypertrophy (OTH) and recurrent tonsillitis (RT) patients. SUBJECTS AND METHOD: Palatine tonsils of patients who received tonsillectomy due to OTH and RT were studied. The excised tonsil was dissected into two pieces and one gram of the core tissue was obtained for examination. Mixture of normal saline and homogenized tissue was inoculated using various culture media. The types of isolates and bacterial concentrations in each isolate was compared between the two groups. RESULTS: Commonly isolated aerobic bacteria in the order of frequency for the OTH group were Streptococcus viridans, Staphylococcus aureus, and Neisseria spp., whereas it was Neisseria spp., Streptococcus viridans, Staphylococcus aureus, and Haemophilus influenzae for the RT group. Peptostreptococcus spp. was the most frequently isolated anaerobe in both OTH group and RT group. There was no statistically significant difference in types of isolates between the two groups except for Haemophilus influenzae and Bacteroides spp. The density of cultured bacteria (number of bacteria per 1 gram of tissue) was greater in the RT group than in the OTH group. CONCLUSION: There was no definite difference in the number of isolate types between the OTH group and RT group. Bacterial density was higher in the RT group than in the OTH group. Therefore, bacterial density might have an influence on the recurrence of tonsillitis.