A Case of Periorbital Necrotizing Fasciitis Occurred in Patient with Fungal Sinusitis / 대한이비인후과학회지

Orbital complications due to sinusitis usually occur in children and spread from the ethmoid or frontal sinusitis. Periorbital necrotizing fasciitis, which is an aggressive infection characterized by extensive necrosis and gas formation in the fascia and subcutaneous tissue, is uncommon as an orbital complication due to sinusitis. Because most of orbital complications of the fungal sinusitis occur from invasive fungal infection in immunocompromised patients, orbital complications due to non-invasive maxillary fungal ball in healthy patients are extremely rare, especially if the complication is periorbital necrotizing fasciitis. We report a case of periorbital necrotizing fasciitis that occurred in a healthy 44-year-old male patient with non-invasive fungal sinusitis, which was treated with a combination of intravenous antibiotics and endoscopic sinus surgery and ophthalmologic surgical treatment.

A Case of Periorbital Necrotizing Fasciitis Occurred in Patient with Fungal Sinusitis / 대한이비인후과학회지

Orbital complications due to sinusitis usually occur in children and spread from the ethmoid or frontal sinusitis. Periorbital necrotizing fasciitis, which is an aggressive infection characterized by extensive necrosis and gas formation in the fascia and subcutaneous tissue, is uncommon as an orbital complication due to sinusitis. Because most of orbital complications of the fungal sinusitis occur from invasive fungal infection in immunocompromised patients, orbital complications due to non-invasive maxillary fungal ball in healthy patients are extremely rare, especially if the complication is periorbital necrotizing fasciitis. We report a case of periorbital necrotizing fasciitis that occurred in a healthy 44-year-old male patient with non-invasive fungal sinusitis, which was treated with a combination of intravenous antibiotics and endoscopic sinus surgery and ophthalmologic surgical treatment.

Melanin extract from Gallus gallus domesticus promotes proliferation and differentiation of osteoblastic MG-63 cells via bone morphogenetic protein-2 signaling

BACKGROUND/OBJECTIVES: Gallus gallus domesticus (GD) is a natural mutant breed of chicken in Korea with an atypical characterization of melanin in its tissue. This study investigated the effects of melanin extracts of GD on osteoblast differentiation and inhibition of osteoclast formation. MATERIALS/METHODS: The effects of the melanin extract of GD on human osteoblast MG-63 cell differentiation were examined by evaluating cell viability, osteoblast differentiation, and expression of osteoblast-specific transcription factors such as bone morphogenetic protein 2 (BMP-2), small mothers against decapentaplegic homologs 5 (SMAD5), runt-related transcription factor 2 (RUNX2), osteocalcin and type 1 collagen (COL-1) by reverse transcription-polymerase chain reaction and western blotting analysis. We investigated the inhibitory effect of melanin on the osteoclasts formation through tartrate-resistant acid phosphatase (TRAP) activity and TRAP stains in Raw 264.7 cell. RESULTS: The melanin extract of GD was not cytotoxic to MG-63 cells at concentrations of 50-250 µg/mL. Alkaline phosphatase (ALP) activity and bone mineralization of melanin extract-treated cells increased in a dose-dependent manner from 50 to 250 µg/mL and were 149% and 129% at 250 µg/mL concentration, respectively (P < 0.05). The levels of BMP-2, osteocalcin, and COL-1 gene expression were significantly upregulated by 1.72-, 4.44-, and 2.12-fold in melanin-treated cells than in the control cells (P < 0.05). The levels of RUNX2 and SMAD5 proteins were higher in melanin-treated cells than in control vehicle-treated cells. The melanin extract attenuated the formation of receptor activator of nuclear factor kappa-B ligand-induced TRAP-positive multinucleated RAW 264.7 cells by 22%, and was 77% cytotoxic to RAW 264.7 macrophages at a concentration of 500 µg/mL. CONCLUSIONS: This study provides evidence that the melanin extract promoted osteoblast differentiation by activating BMP/SMADs/RUNX2 signaling and regulating transcription of osteogenic genes such as ALP, type I collagen, and osteocalcin. These results suggest that the effective osteoblastic differentiation induced by melanin extract from GD makes it potentially useful in maintaining bone health.

Clinical Characteristics of Traumatic Benign Paroxysmal Positional Vertigo Compared with Idiopathic Benign Paroxysmal Positional Vertigo / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) is one of the most common diseases in patients with dizziness after head trauma. The aim of the study was to investigate the clinical characteristics of the traumatic BPPV (tBPPV) compared with idiopathic BPPV (iBPPV). SUBJECTS AND METHOD: From January 2008 to June 2015, a retrospective review was performed on 572 patients diagnosed with BPPV and treated with appropriate canalith reposition maneuver. Clinical characteristics of patients, such as age, sex, affected semicircular canal, and number of reposition maneuver were evaluated and compared between iBPPV and tBPPV. Canal change and recurrence rate were also assessed. RESULTS: Among 572 BPPV patients, 509 were iBPPV and 63 were tBPPV. The male to female ratio was higher in tBPPV (26/37) than in iBPPV (142/367) (p=0.028). Posterior semicircular canal (PSCC) was more commonly affected than lateral semicircular canal in the tBPPV group compared with the iBPPV group (38/18 vs. 244/257). Also multiple canal was more commonly affected in the tBPPV group than in the iBPPV group (11.11/3.54%) (p=0.001). The tBPPV group needed fewer number of canalith reposition maneuver for symptom relief than the iBPPV group did (1.35 vs. 1.53, p=0.048). The side of affected canal was more frequently changed in tBPPV than in iBPPV (22.22% vs. 11.98%, p=0.023). There was no significant difference in recurrence rate between tBPPV and iBPPV (18.87% vs. 19.25%, p=0.518). However, the tBPPV group had a tendency of earlier recurrence than the iBPPV patients (1.33 month vs. 2.86 month, p=0.050). CONCLUSION: tBPPV was more common in male and PSCC was usually affected. The tBPPV patients had a tendency of frequently changing the canal type and an earlier recurrence than the iBPPV patients. These distinguished clinical features would be useful in diagnosing and managing tBPPV patients.

Appropriate Surgical Extent in the Surgery for Graves' Disease / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Thyroidectomy for Graves' disease is a rapid, safe, highly successful treatment modality. Also thyroidectomy allows pathological examination for diagnosis of suspected cancer. However, the extent of thyroidectomy in Graves' disease is still controversial. The aim of this study is to evaluate the appropriate surgical extent by comparing the postoperative outcomes of two groups of patients with Graves' disease who underwent total or less than total thyroidectomy. SUBJECTS AND METHOD: We carried out a retrospective review of 33 patients who underwent thyroidectomy for Graves' disease from January 2001 to December 2010. We investigated the postoperative thyroid hormone function and complication rate according to the extent of thyroidectomy. RESULTS: Among the 33 patients with Graves' disease, 19 patients underwent total thyroidectomy, six patients bilateral subtotal thyroidectomy (BST) and eight patients lobectomy and contralateral subtotal lobectomy (LCSL). Postoperative hypothyroidism, euthyroidism, and hyperthyroidism occurred in 27 (81.7%), 2 (6.1%) and 4 (12.2%) patients, respectively. Postoperative recurrent hyperthyroidism was observed in 2 (33.3%) patients of BST and in 2 (25.0%) of LCSL. One patient was found with permanent hypoparathyroidism, and two with transient vocal cord paralysis. According to histopathologic report, nine patients were accompanied with thyroid cancer. CONCLUSION: Thyroidectomy for Graves' disease has high success rate, low recurrence rate and low complication rate. In terms of surgical extent, total thyroidectomy is a more appropriate procedure because of its low recurrence of hyperthyroidism.

The Association of Anterior Inferior Cerebellar Artery in Internal Auditory Canal with Tinnitus and Hearing Loss

BACKGROUND AND OBJECTIVES: Tinnitus is a common disorder, but the etiology of this disorder remains unknown. The objective of this study was to assess the correlation between anatomical type and the thickness of the anterior inferior cerebellar artery (AICA) loop with tinnitus, using 3D-fast imaging employing steady state acquisition magnetic resonance image (MRI). MATERIALS AND METHODS: 74 patients with tinnitus and 82 asymptomatic controls were included in this study. Otologic symptoms, which was measured based on the results of a pure tone audiometry, were reviewed. We evaluated the position and thickness of the AICA vascular loop in 3D-FIESTA MRI using two scoring systems. The first system was Chavda classification based on the anatomical location of the AICA loop. The second scoring system was used to measure the thickness of the AICA loop. The AICA loops were classified into two groups based on thickness, thinner than adjacent facial nerve and thicker than the facial nerve. RESULTS: Ears with type I, II AICA loops showed significantly higher rates of tinnitus than those with type III. There was no association between the type of AICA loop and subtype of tinnitus (pulsatile, nonpulsatile). There was no association between the type of tinnitus and hearing loss. Ears with thinner AICA loop had a higher rate of tinnitus than those with thicker AICA loop. CONCLUSIONS: The type I, II and thinner AICA loop was significantly correlated with tinnitus. Compression of VIIIth cranial nerve by AICA loops at a cerebellopontine angle and impaired blood flow through the vessel may be the pathophysiology of tinnitus.

The Association of Anterior Inferior Cerebellar Artery in Internal Auditory Canal with Tinnitus and Hearing Loss

BACKGROUND AND OBJECTIVES: Tinnitus is a common disorder, but the etiology of this disorder remains unknown. The objective of this study was to assess the correlation between anatomical type and the thickness of the anterior inferior cerebellar artery (AICA) loop with tinnitus, using 3D-fast imaging employing steady state acquisition magnetic resonance image (MRI). MATERIALS AND METHODS: 74 patients with tinnitus and 82 asymptomatic controls were included in this study. Otologic symptoms, which was measured based on the results of a pure tone audiometry, were reviewed. We evaluated the position and thickness of the AICA vascular loop in 3D-FIESTA MRI using two scoring systems. The first system was Chavda classification based on the anatomical location of the AICA loop. The second scoring system was used to measure the thickness of the AICA loop. The AICA loops were classified into two groups based on thickness, thinner than adjacent facial nerve and thicker than the facial nerve. RESULTS: Ears with type I, II AICA loops showed significantly higher rates of tinnitus than those with type III. There was no association between the type of AICA loop and subtype of tinnitus (pulsatile, nonpulsatile). There was no association between the type of tinnitus and hearing loss. Ears with thinner AICA loop had a higher rate of tinnitus than those with thicker AICA loop. CONCLUSIONS: The type I, II and thinner AICA loop was significantly correlated with tinnitus. Compression of VIIIth cranial nerve by AICA loops at a cerebellopontine angle and impaired blood flow through the vessel may be the pathophysiology of tinnitus.

A Case of Fungal Infection in Onodi Cell with Visual Loss / 대한이비인후과학회지

The Onodi cell, which is a posterior ethmoid cell that gets pneumatized far laterally and to some degree superiorly to the sphenoid sinus, is intimately associated with the optic nerve. The problem with most cases of Onodi cells is that acute visual loss may occur in association with a compression to the optic nerve by a mucocele of an Onodi cell. We report, with a review of literature, a case of fungal infection in Onodi cells with acute visual loss in a 71 year-old female patient, who was treated by endoscopic sinus surgery with electrical drill and steroid therapy.