Clinical Analysis of Factors Affecting on Treatment of Deep Neck Infection / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The treatment of deep neck infection is antibiotic therapy followed by surgery when it is indicated. There is no detailed guideline for the treatment according to clinical feature or extension of infection. So the purpose of this study is to find out factors affecting the treatment of deep neck infection in the point of clinical feature, laboratorial study and CT finding. SUBJECTS AND METHOD: We have conducted a retrospective study of 67 patients that had been seen between January 2005 and July 2007. We divided patients into a non-surgical group and a surgical group, analyzed clinical informations and laboratorial tests between the two groups, and studied the relations between lesion size, degree of infection and treatment method. RESULTS: There were significant differences between the non-surgically treated and surgically treated groups. The latter group presented with older age, larger lesion, more numbers of involved spaces, highly elevated WBC counts, more decreased in protein counts and had longer treatment period prior to hospitalization than the former group. Also, the size of the affected lesion was bigger, the incidence of abscess formation higher and required surgical treatment more often. CONCLUSION: Surgical management has an advantage when the lesion size is more than 7 cm, even if it presents an incomplete abscess. If the laboratory study reveals highly sustained WBC counts after proper antibiotic therapy and low protein counts, more aggressive treatment should be considered, especially for old patients.

Anterior Inferior Cerebellar Artery Infarction Misdiagnosed as Labyrinthitis: A Case Report / 대한이비인후과학회지

Anterior inferior cerebellar artery infarction is the second most common cause of brainstem stroke, and usually accompanied by vertigo, unilateral deafness, ipsilateral facial weakness and ataxia. These symptoms can be confused with other peripheral causes of sudden hearing loss accompanying dizziness including acute labyrinthitis, idiopathic sudden hearing loss, perilymphatic fistula and acoustic neuroma. This case report presents a man who first visited our clinic for sudden hearing loss with vertigo, and whom we treated for acute labyrinthitis. However, 3 days later, left facial numbness was observed and the magnetic resonance imaging (MRI) showed an anterior inferior cerebellar infarction. The patient was then transferred to the neurology department and treated with anticoagulant and antiplatelet agents. After 7 days of treatment, the hearing loss and dizziness were improved and the facial numbness resolved.

A Case of Desmoplastic Fibroblastoma Originated from the External Auditory Canal and Mastoid / 대한이비인후과학회지

Desmoplastic fibroblastoma is a rare but distinctive fibrous benign soft tissue tumor that presents a slowly growing, painless, fibroproliferative mass. Occuring in patients of various ages, it appears hypocellular microscopically, and consists of widely spaced bland spindles or stellar-shaped cells that are embedded in rich wavy collagenous or myxocollagenous stroma. Desmoplastic fibroblastoma was first characterized by Evans in 1995. Thereafter, there were several reports of desmoplastic fibroblastoma that it occured commonly in the upper extremity including regions such as shoulder, upper arm, and lower extremity, followed by the head and neck region. But there was no report of occurrence at the ear. We report our experience of desmoplastic fibroblastoma with histopathologic confirmation: we removed a mass at the mastoid cavity and external auditory canal. We also provide a review of literature related to it.

The Optimization of Galvanic Vestibular Stimulation according to Evoked Nystagmus

BACKGROUND AND OBJECTIVES:The aim of this study were to observe the nystagmus of normal general populations on galvanic vestibular stimulation, to set a new korean standard for galvanic vestibular stimulation. MATERIALS AND METHOD:We recruited 10 healthy adults and they were stimulated by 1,2,3 mA monaural monopolar, monaural bipolar, binaural monopolar, binaural bipolar galvanic vestibular stimulation through carbon-rubber electrode and Ag-AgCl electrode. We evaluated galvanic stimulating nystagmus and after galvanic stimulating nystagmus on sitting position through Frenzel goggle and video-nystagmography. RESULTS:We detect stimulating and after-stimulating nystagmus on 1,2,3 mA monaural monopolar, monaural bipolar, binaural monopolar, binaural bipolar galvanic vestibular stimulation. The nystagmus on galvanic vestibular stimulation was directed to the negative electrode side and after-galvanic stimulating nystagmus was directed to opposite side. The greater current, the more occurrence of nystagmus was found. We detect nystagmus mostly on monaural bipolar vestibular stimulation through carbon-rubber electrode. We thought most effective Galvanic vestibular stimulation was 2 mA monaural bipolar vestibular stimulation through carbon-rubber electrode in consideration of increased pain and discomfort on 3 mA monaural bipolar vestibular stimulation in spite of high occurrence of nystagmus. CONCLUSION:Galvanic vestibular stimulation evoked different nystagmus according to stimulation, stimulated site. We thought 2 mA monaural bipolar vestibular stimulation through carbon-rubber electrode was most effective, stable galvanic stimulation. Specifity and sensitivity of 2 mA monaural bipolar vestibular stimulation were 100%, 100% respectively. Galvanic vestibular stimulation is useful to evaluate vestibular function.