Changes of Serum Aldosterone Concentration after Noise Exposure in Mice

BACKGROUND AND OBJECTIVES: The study was designed to measure the change of serum aldosterone concentration after noise exposure in BALB/c mice. MATERIALS AND METHODS: BALB/c hybrid mice with < or =25 dB nHL in auditory brainstem responses (ABR) were used. Six mice were exposed to 120 dB SPL broad white band noise for 3 hours per day for 3 consecutive days. ABRs in all mice were examined after noise exposure. Serum aldosterone concentration was checked by radioimmunoassay in three mice without noise exposure, in three mice immediately after noise exposure (0 day after noise group), and in three mice 3 days after noise exposure (3 days after noise group). RESULTS: Permanent noise exposure-related threshold shift was induced in mice of 0 day after noise group and 3 days after noise group (83.3+/-2.9 and 88.3+/-2.9 dB nHL, respectively). The serum aldosterone concentration of the mice after noise exposure was significantly lower than control mice (p=0.046). The changes of aldosterone concentration were 879+/-137.5 pg/mL without noise exposure, 623+/-75.9 pg/mL immediately after noise exposure, and 683+/-49.2 pg/mL 3 days after noise exposure. CONCLUSIONS: In BALB/c mice, serum aldosterone concentration is decreased significantly after noise exposure.

Compliance with Positive Airway Pressure Treatment for Obstructive Sleep Apnea

OBJECTIVES: Positive airway pressure (PAP) is considered a standard treatment for moderate-to-severe obstructive sleep apnea (OSA) patients. However, compliance with PAP treatment is suboptimal because of several types of discomfort experienced by patients. This study investigated compliance with PAP therapy, and affecting factors for such compliance, in OSA patients. METHODS: We performed a survey on 69 patients who engaged in PAP therapy between December 2006 and November 2007. After diagnostic polysomnography and manual titration, patients trialed PAP using the ResMed instrument and explored autoadjusting PAP (APAP), continuous PAP (CPAP), and flexible PAP (using expiratory pressure relief [EPR]) at least once every week for 1 month. Compliance measures were mean daily use (hr), percentage of days on which PAP was used, and percentage of days on which PAP was used for >4 hr. Data were obtained at night using the software Autoscan version 5.7(R) of the ResMed Inc. We obtained data on anthropometric (age, BMI, neck circumflex, Epworth sleepiness scale, Pittsburgh Sleep Quality Index, hypertension, alcohol intake), polysomnographic data (severity of apnea-hypopnea index [AHI], proportion of nonsupine sleep time, position dependence of sleep), PAP mode and AHI during PAP use for affecting factors. RESULTS: After 1 month, 41 of the 69 patients (59.4%) were pleased with PAP therapy and purchased instruments. Twenty-four patients (34.7%) used PAP for more than 3 months. The percentage of days on which PAP was used was statistically higher in patients with hypertension than in normotensive patients (P=0.003). There were negative correlations 1) between nonsupine position sleep time and percentage of days on which PAP was used (r=-0.424, P=0.039), and 2) between the AHI during PAP use and the percentage of days on which PAP was used for >4 hr (r=-0.443, P=0.030). There were no statistical differences between AHI, BMI, PAP pressure, or other measured parameters, on the one hand, and compliance, on the other. CONCLUSION: The affecting factors for PAP use were hypertension history, sleep posture (shorter nonsupine sleep time), and lower AHI during PAP use.

Hearing Results after Stapedotomy in Stapes Fixation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Many studies have demonstrated that stapedotomy is a successful means of improving hearing for stapes fixation. The aim of this study was to analyze the pre and post-operative hearing improvements and causes of unsuccessful cases after stapedotomy. SUBJECTS AND METHOD: We reviewed the medical records and video recordings of 38 patients(39 ears) retrospectively who underwent stapedotomy between January 1994 and March 2006. Beside stapes fixation, patients, having other ossicular anomaly, stapes fixation in chronic middle ear disease and past history of ear surgery, were excluded. Patient ages ranged from 6 to 60 years, with the patients consisting of 15 males, 16 ears and 23 females, 23 ears. Observation ranged from 8 to 50 months and the mean observation time was 15.4+/-11.6 months. Hearing improvements at the final examination were designated as successful when air-bone gap was reduced to 20 dB or less. RESULTS: Pre-operative mean bone and air conduction thresholds were 21.6+/-10.8 (mean+/-SD) dBHL, 53.4+/-12.1 dBHL respectively and mean air-bone gap were 31.8+/-8.8 dB. After stapedotomy, mean bone and air conduction thresholds were 17.6+/-9.0 dBHL, 29.6+/-11.9 dBHL respectively and mean air-bone gap were 11.5+/-7.1dB at the last audiologic follow-up. Successful hearing improvements were achieved in 36 ears (92.3%). Three patients underwent revision surgery. CONCLUSION: This study suggests that stapes surgery is successful for hearing improvement for stapes fixation with unknown etiology.

Surgical Outcome of Revision Stapedotomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study is to analyze the causes of recurrent conductive hearing loss following stapedotomy, and then the final hearing results. SUBJECTS AND METHOD: This study was a retrospective chart review of 6 patients who underwent revision stapedotomy for recurrent or persistent conductive hearing loss after primary stapedotomy. The intraoperative findings, surgical outcome including audiologic data and complications were noted. RESULTS: Obstruction of oval window fenestration was demonstrated in 5 patients (83.3%), short prosthesis in 4 patients (66.7%), incus erosion in two patients (33.3%) and granulation around prosthesis and stapes in one patient. Successful hearing improvements, air-bone gap (ABG) reduced to 20 dB or less, were achieved in 5 ears (83.3%). There were no patients who noted sensorineural hearing loss and other significant complications after surgery. CONCLUSION: More than 83% of revision stapedotomy cases have had successful closure of their ABG. The most common problem was obstruction of oval window fenestration (83.3%).

Primary Mucoceles of the Maxillary Sinus / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Maxillary sinus mucoceles are usually developed long after Caldwell-Luc's operation, which are known as postoperative cheek cysts and common in Korea. However, primary mucoceles of the maxillary sinus are relatively rare compared to frontal or ethmoid sinus mucoceles. This study aims to describe the clinical manifestation of the primary maxillary sinus mucoceles and to determine the long-term efficacy of the surgical treatment. MATERIALS AND METHOD: Seven cases, comprised of 2 women and 5 men with an age range of 23 to 72 years, finally diagnosed as primary maxillary sinus muco (pyo)celes between March 1995 and July 2004 were studied. The presenting signs and symptoms, radiological findings, and surgical management were retrospectively reviewed. RESULTS: All patients complained of nasal obstruction, while only one patient had cheek pressure and pain. In the endoscopic nasal examination, the medial wall of maxillary sinus was bulging with prolapsed middle meatal mucosa in 6 cases. Five patients were treated with endonasal endoscopic sinus surgery and two with sublabial approach. Intraoperative cultures grew organisms in four patients. In all patients, the middle meatal antrostomy openings were patent without recurrence at the latest follow-up ranging from 11 to 47 months. CONCLUSION: A primary maxillary sinus mucocele appears as a bulging medial wall with unilateral nasal obstruction. Endoscopic sinus surgery is a reliable therapeutic measure with lesser morbidity and favorable long-term outcome.

Isolated Microorganisms and Antimicrobial Resistance of the Deep Neck Infection: A Retrospective Review of 76 Cases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The incidence of deep neck infection has decreased after the introduction of antibiotics and improvement of oral hygiene, but they still may be lethal especially when life-threatening complications occur. The purposes of this study are to find out common organisms, rates of antimicrobial resistance in the deep neck infection. SUBJECTS AND METHOD: We have conducted a retrospective study of 76 patients with the diagnosis of deep neck infection that had been seen between January 1998 and December 2003. RESULTS: The most common pathogens found were Streptococcus viridans (34%), followed by Klebsiella pneumoniae (19.4%), Streptococcus Group F (11.9%), beta-hemolytic streptococci (11.9%) and Peptostreptococcus (7.5%). Staphylococcus species was not found. Of the aerobes found, 74.1% were sensitive to all antibiotics. All Streptococci, with one exception, were not resistant to any antibiotics. All Klebsiella pneumoniae were resistant to ampicillin. Klebsiella pneumoniae were cultured in 50% of DM patients. CONCLUSION: The most common pathogens were Streptococcus viridans (34%). Of these aerobes, 74.1% were sensitive to all antibiotics. All isolated microorganisms were sensitive to ampicillin/sulbactam (Unasyn(R)) used before the results of bacterial cultures.

Clinical Characteristics and Treatment Outcomes of Endoscopic Sinus Surgery in Pediatric Chronic Rhinosinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Pediatric rhinosinusitis continues to be a challenging problem to otolaryngologists. This study aims to assess the clinical characteristics of chronic rhinosinusitis and the treatment outcomes of endoscopic sinus surgery (ESS) in children. SUBJECTS AND METHOD: Forty eight patients (13 women and 35 men with an age range of 7 to 17 years) were available for analysis by medical records and questionnaire. We classified the patients into three groups: 25 cases of chronic rhinosinusitis with nasal polyposis (CRSNP), 11 cases of chronic rhinosinusitis without nasal polyposis (CRS), 12 cases of antrochoanal polyps (ACP). Objective outcome of ESS was evaluated through endoscopic examination and subjective outcome through questionnaire. Postoperative follow-up period ranged between 6 and 26 months. RESULTS: Thirty-nine patients were treated with ESS and nine with ESS with concomitant adenoidectomy. Thirty-nine patients (81.2%) showed good outcomes by endoscopic examination. Also, thirty-eight patients (79.2%) reported high satisfaction by questionnaire. There were no statistical differences in the results through endoscopy and subjective satisfaction through questionnaire among three groups. CRSNP and ACP groups tended to have higher recurrence rate than CRS group. CRSNP group showed higher CT Lund-Mackay scores than ACP group and CRS group. Synechia occurred in 4 (8.3%) of 48 patients. Ten patients (20.8%) required endoscopic polypectomy or revision surgery. CONCLUSION: While pediatric ESS is still in progress and its role continues to be defined, the results of current study suggest that pediatric ESS is a safe and efficacious therapy for management of chronic rhinosinusitis in children.

The Complications of Type I Thyroplasty with Silastic Block / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The type I thyroplasty has become the gold standard against which glottal incompetence caused by unilateral vocal fold palsy may be improved. The primary purpose of this study was to investigate the types and incidence of complications in the type I thyroplasty with sialstic block. MATERIAL AND METHOD: Fifty-eight patients undergoing medialization thyroplasty due to unilateral vocal fold palsy between January 1996 and December 2003 were included for this study. Of 58 patients, 23 were women and 35 were men, with an age range of 18 to 88 years (average 47.8+/-16.4 years). A retrospective study was performed with medical records for surgical complications. RESULTS: The most common complications were incompletely corrected posterior chink in four patients. Other complications include incorrected aspiration in two patients, poor voice quality requiring revision surgery in one patient and endolaryngeal extrusion of implant in one patient. But there were no airway complications acquiring intervention. The overall complication rate was 13.7% but major complication rate was 6.7%. CONCLUSION: Complications of the type I thyroplasty with silastic block are relatively few. This procedure can be used safely in patients with unilateral vocal cord palsy. Surgeons should be well aware of complications of the type I thyroplasty with silastic block to cope with them.

Granular Cell Tumors of the Head and Neck: A Case Report of 9 Cases / 대한이비인후과학회지

Granular cell tumor (GCT) is a rather uncommon neoplasm. Though GCTs are usually small, solitary and benign in most cases, a small number (1-2%) of cases are malignant. They can originate from anywhere in the body but are most frequently found in the head and neck, particularly in an oral cavity. Histopathologically, GCT is composed of large, round, or polygonal cells with small dense nuclei. Cytoplasm contains abundant eosinophilic granules. In an immunohistochemical study, granules of GCT are positive for S-100 protein. Surgical intervention, wide excision with enough margin, is the treatment modality of choice. Inadequate resection of a tumor may result in local recurrence, even with a benign GCT. We have experienced 9 cases of GCT between December 1997 and June 2003, and report on them with a review of literatures.

Spindle Cell Sarcoma after Radiation Therapy for Nasopharyngeal Cancer: A Case Report / 대한이비인후과학회지

Radiation-induced sarcoma of the head and neck (RISHN) is one of long-term complications of radiotherapy. The rarity of this tumor is reflected in a few cases reported in the English language medical literature. The incidence of RISHN is, however, likely to increase due to progressive aging of the population combined with improved survival of head and neck cancer patients resulting from better treatment regimes. Diagnosis and management of this problem can be extremely challenging. We have experienced a case of spindle cell sarcoma arising in the nasopharynx of a 52-year-old who followed radiotherapy for nasopharyngeal undifferentiated carcinoma. So, we elaborate on it in our report with a review of literatures. To our knowledge, this is the first report about radiation-induced spindle cell sarcoma in Korea.

Otogenic Brain Abscess: Recent Experience of 13 Cases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although the modern antibiotic regimen has decreased the incidence of serious otogenic complications, the brain abscess is still one of the most significant life threatening complications of otologic diseases. The aim of this study was to evaluate the clinical aspects of patients with otogenic brain abscesses and to evaluate the appropriate treatment for the disease. MATERIALS AND METHOD: We reviewed 13 patients of otogenic brain abscess who were treated during a 7-year period. RESULTS: In all but three of the above cases, a stereotaxic CT guided aspiration of the brain abscess was performed prior to otologic surgery of the temporal bone. For the exceptions, the drainage of the brain abscess was performed simultaneously with a subtotal petrosectomy. After an average of 40.2 months of follow-up, none of the patients showed a recurrence or a neuro-logical deficit. CONCLUSION: We concluded that the adequate use of intravenous antibiotics and the drainage of the brain abscess followed by temporal bone surgery could decrease mortality and morbidity. Total removal of cholesteatoma and the use of parenteral antibiotics for 4 to 8 weeks are needed to eradicate a brain abscess.