One Case of Objective Tinnitus due to Palatal and Middle Ear Myoclonus / 대한이비인후과학회지

Tinnitus is very frequent and internal noise that impaires the quality of life. Objective tinnitus, which may be caused by palatal and middle ear myoclonus, is an extremely rare disorder. Such tinnitus may present very rapid, irregular and involuntary vibratory sound. Because it is a very rare disorder and patients have difficulty expressing their symptoms of tinnitus, the examiner may miss the diagnosis unless a careful history taking and physical examination is done. We have experienced a patient with objective tinnitus caused by both palatal myoclonus and middle ear myoclonus, who responded poorly to medical therapy and injection of botulinum toxin. However, this patient is treated with pterygoid hamulus fracture and sectioning of the tensor tympani and stapedial tendons. We report a review of the literature and present a case of a 26-year old man who did not respond to medical treatment and had to be relieved of the symptoms with surgical intervention.

Clinical Study of Benign Paroxysmal Positional Vertigo / 대한평형의학회지

BACKGROUND AND OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) was the most frequent peripheral type vertigo. It has been well controlled with canalith repositioning procedure. Canalith repositioning procedure provides rapid and long-lasting relief of symptoms in most patients with BPPV. However, some patients express nonspecific symptoms such as anxiety or discomfort after canalith repositioning procedure, even after the disappearance of nystagmus and vertigo. The purpose of this study is to assess type distribution of BPPV and relationship between recurrence and subjective residual dizziness after canalith repositioning procedure in patients. MATERIALS AND METHODS: Ninety-five BPPV patients of 501 patients with dizziness who visited Dizziness Clinic in the Department of Otolaryngology at Soonchunhyang University Hospital from July 2005 to June 2008 were included in this study. These patients were retrospectively reviewed based on clinical charts. In the case of BPPV, repositioning procedure was performed. We analyzed the recurrence, the relationship between recurrence and subjective residual dizziness after canalith repositioning procedure. RESULTS: Overall recurrence rate was 13.6%. Lateral canal origin was more common than posterior canal origin. All cases except 1 were recovered by canalith repositioning procedure. There was no correlation between recurrence and origin, type, subjective residual dizziness of patients. CONCLUSION: Patients showed various origin, type and recurrence. After the successful canalith repositioning procedure, residual subjective symptoms of patients were presented sometimes, but was no relation to recurrence. Thus, additional follow up and emotional management may be needed.

Clinical Analysis of Cholesterol Granuloma in the Middle Ear / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The Cholesterol granuloma is often observed in middle ear surgeries. In the clinic, it can be found in a normal ear, but also as a recurrent serous otitis media in non-responding medical therapy. The purpose of this study is to analyze the clinical characteristics of cholesterol granuloma with or without cholesteatoma. SUBJECTS AND METHOD: We performed a retrospective study of 40 patients who underwent tympanomastoidectomy between January, 2000 and January, 2009 for cholesterol granuloma. We divided patients into a non-cholesteatoma group and a cholesteatoma group and observed the following clinical manifestations: initial symptom findings, ear drum findings, preoperative audiogram, postoperative audiogram, operative technique and operative findings. RESULTS: Cholesterol granuloma was found in 10.2% of 393 cases (40 cases) who underwent chronic otitis media surgery. Of these, 5.3% (21 cases) was diagnosed with non-cholesteatoma group and 4.8% (19 cases) was diagnosed in the cholesteatoma group. Chief complaints were the difficulty of hearing in the non-cholesteatoma group and otorrhea in the cholesteatoma group. Ear drums were nearly retracted and perforated in both groups, although the cholesteatoma group had more damaged ear drum. Distinctive features of hearing were the conductive type with a moderate degree and ossicular destruction showed missing or eroded incus. Major sites of cholesterol granuloma were antrum, air cells and epitympanum. CONCLUSION: Although ear drum was relatively preserved in the non-cholesteatoma group of cholesterol granuloma, the hearing level and the degree of ossicular destruction were not so much different between the two groups. Therefore, a complete removal of cholesterol granuloma and ossiculoplasty should be considered for better hearing restoration.