Impact of Time Interval between Index Event and Stenting on Periprocedural Risk in Patients with Symptomatic Carotid Stenosis

Objective@#: The purpose of this study was to evaluate the impact of time interval between index event and stenting on the periprocedural risk of stenting for symptomatic carotid stenosis and to determine the optimal timing of stenting. @*Methods@#: This retrospective study included 491 (322 symptomatic [65.6%] and 169 asymptomatic [34.4%]) patients undergoing carotid stenting. The symptomatic patients were categorized into Day 0–3, 4–7, 8–10, 11–14, 15–21, and >21 groups according to the time interval between index event and stenting. Periprocedural (≤30 days) risk for clinical (any neurological deterioration) and radiological (new infarction on postprocedural diffusion-weighted imaging) events of stenting in each time interval versus asymptomatic stenosis was calculated with logistic regression analysis adjusted for confounders, and provided as odds ratio (OR) and 95% confidence interval (CI). @*Results@#: Overall clinical event rate (4.3%) of stenting for symptomatic carotid stenosis was higher than that for asymptomatic stenosis (1.2%; OR, 3.979 [95% CI, 1.093–14.489]; p=0.036). Stenting in Day 0–3 (13.2%; OR, 10.997 [95% CI, 2.333–51.826]; p=0.002) and Day 4–7 (8.3%; OR, 6.775 [95% CI, 1.382–33.227]; p=0.018) was associated with high risk for clinical events. However, the clinical event rates in stenting after 7 days from index event (Day 8–10, 1.8%; Day 11–14, 2.5%; Day 15–21, 0%; Day >21, 2.9%) were not different from that in stenting for asymptomatic stenosis. Overall radiological event rate (55.6%) in symptomatic stenosis was also higher than that in asymptomatic stenosis (35.5%; OR, 2.274 [95% CI, 1.553–3.352]; p21 : 54.8%; OR, 2.203 [95% CI, 1.342–3.641]; p=0.002). @*Conclusion@#: This study showed that as stenting was delayed, the periprocedural risk for clinical events decreased. The clinical event risk was high only in stenting within 7 days and comparable with that for asymptomatic stenosis in stenting after 7 days from index event, although the radiological event risk was not affected by stenting timing. Therefore, our results suggest that delayed stenting after 7 days from symptom onset is a safe strategy for symptomatic stenosis.

Primary Intraocular T-cell Lymphoma

PURPOSE: Intraocular lymphoma can be divided into primary and secondary usually involving B-cell lymphoma. Intraocular T-cell lymphoma is mostly secondary lymphoma while primary intraocular T-cell lymphoma is extremely rare. We report a case of primary T-cell lymphoma. CASE SUMMARY: A 62-year-old male without any systemic disease presented with a floater in the right eye. A fundus examination showed multiple whitish retinal infiltrations in the right eye. Intraocular lymphoma was suspected, and systemic examination was performed, but all results were normal. During steroid treatment, previous lesions were enlarged, new lesions developed, and a diagnosis of primary T-cell lymphoma was made by diagnostic vitrectomy. Consecutive intravitreal injections of methotrexate were performed. After eight injections, the vitreous and retinal lesions improved but we decided to terminate the injections due to corneal epitheliopathy. The corneal epitheliopathy was recovered and the patient is currently undergoing periodic follow-ups without progression of the lesion. CONCLUSIONS: Although intraocular T-cell lymphoma is a rare condition, this primary T-cell type should be considered when an intraocular lymphoma lesion is suspected.

Analysis of Medical Dispute Relating to Ophthalmology in Korea Medical Dispute Mediation and Arbitration Agency

PURPOSE: To analyze the characteristics of medical disputes relating to ophthalmology for prevention in advance. METHODS: Retrospective analyses of ophthalmic cases applied for Korea Medical Dispute Mediation and Arbitration Agency between June 2013 and September 2016. RESULTS: A total of 41 cases were analyzed. The number of cases relating to cataract were 19 (46.3%), refractive surgery 4 (9.8%), anterior segment 4 (9.8%), retina 7 (17.1%), oculoplasty 3 (7.3%), glaucoma 2 (4.9%), and miscellaneous 2 (4.9%). The specialty with the lowest mean payment of mediation per case was cataract (￦3,591,700), which has the largest number of cases, and oculoplasty was the highest mean payment per case (￦21,933,000). There were 16 cases confirmed as negligence by authenticators. Among these 16 cases, 7 (44%) were related to accident during surgery or procedure, 5 cases (31%) were insufficient explanation, and 4 cases (25%) were lack of tests which should have be performed before or after surgery. The results of mediation were agreement in 25 cases (61%), decision made by mediation department in 6 cases (15%), 7 cases were not adequate to mediate (17%), and 3 cases were canceled (7%). CONCLUSIONS: The number of cases associated with cataract was the largest. Among negligence of doctors, cases during surgery were most common, suggesting the need to explain surgical factors such as complications or side effects and the need for complete surgical records. If a medical dispute occurs, the Korea Medical Dispute Mediation and Arbitration Agency can be used to achieve an agreement.

Prevalence of Dry Eye Syndrome and Association with Life Behaviors in Adolescents

PURPOSE: To investigate the prevalence and risk factors of dry eye syndrome (DES) among adolescents based on the Ocular Surface Disease Index (OSDI) questionnaire. METHODS: A questionnaire survey was conducted on middle and high school students in Daejeon. DES was diagnosed by an OSDI score ≥ 13. According to the OSDI score, DES was classified as mild (13-22 points), moderate (23-32 points), or severe (33-100 points). Additionally, responses to the questions regarding adolescents' life behaviors including the duration of electronic device use per week (cellphone, computer, TV), study hours per day, sleeping hours per day, contact lenses use, glasses use, and humidifier use were analyzed to determine the associations with DES. RESULTS: Of 332 students, DES was diagnosed in 147 (44.3%), and 54 (16.3%) complained of severe DES. The prevalence of DES was higher in female students (p = 0.004), long-time electronic device users (divided on the basis of the mean value, 15.3 hours per week, p = 0.011), and contact lenses users (p = 0.001). The prevalence of DES was 53.9% in groups with ≥ 14 hours of electronic device usage time per week, 40.2% in groups with ≥ 7 hours, and 33.7% in groups with < 7 hours (p = 0.002). The duration of electronic device use per week was a significant risk factor of DES for male students, and contact lenses use was a significant risk factor of DES for female students (p = 0.009). CONCLUSIONS: The prevalence of DES was high among adolescents. Long-time electronic device usage and contact lenses wear were associated with DES and increased the risk of DES.

Learning Curve for Endoscopic Endonasal Dacryocystorhinostomy

PURPOSE: To elucidate the learning curve for endoscopic endonasal dacryocystorhinostomy (EE-DCR) based on the results of EE-DCR performed by three surgeons at three different tertiary hospitals. METHODS: A retrospective review of the medical records of 386 eyes of 337 patients who had undergone EE-DCR by three surgeons at three tertiary hospitals and who were available for a >6-month postoperative observation period was conducted. The success of a given surgery was determined based on the results of a test performed during the patient's last outpatient visit to the hospital. The learning curve was identified by dividing the patients into four groups (20, 30, 40, and 50 eyes in each respective group) and comparing their success rates. RESULTS: The overall success rate of the entire study population was 86.3%. The success rates for each of three surgeons was 83.3%, 85.6%, and 88.1%, respectively. After dividing the patients into groups of 30 eyes each, all three surgeons showed a significant increase in surgery success rates after their first group of 30 eyes (p 90% (A, 94.4%; B, 90.8%; C, 95.4%). CONCLUSIONS: A surgeon should be required to perform at least 30 EE-DCR procedures to obtain stable surgical skill for this procedure.

Influence of Biometric Variables on Refractive Outcomes after Cataract Surgery in Angle-closure Glaucoma Patients

PURPOSE: To evaluate the influence of biometric variables on refractive outcomes after cataract surgery in angle-closure glaucoma (ACG) patients. METHODS: In this case-control study, 42 ACG patients, 40 open-angle glaucoma (OAG) patients, and 35 controls without glaucoma who had undergone conventional cataract surgery were enrolled consecutively. Electronic medical records, including preoperative biometric variables (keratometric diopter, axial length, anterior chamber depth, and lens thickness), the refractive change (RC), and the absolute value of refractive change (ARC) were reviewed. RESULTS: In the control and OAG patients, the anterior chamber depth was negatively correlated with the ARC (r = -0.344, p = 0.043 and r = -0.431, p = 0.006, respectively), whereas there was no correlation in the ACG patients. Lens thickness was positively correlated with the RC, but not with the ARC, in the control and OAG groups (r = 0.391, p = 0.020 and r = 0.501, p = 0.001, respectively). In contrast, lens thickness in the ACG group was not correlated with the RC but was positively correlated with the ARC (r = 0.331, p = 0.032). CONCLUSIONS: In contrast with the anterior chamber depth, preoperatively measured lens thickness may be a useful predictor of the direction of the RC after cataract surgery in control and OAG patients. However, in ACG patients, a thicker lens was correlated with a larger RC, regardless of the direction of the shift (hyperopic or myopic).

Corneal Iron Lines Observed in the Clinical Practice

PURPOSE: To unveil the etiology, pathogenic mechanism and the clinical significance of the corneal iron line through various clinical aspects of the corneal iron line. METHODS: This study included 45 eyes of 39 patients who visited the Department of Ophthalmology in Chungnam National University Hospital between April 2011 and March 2014. Anterior segment of the eye was photographed during the diagnostic process. The medical history of the patient was investigated and corneal topography was performed to discover the relationship between the position of the corneal iron line and the curvature of the corneal surface. RESULTS: The corneal iron line was identified in various corneal diseases such as herpetic stromal keratitis and; corneal ulcer. The average age of patients was 57.8 years. Corneal topography was performed in 12 patients and a connection was found between the curvature of the corneal surface and the position of corneal iron line at 75%. During the research period, corneal disease progressed and associated corneal iron line became clearer in 2 eyes. However, there was no repositioning or new appearance in different areas. The corneal iron line was not associated with visual acuity and the shape varied in accordance with the accompanying corneal disorder. The location where the tears repeatedly accumulate was associated with corneal surface. CONCLUSIONS: Based on the occurrence location and the shape of the corneal iron line, we could understand that the occurrence of corneal iron line is associated with the past and current corneal surface irregularities, which verified the validity of the tear pooling hypothesis. Therefore, this result can aid in establishing the diagnosis and treatment plan when the corneal iron line is discovered during clinical practice.

Corneal Iron Lines Observed in the Clinical Practice

PURPOSE: To unveil the etiology, pathogenic mechanism and the clinical significance of the corneal iron line through various clinical aspects of the corneal iron line. METHODS: This study included 45 eyes of 39 patients who visited the Department of Ophthalmology in Chungnam National University Hospital between April 2011 and March 2014. Anterior segment of the eye was photographed during the diagnostic process. The medical history of the patient was investigated and corneal topography was performed to discover the relationship between the position of the corneal iron line and the curvature of the corneal surface. RESULTS: The corneal iron line was identified in various corneal diseases such as herpetic stromal keratitis and; corneal ulcer. The average age of patients was 57.8 years. Corneal topography was performed in 12 patients and a connection was found between the curvature of the corneal surface and the position of corneal iron line at 75%. During the research period, corneal disease progressed and associated corneal iron line became clearer in 2 eyes. However, there was no repositioning or new appearance in different areas. The corneal iron line was not associated with visual acuity and the shape varied in accordance with the accompanying corneal disorder. The location where the tears repeatedly accumulate was associated with corneal surface. CONCLUSIONS: Based on the occurrence location and the shape of the corneal iron line, we could understand that the occurrence of corneal iron line is associated with the past and current corneal surface irregularities, which verified the validity of the tear pooling hypothesis. Therefore, this result can aid in establishing the diagnosis and treatment plan when the corneal iron line is discovered during clinical practice.

Development of Simplified Ajou Version of MarkeTrak Survey to Evaluate Hearing Aid Use / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: MarkeTrak Survey is designed to evaluate the sociodemographic and HA factors of hearing aid (HA) users and their satisfaction of use. The questionnaire is inconvenient to use because it asked too many questions and requires long time to answer. The purpose of this study was to develop a simplified ("Ajou") version of MarkeTrak Survey and to evaluate its reliability. SUBJECTS AND METHOD: Forty-five HA users who visited the Ajou Hearing Center from 2014 to 2015 were included in the present study. To examine the correlation of the Korean version and the Ajou version of MarkeTrak Survey, 42 patients completed each survey simultaneously. To examine the reliability of Ajou version, test-retest and internal consistency methods were used. For the test-retest method, 22 HA users repeated the survey 2-4 weeks later. RESULTS: The newly developed "Ajou" version of MarkeTrak Survey consisted of 12 questions and was more simplified. Most of the questions of the two surveys showed significant correlation coefficient values (Spearman correlation, p<0.05). For the test-retest method, most questions showed significant correlation coefficient values (Spearman correlation, p<0.05), but they showed lower values than 0.6 in many cases. It showed high internal consistency of overall HA satisfaction. CONCLUSION: The Ajou version may be used as a simplified and alternative questionnaire for the Korean version of MarkeTrak Survey.

Risk Factors of Chronic Subdural Hematoma Progression after Conservative Management of Cases with Initially Acute Subdural Hematoma / 대한신경손상학회지

OBJECTIVE: Acute subdural hematoma (ASDH) patients are treated conservatively or surgically according to the guidelines for surgical treatment. Many patients with thin ASDH and mild neurologic deficit are managed conservatively, but sometimes aggravation of thin ASDH to chronic subdural hematoma (CSDH) results in exacerbated clinical symtoms and consequently requires surgery. The aim of this study is to evaluate risk factors that indicate progression of initially non-operated ASDH to CSDH. METHODS: We divided 177 patients, presenting with ASDH (managed conservatively initially) between January 2008 to December 2013, into two groups; 'CSDH progression group' (n=16) and 'non-CSDH progression group' (n=161). Patient's data including age, sex, past medical history, medication were collected and brain computed tomography was used for radiologic analysis. RESULTS: Our data demonstrated that no significant intergroup difference with respect to age, sex ratio, co-morbid conditions, medication history, ischemic heart disease, liver disease and end-stage renal disease was found. However, Hounsfield unit (hematoma density) and mixed density was higher in the 'ASDH progression group' (67.50+/-7.63) than in the 'non-CSDH progression group' (61.53+/-10.69) (p=0.031). Midline shifting and hematoma depth in the 'CSDH progression group' were significantly greater than the 'non-CSDH progression group' (p=0.067, p=0.005). CONCLUSION: Based on the results of this study, the risk factors that are related to progression of initially non-operated ASDH to CSDH are higher Hounsfield unit and hematoma depth. Therefore, we suggest that ASDH patients, who have bigger hematoma depth and higher Hounsfield unit, should be monitored and managed carefully during the follow-up period.

Comparison of Ocular Adnexal Mantle Cell Lymphoma and MALT Lymphoma

PURPOSE: Mantle cell lymphoma (MCL) is known to have systemic dissemination with poor prognosis, but very few cases have been reported in Korea. Therefore, we analyzed clinical features and prognosis of MCL by comparing 3 cases of ocular adnexal MCL and mucosa-associated lymphoid tissue (MALT) lymphoma. METHODS: The medical records of patients with ocular adnexal MALT lymphoma and MCL from Chungnam National University Hospital and Pusan National University Hospital from January 1999 to April 2014 were retrospectively reviewed. Immunohistochemical examination was selectively used to diagnose lymphoma subtypes. Systemic dissemination, treatment response, and recurrence were identified using radiological testing and bone marrow aspiration. RESULTS: This study included 39 patients with ocular and ocular adnexal MALT lymphoma and 1 patient with MCL from Chungnam National University Hospital and 53 patients with MALT lymphoma and 2 patients with MCL from Pusan National University Hospital. All 3 (100%) patients diagnosed with ocular adnexal MCL were over 60 years of age. However, 28 of 92 (30.4%) patients diagnosed with MALT lymphoma were over 60 years of age. In MALT lymphoma, 3 of 92 patients presented with systemic dissemination and most patients recovered with radiotherapy. Conversely, all 3 patients with MCL showed systemic dissemination and recurrence after radiotherapy or chemotherapy, therefore, additional chemotherapy was required. CONCLUSIONS: Contrary to MALT lymphoma, ocular and ocular adnexal MCL usually presented with systemic dissemination and complete remission was difficult even though many regimens of chemotherapy were attempted. Because MCL can be misdiagnosed as MALT lymphoma, careful evaluation should be performed.

A Case of Successful Endoscopic Dacryocystorhinostomy in Nasolacrimal Duct Obstruction with Wegener Granulomatosis

PURPOSE: To report a case of nasolacrimal duct obstruction occurring in a patient with Wegener granulomatosis treated successfully with endoscopic dacryocystorhinostomy. CASE SUMMARY: A 36-year-old female diagnosed with Wegener's granulomatosis 3 years prior and treated with rituximab and currently taking azathioprine 100 mg presented with a 1-year history of left epiphora and mucus in the left eye. Her left tear meniscus was higher than the right and was a hard stop with lacrimal probe when a lacrimal probing test was performed. Mucus was regurgitated during lacrimal irrigation and middle turbinate was not observed due to granuloma in the nasal cavity. Dacryocystography showed proximal nasolacrimal duct obstruction and a well-defined dacryocystocele 6 x 5 x 6 mm in size was observed on the left lacrimal fossa on facial 3D computed tomography. After synechiolysis for a granuloma in the nasal cavity, endoscopic dacryocystorhinostomy was performed and silastic sheet sutured on the nasal septum to prevent resynechia. After 2 weeks and 4 months, the silastic sheet and silicon tube were removed, respectively. The patient was asymptomatic following surgery and there was no regurgitation during lacrimal irrigation test. The ostium was patent at 5 months after surgery using the endoscopic dye test. CONCLUSIONS: Nasolacrimal duct obstruction occurring in a patient with Wegener's granulomatosis can be treated effectively with endoscopic dacryocystorhinostomy even if the nasal cavity is narrow due to granuloma.

Usefulness of Objective Hearing Tests for Screening Patients with Partial Deafness / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: 'Partial deafness' characterized by normal or slightly impaired hearing in the low frequency band and nearly total deafness in the high frequency range, is difficult to assess with conventional behavioral tests in infants and young children. Therefore, this study aimed to assess the usefulness of objective hearing tests, such as auditory brainstem response (ABR) and auditory steady state response (ASSR) in evaluating patients with partial deafness. SUBJECTS AND METHOD: One hundred thirty three patients who underwent ASSR in Ajou University Hospital from January 2008 to January 2013 were enrolled to this study. Correlations between ASSR, ABR and pure tone audiometry (PTA) thresholds were analyzed. RESULTS: ASSR thresholds of 133 patients were highly correlated with both ABR and PTA thresholds in majority of the tested frequencies. Partial deafness was detected in 9 out of 133 patients, based on the results of PTA and ASSR. ASSR thresholds of patients with partial deafness were significantly correlated with PTA thresholds in all frequencies, with especially high correlation found at 1 and 4 kHz. However, there was no significant correlation between ASSR and ABR thresholds. ABR thresholds of partial deafness patients were measured at 65 dB in one patient, 70-90 dB in 3 patients, and no response at 90 dB in 5 patients, respectively. In 8 (6%) out of 124 patients, ABR thresholds were measurable with profound hearing loss and residual hearing was observed at low frequencies. CONCLUSION: ASSR is useful for predicting residual hearing at low frequencies of infants and young children for whom assessment of hearing is difficult using conventional behavioral tests.

Acute decompensated heart failure and acute kidney injury due to bilateral renal artery stenosis / 영남의대학술지

Atherosclerotic renal artery stenosis (RAS) may result in hypertension, azotemia, and acute pulmonary edema. We report on a renal angioplasty with stent placement for bilateral RAS in a patient with acute decompensated heart failure and acute kidney injury. A 67-year-old female patient was admitted to our hospital with acute shortness of breath and generalized edema. Echocardiography showed left ventricular wall motion abnormality and the follow up electrocardiography showed T wave inversion in the precordial leads. We performed a coronary angiography to differentiate ischemic heart disease from non-cardiac origin for the cause of the heart failure. The coronary angiography showed no significant luminal narrowing, but bilateral RAS was confirmed on the renal artery angiography, therefore, we performed renal artery revascularization. After the procedure, the pulmonary edema was improved and the serum creatinine was decreased. Two weeks later, an echocardiography showed improvement of the left ventricular systolic function.

Prognostic Factors for Successful Endonasal Dacryocystorhinostomy

PURPOSE: To evaluate the factors useful for predicting the surgical outcome of endonasal dacryocystorhinostomy. METHODS: This retrospective observational study included 117 eyes of 94 patients with nasolacrimal duct obstruction who underwent endonasal dacryocystorhinostomy and were followed up for more than 6 months. Factors associated with successful surgery were analyzed based on the preoperative and intraoperative factors and postoperative clinical features. Preoperative factors such as age, gender, laterality, presence or absence of hypertension, and diabetes were analyzed. Intraoperative factors such as use of triamcinolone, removal of uncinate process or middle turbinate during surgery, and location of the sac were analyzed. The postoperative clinical features including high tear meniscus, no intranasal silicone tube movement, and no air reflux feeling were each given a score of 1. Based on aggregate score, the patients were divided into 2 groups, the high score and low score groups and analyzed accordingly. RESULTS: The success rate was 91.5%. Patients with diabetes showed a significantly low success rate (73.3%, p = 0.007). In patients with high tear meniscus at 3, 6, and 9 weeks after surgery, the success rate was significantly low (76.9%, 81.8% and 75.0%; p = 0.003, p = 0.029 and p = 0.002, respectively). The low score group at 3 and 6 weeks after surgery showed a significantly high success rate (100% and 95.9%; p < 0.001 and p = 0.023, respectively). CONCLUSIONS: Besides preoperative and intraoperative factors, the early postoperative clinical features are important for predicting the success of the surgery. If tear meniscus is high and there is no intranasal silicone tube movement and air reflux from the punctum in the early stages after surgery, more active management from the initial treatment is needed.

Changes of Higher Order Aberration Analyzed by Continuous Measurement after Phacoemulsification

PURPOSE: To analyze the changes of higher order aberration (HOA) measured serially by KR-1W(R) wavefront at every second for 10 seconds between, before, and after phacoemulsification and to evaluate the relationships between HOA and the ocular surface indicators (Schirmer test, tear break-up time, superficial punctate keratitis). METHODS: Corneal HOA was measured in 47 eyes of 30 patients pre- and postoperatively at 2, 4, 6, and 8 weeks by KR-1W(R) using the continuous measurement mode. The patients were divided into 2 groups according to their Schirmer test (above 10 mm or under 10 mm), tear break-up time (above 5 seconds or less than 5 seconds), and superficial punctate keratitis (any keratitis, none) for analysis of relationships between HOA and ocular surface indicators, and we also analyzed the correlation coefficient. RESULTS: Short-term follow up after phacoemulsification revealed that corneal HOA rapidly increased at 2 weeks and recovered to the preoperative level 8 weeks after surgery. Corneal HOA values showed increasing tendency depending on time at preop and 8 weeks after phacoemulsification, and the differences were statistically significant (preop: p < 0.001, 8 weeks: p = 0.027). There were no significant differences of HOA between the 2 groups divided according to their ocular surface indicators, and there were no significant correlations between HOA and ocular surface indicators at any time point. CONCLUSIONS: The HOA of the cornea was restored to its preoperative values at 8 weeks after surgery. Preoperative ocular surface indicators are not significantly influenced on postoperative corneal HOA. The surgical factors are more significant in postoperative corneal HOA than preoperative ocular surface indicators.

Functional Listening Performance of Children with Sequential Bilateral Cochlear Implantation in Daily Life / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study aims to identify whether the sequential bilateral cochlear implantation in children with a long inter-implant interval provides functional benefits in everyday situation. SUBJECTS AND METHOD: Seventeen children with sequential bilateral cochlear implants (BiCIs) (mean age at first implantation, 2.6 years; mean age at second implantation, 8.5 years; mean inter-implant interval, 6.0 years) and 17 children with unilateral cochlear implants (UniCIs) were included in this study. The questionnaire SSQ (The Speech, Spatial, and Qualities of hearing scale for parents of children with impaired hearing, Galvin, 2007) was used to evaluate the performance of two groups by individually interviewing the parents of the subjects. For the BiCIs, anecdotal reports of the performance in everyday listening situation and device use were also collected in interviews. RESULTS: The BiCI group showed significantly better performance in all three areas (speech perception, spatial hearing, and other qualities of hearing) of the SSQ than did the UniCI group. The differences between the two groups were significantly larger in performance on 'spatial hearing' and 'other qualities of hearing' than on 'speech perception'. All subjects with bilateral cochlear implants had a positive attitude on bilateral hearing. Anecdotal reports indicated that bilateral hearing has positive effects such as reduced repeated questions, increased participation in conversation, facilitated language and learning acquisition, and improved concentration. CONCLUSION: Children who received sequential bilateral cochlear implantation with a long inter-implant interval could obtain functional benefits in daily life. Also it turned out that these benefits have positive effects on children's communication, language, learning, and socio-emotional areas.

A Case of Pituitary Metastasis of Lung Cancer Presenting as Cavernous Sinus Syndrome / 대한이비인후과학회지

The cavernous sinus contains significant structures such as the internal carotid artery and cranial nerves III to VI. Cavernous sinus lesions may cause ophthalmoplegia, proptosis, and diplopia. We report a 56-year-old woman who presented with throbbing headache and associated right-sided ocular pain. While awaiting imaging studies, she suddenly developed opthalmoplegia and ptosis of the right eye. She had ipsilateral palsy of the third and fourth cranial nerves, while the sixth nerve remained intact. Magnetic resonance imaging revealed a pituitary gland mass extending into the right cavernous sinus with associated sphenoid sinusitis. The patient underwent endoscopic sinus surgery and subsequent pituitary tumor removal by transsphenoidal approach. During preoperative evaluation, a mass was found protruding in her left bronchus. The pituitary tumor pathologic examination revealed metastatic adenocarcinoma of the lung. In this patient, the initial symptoms of lung cancer were headache and cavernous sinus syndrome, which had metastasized to the pituitary gland.

Usefulness of the Attic Reconstruction Using the Tragal Cartilage and Perichondrium for Prevention of a Retraction Pocket

BACKGROUND AND OBJECTIVES: Bone defect of the attic wall is a critical cause of the postoperative retraction pocket after canal wall up mastoidectomy. So, proper treatment of the attic defect is important and attic reconstruction is an acceptable procedure but it is controversial when the attic is reconstructed or not. The aim of this study is to analyze the usefulness of the attic reconstruction using tragal cartilage and perichondrium for prevention of retraction pocket and propose the indication to perform the attic reconstruction. SUBJECTS AND METHODS: We retrospectively reviewed the medical records of 46 consecutive patients who underwent tympanomastoidectomy and attic reconstruction using tragal cartilage between January 2005 and January 2009. The follow-up period varied from 12 to 65 months, with the average period of 34 months. We analyzed postoperative status of the scutum and the tympanic membrane, and development of the residual or recurrent cholesteatomas and evaluate development of the retraction pocket according to the preoperative size of the bony defect of the scutum and status of the ossicular chain. RESULTS: Retraction pocket was developed in the 13% of the operations and most of the cases had large attic destruction more than 3 mm and destructed ossicular chain. CONCLUSIONS: Attic reconstruction using tragal cartilage is a simple method to repair the bony defect of the external ear canal and effective in preventing postoperative retraction pocket if the size of destructed scutum is less than 3 mm.

A Case of Superior Semicircular Canal Dehiscence Syndrome Treated with Surgical Repair / 대한이비인후과학회지

Superior semicircular canal dehiscence syndrome (SCDS) is a rare disease caused by dehiscence in the bone overlying superior semicircular canal. Patients with SCDS present vestibular and auditory manifestations including dizziness and hyperacusis. These manifestations can be controlled by surgical repair of the dehiscence such as plugging or resurfacing the defect. We report a case of a 25 year-old man with SCDS who underwent surgical repair of dehiscence through middle fossa approach.