Carcinosarcoma of the Maxillary Sinus

Carcinosarcoma is a highly malignant tumor characterized by dual malignant histologic differentiation of epithelial and mesenchymal components. The tumor is extremely rare in the sinonasal tract. We report a case of a 62-year-old man with carcinosarcoma involving the maxillary sinus.

A Case of Primary Ewing's Sarcoma of Arising from the Nasal Cavity / 대한이비인후과학회지

Ewing's sarcoma is an uncommon malignancy that usually occurs in children. It most commonly involves the lower extremity, with the pelvis being the next most common site. Primary Ewing's sarcoma that arises in the head and neck region is extremely rare, representing only 1-4% of all Ewing's sarcoma cases. We report a case of primary Ewing's sarcoma in the nasal cavity in a 10-year old patient with a non-specific past medical history, in which the patient received 3 trials of neoadjuvant chemotherapy, endoscopic wide excision, followed by 2 more trials of adjuvant chemotherapy. Currently, it has been 5 years since treatment and the patient did not exhibit any signs or symptoms of recurrence of the disease.

Estimate Hearing Recovery Rate Using Statistical Analysis of Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sudden deafness is not rare but its pathophysiology has not been fully determined and treatment is controversial at present. There is much debate regarding the prognostic factors in sudden deafness patients. Various studies have been done to find out factors concerned with the recovery of sudden deafness, but there are still many unknown components as the probability of recovery from sudden deafness depends on many factors. The aim of this study is to identify an expectation of recovery by regression formula. SUBJECTS AND METHOD: We reviewed the records of 241 patients who were admitted for treatment between 2002 and 2005 under the initial diagnosis of idiopathic sudden hearing loss. The patients were treated with steroid, vasodilator and plasma expander. Improvement of hearing was measured by Siegel's criteria and correcting rate. Prognostic factors that might be associated with the degree of hearing recovery were classified and analyzed by the optimal scale regression analysis method using SPSS ver. 12.0. RESULTS: Siegel's criteria and correcting rate have statistical correlation with respect to age, initial hearing level, patterns of pure tone audiogram and duration of initial treatment from onset to hearing improvement after treatment. Vertigo is not associated with hearing improvement. CONCLUSION: The initial hearing level, patterns of pure tone audiogram and duration of initial treatment from onset are associated with the degree of hearing recovery. We produced a calculating model of hearing improvement based on factors affecting hearing improvement.

Availability of Spectral Gradient Acoustic Reflectometry / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Spectral gradient acoustic reflectometry (SGAR) determines the probability of middle ear fluid by measuring the response of the tympanic membrane to a sound. To assess the sensitivity and specificity of SGAR for the diagnosis of otitis media with effusion (OME) in the Korean population, we compared accurate diagnostic rates of OME obtained from SGAR and tympanometry. Pneumatic otoscope was used for diagnostic standard of OME. SUBJECTS AND METHOD: SGAR and tympanometry were performed on 488 ears from May 27th, 2008 to July 30th, 2008. Exclusion criteria were the presence of tympanic membrane perforation, and/or pressure equalization tubes, noncompliance, otorrhea, external auditory canal stenosis and signs of acute inflammation such as fever or otalgia. In all cases, pneumatic otoscopic examination was conducted and diagnostic accurate rates of OME were calculated in SGAR and tympanogram. RESULTS: Using spectral gradients of 3 or higher as breakpoints for indicating OME, in the case of pediatrics under 2 years old, with the sensitivity of 58.3%, specificity of 94.7%, positive predictive value (PPV) of 77.8% and negative predictive value (NPV) of 87.8%. In the case of the pediatrics between 2 and 12 years old, it showed the sensitivity of 67.2%, specificity of 90.3%, PPV of 74.5% and NPV of 86.8%. In the case of the pediatrics over 12 years old, they showed sensitivity of 87.3%, specificity of 88.8%, PPV of 67.6% and NPV of 96.3%. CONCLUSION: SGAR has the higher tendency of specificity and NPV, and will be a useful screeningtest with good portability and economical efficiency.

Change of Middle Ear Mechanics after Tympanoplasty Type I with Thin Sliced Cartilage Island / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cartilage offers the advantage of higher mechanical stability compared with membranous transplants but it may alter the acoustic transfer characteristics, which could depend on its thickness. So, author attempted to design the thin sliced cartilage island for grafting material by tragal cartilage. The purpose of this study is to understand the usefulness of the thin sliced cartilage technique by comparing with conventional temporalis fascia technique with the method of tympanometry. SUBJECTS AND METHOD: From March 2002 to August 2005, 101 cases of tympanoplasty type I using the thin sliced cartilage island technique and 50 cases of tympanoplasty type I using the temporalis fascia performed by one surgeon had been followed up for 6 months and reviewed. Static compliance, tympanometric width and tympanometric pattern were followed up after 6 month. RESULTS: The static compliance in the thin sliced cartilage island technique group was 72% and temporalis fascia group was 66% at normal compliance (0.2-1.6 ml). The tympanometric width in the thin sliced cartilage island technique group was 59% and temporalis fascia group was 54% at normal tympanometric width (60-150 mmH2O). The tympanometric pattern in the thin sliced cartilage island technique group was 67% and temporalis fascia group was 62% at normal tympanometric pattern (A type). CONCLUSION: There is no significant statistical difference between the thin sliced cartilage island and temporalis fascia observed in the impedence audiometry. The thin sliced cartilage island technique is suggested to be good for tympanoplasty.

The Effect of Lesser Palatine Nerve Block on Pain after Pediatric Tonsillectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This prospective, randomized double-blind study was performed to evaluate the analgesic effect of lesser palatine nerve block after pediatric tonsillectomy, and we measured analgesic efficacy and degree of blocks induced by ropivacaine. SUBJECTS AND METHOD: Children who weighed 20-40 kg and scheduled for an elective tonsillectomy were randomized into three groups. Patients received lesser palatine nerve block, using divided doses of 0.05 ml/kg of 0.2% ropivacaine (Naropin registered), 5 min prior to the beginning of tonsillectomy (Pre-block group) or immediately after surgery (Post-block group). Patients allocated into the control group did not receive any nerve blocks. Postoperative pain was measured immediately after surgery and at 3, 6, 12 and 24 hours following the operation by using a 0 to 4 points pain scale, based on a facial expression of pain scale ruler. Side effects and the number of analgesic inductions were observed for 24 hours postoperatively. RESULTS: No significant differences in the pain scores were observed immediately after surgery and at 3, 6, 12 and 24 hours after operation in the three group (p>0.05). The number of analgesic injections were similar in the groups. CONCLUSION: The results of this study reveal that the lesser palatine nerve block was not effective for postoperative pain control following pediatric tonsillectomy, and that the pre-emptive block offered no pain control benefit over the postoperative block. Therefore, we do not recommend lesser palatine nerve blocks for the management of postoperative pain after pediatric tonsillectomy.

The Morphological Changes of the Cochlea in the Guinea Pig after Single Blast Wave Stimulation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The mechanism of the noise damage to the cochlea is not fully understood in spite of many studies. The morphological changes in a noise stimulated model show various features relating to the duration of the exposure and sound intensity. Until now there had been a lot of the morphological studies on noise induced hearing loss models, but only a few reports of single blast injury of more than 150 dB. MATERIALS AND METHOD: We observed with a transmission electron microscope by using the microslicing technique for minimizing the tissue injury and successful hair cell counting in resin embedded cochlea of the guinea pig, stimulated by a 178 dB single blast wave. RESULTS: The area of hair cell damage in L.M. showed stereocilia bending at 24 hours, proliferation of Hensen's body, subsurface cistern in outer hair cell and mitochondria proliferation in inner hair cell within 2wks. The area of no hair cell damage in L.M. showed minimal changes in E.M., as well. CONCLUSION: These results suggest that the 178 dB single blast wave injury may not cause severe distortion of the organ of Corti in the guinea pig and thus the compensation process can be advanced gradually.

Immune-mediated Inner Ear Dysfunction Caused by Histones, as Planted Target Antigens / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Histones, a set of highly cationic proteins essentially involved in the binding and packing of DNA in the cell nucleus chromatin, have five subclasses (H1, H2a, H2b, H3, H4) in mammalian animals. These components play the most important role in producing autoantibody in SLE and etc. Some studies proposed that there were a relationship between the activity of the disease and the titer of these autoantibody. Recently, histones were revealed to be involved in the immune deposit on GBM in MRL/lpr mice, and cause immune-mediated glomerulonephritis in normal animals. MATERIALS AND METHODS: We examined IgG deposition on the basement membrane of strial capillaries and recorded the endocochlear potential from the basal turn by an electrode inserted though the round window in guinea pigs which was injected by histone(H2a) and anti-histone antisera. RESULTS: IgG depositions were seen on the basement membrane of stria capillaries. IgG was also found to be accumulated on the extravascular side of the basement membrane. However, C3 was almost never observed in the stria vascularis of histone and the anti-histone antisera injected group. In these animals, intracellular edema was evident in the stria vascularis especially at the second and more apical turns but no inflammatory cell infiltration was present. The signifcant decrease in EP was observed just after the injection of anti-histone antisera in the animals receiving an intra-arterial injection of histones. CONCLUSION: This study indicated that cationic antigen could be trapped on the negatively charged basement membrane of strial capillaries, leading to the in situ immune complex formation, and eventually causing immune-mediated hearing loss.

Expression of CC Chemokines in Nasal Polyps / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The number of eosinophil in nasal polyps has been reported to be strongly elevated when compared to non-affected nasal tissue, indicating an important role for eosinophils in the pathogenesis of nasal polyposis. The mechanisms determining selective eosinophilic tissue infiltration into diseased nasal mucosa as yet are specualtive. Panleukotactic factors also known to be present on nasal polyps cannot explain the type-selective tissue infiltration in eosinophilic or neutrophilic-featured diseases. Chemokines are known to have leukocyte subtype-selective chemotactic properties in vitro and thus are candidates explaining leukocytic characteristic tissue infiltration. The aim of this study was to investigate whether specific chemokines are associated with different forms of nasal polyps. This study was designed to demonstrate the expressions of various CC chemokines. MATERIALS AND METHODS: Nasal polyp from patients with systemic allergy (AP group, n=7) and negative allergic skin tests (NP group, n=10) were sampled. Expressions of RANTES, eotaxin, MCP-1, MIP-1alpha,beta were studies by RT-PCR and immunohistochemical studies. RESULTS: Expression and mean density of RANTES, MCP-1, MIP-1beta were significantly stronger in NP group than in AP group (p<0.05). However, those of eotaxin and MIP-1alpha were significantly stronger in AP group than in NP group (p<0.01). CONCLUSION: This results suggest that only selective chemokines could be involved to develop the pathologic conditions in different type of nasal polyp.

Functional Changes of Interleukin-4 and Interferon-gamma of Peripheral Blood and Nasal Mucosa after Immunotherapy in Patients with Perennial Allergic Rhinitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Immunologic changes of immunotherapy can include reduced allergenstimulated mononuclear cells prolifer-ation and lymphokine production and the generation of allergic-specfic suppressor T cells. The changes and the relationships of the mononuclear cells between the peripheral blood and the nasal mucosa are still unclear during immunotherapy. The purpose of this study was to evaluate the functional changes of the mononuclear cells in peripheral blood and the nasal mucosa following immunotherapy. MATERIALS AND METHODS: We collected the mononuclear cells from the peripheral blood and the nasal mucosa in 25 patients who had received immunotherapy and 10 patients without any treatment. All of the patients were sensitive to house dust mites. And 5 healthy subjects were used as a control. The mononuclear cells were incubated with antigen or phytohemaglutinin (PHA) for 48 hours. And productions of Interleukin-4 and Interferon-gamma were measured in supernatants by ELISA. On the peripheral mononuclear cells stimulated by antigens, the production of Inter-leukin-4 was dominant in the non-treated allergic group and there were no differences of the productions in the group of immunotherapy and healthy control group. Similar findings of Interleukin-4 production were seen on mononuclear cells from the nasal mucosa. And there were no differences of Interferon-gamma production in the nontreated and control group. However the immunotherapy group showed more Interferon-gamma production than those 2 groups in mononuclear cells from both sites. CONCLUSION: These findings suggests that immunotherapy can change the function of mononuclear cells from the peripheral blood as well as the nasal mucosa.

Changes of the Sialoglycoconjugates in the Maxillary Sinus Mucosa of theRabbits after Inoculation of Influenza a Virus / 대한이비인후과학회지

The present study was carried out in order to observe the changes in the expression of the sialoglycoconjugates of the rabbit sinus mucosa after inoculation of influenza A virus utilizing a biotin labeled lectins for light microscopy with four different lectins; Maackia amurensis(MAA), Wheat germ agglutinin(WGA), Sambucus nigra(SNA), and Peanut(PNA). A comparison of the affinity of these lectins demonstrated the different distribution of sialoglycoconjugates in the ciliary layer and goblet cells. The normal sinus mucosa stained with four types of lectins showed that the sialoglycoconjugates were mainly distributed in the ciliary layer and goblet cells. Moreover, the main sugar residues of the sialoglycoconjugates were figured out to be consisted of Neu5Ac(alpha2,3)Gal, GlcNAc and Neu5Ac. Influenza A virus infection decreased the staining intensity of the mucosa with MAA, but not with WGA. The staining intensity of PNA, however, was highly increased in the viral infected mucosa. These results suggest that Neu5Ac(alpha2,3)Gal sugar residues may be required as protecting factor or modulator for Influenza A virus infectivity.

Effect of Steroid Administration on Immune-Mediated Sensorineural Hearing Loss in MRL/MP-lpr/lpr Mice / 대한이비인후과학회지

In our daily clinical practice, we have come across several patients suffering from a fluctuating sensorineural hearing loss of unknown origin. Such patients were sometimes treated with sucess by steroid administration. Some kinds of immune injury in the inner ear have been proposed as a possible pathogenesis. However, the minute mechanisms of immune injury in the inner ear and the way in which steroids improve the hearing loss remained obscure. We have previously reported that the MRL/MP-lpr/lpr(MRL/lpr) autoimmune strain of mice showed IgG deposition in the stria vascularis with elevated thresholds of auditory brainstem response. This strain of mice though to be a good model for studying immune mediated inner ear dysfunction. The purpose of this study was to evaluated the therapeutic efffects of prednisolone on the hearing impairment in MRL/lpr mice, morphologically and electrophysiologically.

A case of salivary gland choristoma of the middle ear / 대한이비인후과학회지

No abstract available.

The clinical and histopathological studies of nasal polyps / 대한이비인후과학회지

No abstract available.

A case of large tonsillolith / 대한이비인후과학회지

No abstract available.

Ultrastructural study of basement membrane of choleastoma epithelium / 대한이비인후과학회지

No abstract available.