Changes of external ear resonance before and after surgery in chronic otitis media / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: External ear resonance (EER) can normally increase the sound pressure level at the tympanic membrane by as much as 20 dB at the frequency between 2 and 4 kHz. Perforation of tympanic membrane (TMP) may alter the resonance characteristics. Surgical modifications of the external auditory canal by tympanoplasty may also change the EER features. We aimed to analyze the EER of patients with the TMP before and after surgery. MATERIALS AND MEHTOD: This study comprised of 130 patients (135 ears) with chronic otitis media. We checked EERs before and after the surgery. The preoperative group was divided into two groups according to perforation size. Postoperatively, the EER was checked at 3, 6, 9, 12 months or after 15 months. We compared these data with the control group which comprised of 96 adult ears. RESULTS: In the preoperative group, the peak resonant gain and the frequency were not different from the control's and the peculiar negative peaks appeared around 1500 Hz in half of the cases. No significant differences were found in the first peak gains according to the perforation size. The negative peaks appeared deeper in the larger perforation group. After tympanoplasty, the gain markedly increased. As time passed, the gain tended to decrease, but did not equalize with the control's data. CONCLUSION: Additional gain should be considered in the frequency of around 1 kHz for hearing aid users with the TMP. We could expect alterations of EER after tympanoplasty, suggesting that these changes should be considered at the time of fitting hearing aids.

Development of a Device Equipped with a Thermocouple for Measuring Nasal Airflow

BACKGROUND AND OBJECTIVES: To measure nasal cavity function as an airway, rhinomanometry and acoustic rhinometry are currently being used in clinical settings. However, these methods are not helpful for continuously measuring the aerodynamic status of both nasal cavities simultaneously. Therefore, a new instrument to evaluate the nasal flow is required. MATERIALS AND METHODS: To measure the airflow of bilateral nasal cavity simultaneously, two thermocouples are held in the headset, with the tips of thermocouples positioned below nostrils. The thermocouples are connected to the analog-digital converter and the digitized data is transferred to a notebook computer, in which a graphical programming language software is installed. Eighteen adults were recruited for this study who had no structural abnormality in their nasal cavities. For every subject, measurements from acoustic rhinometry, the thermocouple device, and rhinomanometry were taken in succession. The data from the thermocouple device was compared with those taken from the acoustic rhinometry and rhinomanometry. RESULTS: A negative correlation was noted between the minimum cross-sectional area by acoustic rhinometry and the inspiratory slope by thermocouple. No correlation was noted between the results for rhinomanometry and the thermocouple device. CONCLUSION: The thermocouple device has some advantages over other devices for its non-invasive, continuous, and real-time measurements and its ability to measure bilateral nasal cavity simultaneously.

Endoscopic Orbital Decompression for Dysthyroid Orbitopathy

Since 1957, when Walsh and Ogura introduced transantral orbital decompression, various surgical approaches have been introduced for the treatment of dysthyroid orbitopathy. With the development of endoscopic sinus surgery, orbital decompression can now be approached transnasally by endoscope alone. We reviewed the medical records of 10 patients who had received endoscopic orbital decompression. Of the 10 patients, four eyes from three patients were managed for decreased visual acuity, while 13 eyes from seven patients were managed for exophthalmos. Three patients who had initially complained of decreased vision demonstrated eventual improvement. An initial mean proptosis of 19.3 mm decreased to 16.5 mm. Six eyes with abnormal color vision were resolved after the decompression. Four patients with diplopia complained of continued diplopia after the decompression and were managed with extraocular muscle surgery or prism glasses. Compared to the conventional transantral approach, endoscopic orbital decompression features less morbidity and comparable ophthalmic results.

Changes in External Ear Resonance after Ventilation Tube Insertion in Pediatric Patients with Middle Ear Effusion / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Middle ear effusion (MEE) is common in children, so the effects of the ventilation tube (VT) should be taken into account in prescribing hearing aids. With the ventilation tube, the external auditory canal communicates with the middle ear space, hence changing the impedance in the middle ear. This change, in turn, will have an effect on the external ear resonance (EER, real ear unaided response (REUR)). The aim of this study is to observe the effects of the tympanic membrane perforations caused by the ventilation tube on EER. MATERIAL AND METHODS:We selected 30 ears with MEE and measured EER before and after the ventilation tube insertion. We compared the EERs of the control group with the MEE group and two types of VT groups. RESULTS: In the subjects who had middle ear effusion, the average gain of the peak resonance was larger than that of the control group. After the VT insertion, the amplitude of the gain decreased to the level of control groups, although negative gain appeared in some cases characteristically around 1000 Hz. This negative gain was observed more frequently in the VT with larger diameter. CONCLUSION: The external ear resonance gain can be changed according to disease status or by VT insertion in patients with MEE. These changes should be considered especially in the low frequencies around 1000 Hz when prescribing the hearing aids for patients.

The Shape of Expiratory Nasal Flow

The characteristics of the expiratory nasal flow consist of three parts - amount, content and shape. By far, most reports are confined only to the nasal resistance, nasal pressure, temperature, humidity and gas concentration of the expiratory nasal flow. There are few reports on the shape of the expiratory nasal flow. We aimed to visualize the expiratory nasal flow and to see whether there is any correlation between the shape of the expiratory nasal flow and the shape of the external nose. For each seven normal adult males and females, the shape of the expiratory flow was checked with infrared imaging thermometer placed on the frontal and sagittal planes. We also measured the external nasal indices and compared them with the shape of the nasal flow. We could see the shape of the expiratory nasal flow through the infrared imaging thermometer in real time. The mean of the angles formed by each side of the expiratory nasal flows on the frontal plane was 39 degrees, and the frontal angle showed good correlation with the shape of the external nose. The real-time visualization of the expiratory nasal flow, conducted with the infrared imaging thermometer, was an absolutely non-invasive technique and may be used to investigate nasal functions.

Isolated Sphenoid Sinus Disease / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Chronic paranasal sinusitis is a common disease and easily diagnosed by physical examination and its typical symptoms. However, isolated sphenoid sinusitis is very rare and may be misdiagnosed by an initial evaluation because it often shows long-standing, subtle symptoms and elusive physical findings. We aimed to characterize the typical clinical features of isolated sphenoid sinus disease. MATERIALS AND METHOD: Ten cases were selected from 6623 patients with sinusitis who had visited Samsung Medical Center ENT clinic from Sep. 1994 to Oct. 1997. Isolated sphenoid sinus disease was distinguished by computed tomography. Only those radiographic diagnoses to be confined exclusively to the sphenoid sinus were included in this study. RESULTS: There were 10 cases of isolated sphenoid sinus disease. Nine were female and one was male. Of 10 cases, five cases were fungal origin, four were chronic sinusitis, and one was mucopyocele. Seven patients had headaches as their major symptom, and two had globus sensation. CONCLUSION: The isolated sphenoid sinus disease requires the maintenance of a high index of suspicion in every patient who has vague or unusual headache, or globus sensation. We recommend a thorough endoscopic examination of sphenoethmoidal recess and clinical suspicion to rule out sphenoid sinusitis.

A Case of Synovial Sarcoma Arising in the Hypopharynx / 대한이비인후과학회지

Synovial sarcomas are rarely occurring, highly malignant tumors of mesenchymal origin. Most cases are confined to the extremities. Fewer than 100 cases of synovial sarcoma have been reported in the head and neck area. We experienced a 24-year-old male patient who first complained of globus sensation. Initial suspension laryngoscopic biopsy specimen of the primary lesion was consistent with hypopharyngeal synovial sarcoma. Surgical excision through lateral pharyngotomy approach and postoperative radiotherapy were performed. We report this rare case with a literature review.