The Relation between Tympanostomy Tube Otorrhea and Types of Immune Cells in Middle Ear Effusion in Children with Otitis Media with Effusion / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tympanostomy tube insertion is one of the most common surgical procedures in children. Despite aseptic procedures with prophylactic antibiotic treatment, postoperative otorrhea may be encountered in some patients. The purpose of this study is to identify the relation between the types of immune cells in otitis media with effusion (OME) and tympanostomy tube otorrhea (TTO) in children. SUBJECTS AND METHOD: Fifty-six patients underwent tympanostomy tube insertion with OME were analyzed retrospectively. Fluid from OME was harvested by suction via syringe connector after myringotomy. Light microscopic examination of middle ear effusion was performed by a pathologist after hematoxylin and eosin staining. We analyzed the relation between the types of immune cells from middle ear effusion and TTO. RESULTS: Of 56 children, 36 were male and 22 were female. The mean age for tympanostomy tube insertion was 3.56 (±2.63) years, with the average follow-up period of 12.56 (±9.96) months. Neutrophils were detected in 19, eosinophils in 14, lymphocytes in 22, mast cells in 2, plasma cells in 7, and histiocytes in 9. TTO occurred in 15 patients. In patients with early TTO, eosinophils were detected more frequently than in patients without TTO (p=0.006). Plasma cells were detected more frequently in patient with late TTO than without TTO (p=0.011). CONCLUSION: According to the analysis of different types of immune cells, eosinophils in the middle ear effusion related with the occurrence of TTO.

Fibrinogen-Based Collagen Fleece Graft Myringoplasty for Traumatic Tympanic Membrane Perforation

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate how fibrinogen-based collagen fleece (Tachocomb®) graft myringoplasty (FCGM), performed under microscopic guidance, improves both hearing and tympanic membrane tissue repair in patients with traumatic tympanic membrane perforation (TMP). SUBJECTS AND METHODS: Between August 2009 and March 2015, a total of 52 patients with traumatic TMP visited the department of otorhinolaryngology at a secondary medical center. Twenty-nine of these underwent FCGM under microscopic guidance in our outpatient clinic. For each patient, we recorded the location and size of the perforation, the time elapsed from the onset of TMP until the myringoplasty, and the hearing level both before and after myringoplasty. RESULTS: The TMP closed completely in all cases (29 of 29 patients). After myringoplasty, the postoperative air-bone gap (ABG) differed significantly from the preoperative ABG. Three of the 29 patients (10.3%) experienced complications. Specifically, 2 presented with otorrhea after FCGM, but conservative management led to improvement without recurrence of perforation. One patient showed delayed facial palsy 1 week after the procedure. The condition of this patient also improved and the palsy was not permanent. CONCLUSIONS: FCGM may be an effective treatment option in case of traumatic TMP. The procedure requires no hospitalization, and can be used to avoid traditional tympanoplasty.

Pseudoaneurysm of the Petrosal Internal Carotid Artery in the Middle Ear as a Complication of Middle Ear Cholesteatoma

We report the case of a 66-year-old man who had significant otorrhagia caused by a ruptured pseudoaneurysm in the petrous internal carotid artery (ICA). The patient had middle ear cholesteatoma, and computed tomography (CT) showed bony erosion and exposure of the ICA into the middle ear cavity. Further angiography of the right carotid artery revealed a pseudoaneurysm protruding from the petrosal ICA into the middle ear cavity. The pseudoaneurysm was promptly treated with coil embolization and stenting. The patient continues to be monitored regularly with clinical follow-up, and carotid angiography and temporal bone CT revealed no interval changes at the embolized site 3 years after the procedure.

Current Trends in the Treatment of Subjective Tinnitus at University Hospitals in Korea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The effective management of subjective tinnitus should start with an accurate diagnosis based on an appropriate classification. Since there is no gold standard for managing subjective tinnitus, clinicians can select from various treatment options after considering the multifactorial etiology of tinnitus. This study surveyed otologists at university hospitals in Korea to identify the treatments used for subjective tinnitus and to obtain basic information on evidence-based medicine for treating tinnitus. SUBJECTS AND METHOD: A five-major-item questionnaire on current tinnitus treatments was sent by email to otologists at 37 university hospitals in Korea; 30 (81.1%) replied. RESULTS: The mean incidence of tinnitus in otology outpatient clinics was 22.7% (range 10-40%). Common treatments were oral pharmacological therapy, regular counseling with tinnitus retraining or cognitive behavioral therapy and hearing aids. Tinnitus retraining therapy and hearing aids were considered the most effective when the visual analog scale scores were 7.0 and 6.6, respectively, and considered safe when the scores were 9.9 and 9.3. Ginkgo biloba and benzodiazepines were the most frequently prescribed drugs, although their reported effectiveness was questionable. Intra-tympanic steroid injection was not considered effective (3.8) or safe (6.3). Somatosensory-based treatments such as treating neck muscle or temporomandibular joint disorders were also used to relieve a subgroup of somatic tinnitus. CONCLUSION: Our results showed trends similar to those in other countries, yet we have not reached the level of evidence-based clinical practice due to the lack of reliable and effective treatment options. Further research on tinnitus-treatments is needed, particularly about randomized controlled studies with blinding.

Multicenter Study on the Clinician's Diagnostic and Therapeutic Approaches for Benign Paroxysmal Positional Vertigo in Korea / 대한평형의학회지

BACKGROUND AND OBJECTIVES: It is necessary to establish the most efficient diagnostic and therapeutic method for benign paroxysmal positional vertigo (BPPV), which is appropriate for Korean healthcare system. We aimed to evaluate current state of Korean clinician's diagnostic and therapeutic approaches for BPPV. MATERIALS AND METHODS: A 16-item survey was emailed to the members of dizziness department of Otology Research Interest Group in the Korean Otologic Society (n=68). 43 were returned and analyzed. RESULTS: All respondents (100%) used Dix-Hallpike test as a diagnostic tool for vertical canal-BPPV. Supine roll test was used for diagnosing lateral canal BPPV in nearly all the respondents (97.7%). Epley maneuver was chosen as otolith repositioning maneuver (ORM) for posterior canal BPPV in all respondents and barbecue rotation (BBQ) was used for treating lateral canal BPPV with geotropic nystagmus in 95.3% of respondents. Extreme variation was noted for therapeutic approach of lateral canal BPPV with ageotropic nystagmus BBQ, with 4 kinds of ORM and adjunctive measures to liberate otolith from cupula, while BBQ was again the most commonly used ORM (76.7%). CONCLUSION: The development of practical and efficient ORM for lateral canal BPPV with ageotropic nystagmus is necessary.

The Influence of the Residential Environment on the Sensitization Rates to Aeroallergens and the Prevalence of Allergic Disorders in the School Children in Jeju / 소아알레르기및호흡기학회지

PURPOSE: This study is to investigate the influence of the residential environment on the sensitization rates to aeroallergens and the prevalences of atopic disorders in the school children. METHODS: Two elementary schools in Jeju, Korea were selected according to their distinctive residential environment, one located in the area surrounded by the tangerine farms and Japanese cedar forests (tangerine farming community) and the other rarely with them (non-tangerine farming community). All the school children (1,550 students) from the two school were enrolled in this study. Under their parents' informed consent, surveys based on International Study of Asthma and Allergies in Childhood questionnaire were answered by the parents and skin prick tests with 16 common aeroallergens were performed. RESULTS: The questionnaire is responded from 1,290 parents (83.2%) and the skin test was done in 1,284 students (82.8%). The sensitization rates to more than one aeroallergen was 41.9%, increasing by age. The children residing in the tangerine farming community showed significantly higher sensitization rates than those from non-farming one (47.5% vs. 38.4%, P=0.004). The former were sensitized more frequently to house dust mite, citrus red mite and Japanese cedar pollen, while the others to outdoor moulds. However, the prevalence of atopic disorders had no difference between the two groups. CONCLUSION: The residential environment might influence the sensitization rates to prevalent aeroallergens in the environment among school children, but there is no difference in the prevalence of the atopic disorders.

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.

Proteomic Analysis of the Protein Expression in the Cochlea of Noise-Exposed Mice

BACKGROUND AND OBJECTIVES: When noise-induced hearing loss occurs, destruction of the hair cells is accompanied by mechanical injury, chemical injury, and hypoxia. Proteomics is a powerful tool for protein analysis, as it provides valuable information regarding the biochemical processes involved in diseases, monitors cellular processes, and characterizes protein expression levels. We attempted to identify the proteins associated with the pathophysiology of noise-induced hearing loss, as well as the mechanisms of this disease, using a proteomics approach. MATERIALS AND METHODS: We used BALB/C male mice. The control mice were placed in a booth without noise, while the experimental mice were exposed to noise for three hours daily for three consecutive days. Cochleae from each group were obtained for total protein extraction. The proteins were separated into numerous spots using two-dimensional electrophoresis. Seven protein spots that were strongly detected only in the noise-exposed cochleae were selected and subsequently analyzed using matrix-assisted laser desorption/ionization time of flight mass spectrometry. RESULTS: Approximately 286 protein spots were detected in the noise group. Seven selected spots were analyzed and various proteins identified, including tyrosine protein kinase MEG2, angiopoietin-like 1, heat shock 70 kDa protein, sodium dicarboxylate cotransporter 1, myeloid Elf-1-like factor, disintegrin, metalloproteinase domain 7, and activated leukocyte-cell adhesion molecule. CONCLUSIONS: We identified several proteins expressed in noise-induced hearing loss using a proteomics approach. These proteins may help us to understand the pathogenic mechanisms of noise-induced hearing loss.

Eosinophilic Otitis Media 3 Cases Discovered with Recurrent and Sticky Otorrhea after Ventilation Tube Insertion / 대한이비인후과학회지

We studied three patients in whom otorrhea occurred without bacterial infection following ventilation tube (VT) insertion. These patients took oral steroids since the conventional therapy was not effective; however, the oral steroids produced temporal effect since sticky otorrhea occurred when the oral steroids were stopped. We collected ear discharge from each patient and consulted the pathologist about histopathologic findings of it. We identified the predominant eosinophilic infiltration at specimen. We tried to relate this type of otitis media with eosinophilic otitis media (EOM) and treated the patients with intratympanic steroid injection.

Efficacy of Oral Prostaglandin I2 in Patients with Chronic Nonspecific Vertigo / 대한평형의학회지

BACKGROUND AND OBJECTIVES: The aim of this study is to evaluate the efficacy of prostaglandin I2 (PGI2) in the patients with chronic nonspecific vertigo using questionnaires of dizziness handicap inventory (DHI) and vertigo symptom scale (VSS). MATERIALS AND METHODS: Forty two patients with chronic nonspecific vertigo from May to December 2010 were enrolled in this study. We administered Berast (synthetic PGI2, beraprost sodium) 2 tablets (0.04 mg) twice a day to patients. Before and after 2, 4 weeks the end of administration patients underwent DHI and VSS for evaluation of state of the vertigo. RESULTS: Twenty four of 42 patients completed this clinical trial. Mean DHI scale score decreased significantly from 23.00 (+/-21.75) to 17.75 (+/-19.78) (p=0.004). All DHI subscales, physical, functional, and emotional factors, decreased after treatment of prostaglandin I2. VSS scale also showed significant decrease from 3.63 (+/-2.55) to 2.50 (+/-2.95) (p=0.044). CONCLUSION: Prostaglandin I2 may be one of the treatments to improve symptoms in the patient s with chronic nonspecific vertigo.

Clinical Results of Atticoantrotomy with Attic Reconstruction or Attic Obliteration for Patients with an Attic Cholesteatoma

OBJECTIVES: We aimed to investigate the clinical results of atticoantrotomy in patients with an attic cholesteatoma. METHODS: Ninety-eight ears in 98 patients were operated on using atticoantrotomy between October 2002 and December 2006. A retrospective review of the otology database (operative findings and methods, postoperative physical examination and pre- and postoperative audiometry) was performed. RESULTS: There were 58 female and 40 male patients with a mean age of 40 yr. The cholesteatoma was limited to the attic region in 24 patients (24.5%); attic with antrum in 18 (18.4%); and attic with antrum and middle ear in 56 (57.1%). Attic obliteration was performed in 59 patients (60.2%), attic reconstruction in 39 (39.8%) and ossicular reconstruction was performed in 59 (60.2%). The mean preoperative and postoperative air-bone gaps were 29.2+/-13.5 dB and 25.0+/-15.4 dB, respectively (P=0.01) and the mean preoperative and postoperative high-tone bone conduction levels were 14.5+/-9.7 dB and 15.23+/-14.0 dB, respectively (P=0.411). A recurrent cholesteatoma was detected in 3 ears (3%) and revision surgery was performed on these patients. CONCLUSION: Atticoantrotomy showed a low recurrence rate and no deterioration in hearing levels. If there is a intact malleus head or body of incus, attic reconstruction was possible and this procedure could lead to improved hearing. However, postoperative retraction occurred in 18% of patients, a problem that will need to be solved in the future.

Pre-operative Evaluation of Eustachian Tube Function Using a Modified Pressure Equilibration Test is Predictive of Good Postoperative Hearing and Middle Ear Aeration in Type 1 Tympanoplasty Patients

OBJECTIVES: The Eustachian tube (ET) plays an important role in maintaining a normally aerated middle ear. Inflammation in middle ear disease is related to ET dysfunction, and postoperative restoration of middle ear integrity and hearing are closely related to ET function in chronic ear disease patients. After successful tympanoplasty, restoration of a well-aerated middle ear with good ET function can permit better compliance of the tympanic membrane. In this study, we evaluated the predictive validity of preoperative ET function measurements. METHODS: We reviewed 137 patients who underwent type 1 tympanoplasty. All patients had non-cholesteatomatous chronic otitis media and received canal wall-up-type tympanomastoidectomies. Patients were categorized into four groups according to preoperative ET function measurements using a modified pressure inflation-deflation equilibration test. Group I patients had residual pressures less than 10 daPa, and Group IV patients showed no pressure change (poor results). Groups II and III were intermediate. Hearing levels were determined using pure tone averages at four frequencies. Postoperative tympanography was performed to determine middle ear aeration. RESULTS: The preoperative air bone (AB) gap was 29.6+/-7.0 dB, and the postoperative gap was 16.5+/-5.7 dB; thus, there was significant overall improvement. In all groups, hearing was significantly better after surgery, but the worst postoperative hearing level was seen in Group IV patients. Type B tympanograms were more frequently recorded in Group IV patients than they were in Group I or II patients. Postoperative AB gaps were 9.2+/-3.8 dB in patients with type A tympanograms, 13.4+/-2.1 dB in those with type As, 24.1+/-2.5 dB in those with type C, and 18.5+/-2.8 dB in those with type B. CONCLUSION: ET function measured with a modified pressure equilibration test using an inflation-deflation manometric method is a good indicator of an aerated middle ear and is predictive of improved postoperative hearing.

Apoptotic Pattern of Cochlear Outer Hair Cells and Frequency-specific Hearing Threshold Shift in Noise-exposed BALB/c Mice

OBJECTIVES: Apoptosis of outer hair cell (OHC) can be identified through nuclear staining by specific nuclear changes. The change of filamentous actin (F-actin) is also involved in early cell death process. The study was designed to investigate OHC death along the whole length of the organ of Corti. METHODS: BALB/c hybrid mice were used in this study. The noise group was exposed to white noise of 120 dB SPL for 3 hr per day for 3 consecutive days. The tone burst auditory brainstem response (ABR) test was conducted and cochleas from each group were obtained for the immunostaining of FITC phalloidin for F-actin and propidium iodide (PI) for nuclei. RESULTS: ABR threshold of the noise group significantly increased after noise exposure (P<0.001). No threshold shift was found in the control group. Threshold shift of the noise group constantly increased from 4 to 16 kHz, but threshold shifts at 16 kHz and 32 kHz were similar. Patterns of OHC staining were subclassified as FITC+PI- cells, FITC+ PI+ cells, FITC-PI+ cells and missing cells. Proportion of normal live OHCs (FITC+PI-) rapidly decreased from the apex to the base. In the basal turn, FITC-PI+ cells and vacancy OHC (missing cells) were observed easily. Apoptotic and missing cells were most abundant at 60% of the whole length of the Corti organ. CONCLUSION: We could subclassify morphologic changes in OHC death after noise exposure. Quantitative changes in OHCs along the whole Corti organ showed a plateau pattern similar to that of a frequency-specific threshold shift.

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.

The Factors Influencing Postoperative Aspiration after Supraglottic Laryngectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Supraglottic laryngectomy is a well established technique for the treatment of appropriate carcinoma of supraglottic larynx. The purpose of this study was to determine factors that may contribute to postoperative aspiration related to deglutition problem following supraglottic laryngectomy. MATERIALS AND METHOD: A retrospective analysis of medical records of 19 patients who consecutively underwent supraglottic laryngectomy was undertaken. Contribution of the following factors was investigated: age, T stage, pack-years of smoking, and parameters of pulmonary function test. The authors used a computerized acoustic analysis program (CSL-MDVP) to measure fundamental frequency, jitter, shimmer, and noise to harmonics ratio. RESULTS: Eleven patients had no problem, 5 patients had clinically insignificant problem, and 3 patients had moderate problem in postoperative 6 months. A greater number of pack-years of smoking and decreasing FEV1/FVC were significantly correlated with poor outcome with regards to postoperative aspiration and deglutition problem. No statistically significant difference was seen between patients with supraglottic laryngectomy and the control group. CONCLUSION: This study showed that less than 60% FEV1/FVC signifies a greater risk for postoperative aspiration.

Clincal Analysis of Stapedial Fixation with Stapedotomy Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Stapedial fixation is most commonly found in congenital anomaly of middle ear. Congenital middle ear anomaly without anomaly of the auricle and inner ear is rare. The surgery of stapedial fixation has evolved during the last 50 years from total to partial stapedectomy, and finally to stapedotomy. Stapedotomy is less likely to induce iatrogenic inner ear lesions and results in better hearing in the higher frequencies than stapedectomy. In recent years, stapedectomy has increasing tendency to be replaced by stapedotomy. This study was carried out to analyse clinical features of stapedial fixation and evaluate the degree of the auditory improvement, and also to analyse the factors affecting the results after stapedotomy. MATERIALS AND METHOD: From Jan. 1992 to Aug. 2001, we analysed 25 cases (23 patients) of stapedotomy operated by one surgeon for stapedial fixation at Asan Medical Center. The clinical features, preoperative and postoperative audiologic findings, postoperative complication and factors affecting the results were analysed. RESULTS: Preoperative mean bone and air conduction thresholds were 26.5 dB, 64.0 dB, respectively and mean air-bone gap was 36.5 dB. After stapedotomy, mean bone and air conduction thresholds were 24.9 dB, 37.0 dB, respectively at the last audiologic follow-up. In one case, sensorineural hearing loss was observed. There were no significant differences of results associated with bilaterality, length of piston wire and con-commitent other ossicular anomaly. CONCLUSION: Stapedotomy is effective and safe for stapedial fixation. But there is a need for carefulness and meticulousness because of complication. There may need various operative trials and larger scale studies to study about factors affecting the results after stapedotomy.

Comparative Analysis of Sleepstrip Versus Laboratory Polysomnography in the Diagnosis of Sleep Disordered Breathing / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Polysomnography is regarded as the gold standard in the diagnosis of sleep disordered breathing, although it is too expensive and uncomfortable to use. There has been a need for more simple and cost-effective techniques to screen large populations for suspected sleep disordered breathing. The aim of this study was to compare sleep parameters between Sleepstrip and laboratory polysomnography in the diagnosis of sleep disordered breathing. MATERIALS AND METHOD: A prospective study was undertaken in 20 patients in whom polysomnography and Sleepstrip were performed simultaneously before surgery from January 2001 to March 2001. Sleepstrip monitored the patients' respiration during sleep, analyzed respiration patterns in real time, and displayed the computed apnea hypopnea index (AHI) on its built-in display the following morning. RESULTS: The correlation between respiratory disturbance index (RDI) of polysomnography and AHI of Sleepstrip was 0.661 (p<.01). When the polysomnography threshold for a positive diagnosis for sleep disordered breathing was set at RDI=20 and the threshold for Sleepstrip 5, sensitivity and specificity of the device were found to be 0.875 and 0.833, respectively. CONCLUSION: Availability of Sleepstrip at a fraction of the cost of a whole night polysomnographic recordings may greatly facilitate the clinical diagnosis of large majorities of yet undiagnosed sleep disordered breathing. Sleepstrip may also prove useful for large scale epidemiological studies and for long term follow-up's of patients after surgery.