The Effect of Intratympanic Dexamethasone on Tinnitus in Inner Ear Diseases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Intratympanic steroid serves as a good therapeutic alternative for various inner ear diseases presenting with vertigo, hearing loss, and tinnitus. This study reports the effect of intratympanically injected dexamethasone (ITDEXA) on tinnitus in various cochlear pathologies. SUBJECTS AND METHOD: 19 patients with cochlear tinnitus (7 sudden sensorineural hearing loss (SSNHL), 5 noise induced hearing loss, 4 Meniere's disease and 3 acoustic trauma) were subjected to the IT-DEXA. The injection was performed with a spinal needle through the posterior superior quadrant of the tympanic membrane for 2 to 5 consecutive days. RESULTS: The overall improvement rate was 31.6%. Tinnitus was improved in 4 patients with SSNHL and 2 patients with Meniere's disease. Tinnitus was not improved in noise induced hearing loss or acoustic trauma. CONCLUSION: IT-DEXA is a therapeutic modality for tinnitus in SSNHL and Meniere's disease.

The Effect of Substance P on Osteoclastogenesis and Osteoclastic Bone Resorption in vitro / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Osteoclasts are the principal cell of bone resorption playing a major role in focal bone erosion associated with cholesteatoma. This study was conducted in order to investigate direct effect of substance P (SP) on osteoclastogenesis and osteoclastic bone resorption in vitro. MATERIALS AND METHOD: SP dose response was measured in receptor activator for NF-kappaB ligand (RANKL)-induced mouse osteoclast culture and osteoclastic bone resorption assay. RT-PCR was performed for the expression of neurokinin(NK) receptor mRNAs in osteoclasts. RESULTS: Treatment with SP (100 nM and 1000 nM) significantly increased osteoclastogenesis. SP (0.1 nM and 1 nM) significantly increased resorption surface area on dentin slices by osteoclasts. Cultured osteoclasts expressed NK-2 receptor mRNA. CONCLUSION: SP has a direct upregulatory effect on osteoclastogenesis and osteoclastic bone resorption that is mediated possibly by NK-2 receptor.

Real Time RT-PCR Quantification of Mucin Genes Expression in Human Mastoid Mucosa / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mucin is involved in the pathogenesis of otitis media, but little is known about its expression in the mastoid mucosa with chronic otitis media. The purpose of this study is to identify MUC1, 2, 4, 5AC, 5B, 8 gene expression in the mastoid mucosa with chronic otitis media, and to compare the results with normal mastoid mucosa. MATERIALS AND METHOD: Normal or inflamed mastoid mucosal specimen were taken at the time of surgery, who underwent cochlear implant surgery and middle ear surgery for chronic otitis media. The profiles of mucin gene expression were examined by Real time reverse transcription polymerase chain reaction. RESULTS: This study revealed that RT-PCR of cDNAs from mastoid mucosa specimen of chronic otitis media showed the expression of MUC1, MUC4, MUC5AC, MUC5B, and MUC8 but MUC2 was not detected while normal mastoid mucosa showed the same pattern of mucin gene expression. In mastoid mucosa with chronic otitis media, mucin mRNA expression was upregulated in MUC1 1.2+/-1.1, MUC4 3.2+/-2.5, MUC5AC 2.5+/-1.0, MUC5B 4.1+/-2.2, and MUC8 2.7+/-2.1 times compared with that of normal mucosa and MUC5B is statistically significant (p<0.05). The MUC1, 4, 5AC, 5B, 8 mRNA expressions were correlated to infiltration of inflammatory cells in the submucosa of mastoid mucosa with chronic otitis media. CONCLUSION: These results suggest that MUC1, MUC4, MUC5AC, MUC5B, and MUC8 are expressed in the normal and inflamed mastoid mucosa and up-regulated by chronic inflammation.

Endoscopic Revision Surgery of Middle Ear / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: With modern endoscopes, the mastoidectomized cavity and the middle ear can be visualized with a minimally invasive technique. The author employed endoscopes in reoperation of the middle ear and analyzed the results to determine whether it can replace a conventional procedure. MATERIALS AND METHODS: Ten ears undergoing endoscopic revision procedures had conventional canal wall up tympanomastoidectomies performed 6-15 months previously for chronic otitis media or cholesteatoma. The endoscopes were introduced through a postauricular hole to inspect the mastoid cavity, attic, and the tympanum systematically. A tympanomeatal flap was elevated to inspect the posterior tympanum and to reconstruct the ossicular chain. RESULTS: The mastoid cavity, attic, and the tympanum were directly visualized with endoscopes in 9 cases. Ossiculoplasties were performed with incus in 4 cases, with TORP in 3 cases, and with PORP in 2 cases. There was an epithelial pearl in the facial recess which was removed endoscopically. The intraoperative and postoperative courses were uneventful in all cases. The postoperative hearing results were favorable in the majority of the cases. CONCLUSION: Endoscopic revision surgeries of the middle ear were successfully performed in 9 out of 10 ears. With the employment of endoscopes, revision surgery of the middle ear can be converted into a minimally invasive one.

Endoscopic Tympanoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Modern endoscopes provide a direct access into the hidden recesses of the middle ear using a minimally invasive approach. The authors employed endoscopes in a transcanal tympanoplasty and analyzed the results for the further application of these endoscopic procedures to various otologic surgeries. MATERIALS AND METHOD: 15 ears with chronic otitis media and 2 ears with congenital cholesteatoma were operated under local anesthesia using 2.7 mm and 4 mm rigid endoscopes, a camera, and a monitor. RESULTS: The structures in the posterior tympanum were directly visualized with 0 endoscope in all cases without removal of the overlying bone. The attic was visualized with 70 endoscope after removal of the incus. 15 tympanoplasties were performed in 14 cases of chronic otitis media and in 1 congenital cholesteatoma. Staged tympanoplasties were performed for the other 2 cases. The intraoperative aid postoperative courses were uneventful in all cases. All cases showed closure of' the perforation and 15 cases showed favorable hearing results postoperatively. CONCLUSION: The endoscopes directly visualized the structures in the posterior tympanum and the transcanal endoscopic tympanoplasties showed closure of the perforation and favorable hearing results postoperatively. With the employment of these endoscopes, minimally invasive otologic surgeries will be possible on the ears with narrow canal, adhesive otitis, ossicular abnormalities, and other abnormalities.

Four Cases of Large Cerebellopontine Angle Tumors Removed by Translabyrinthine Approach / 대한이비인후과학회지

Several approaches to the cerebellopontine angle and internal auditory canal have been described for the removal of large acoustic tumors. Of these, the translabyrinthine removal of the large cerebellopontine angle tumors requires extensive removal of bones in order to manage the low-lying tegmen, the anterior sigmoid sinus, and the high jugular bulb. We removed 4 large cerebellopontine angle tumors by the translabyrinthine approach alone. All tumors were totally removed with acceptable facial nerve function. There was a case of CSF leak which was repaired at the revision surgery.

Endoscopic Transethmoidal Drainage of a Brain Abscess / 대한이비인후과학회지

Advanced techniques of nasal endoscopy made it possible to approach the optic nerve, pituitary gland, and anterior skull base transnasally. Epidural or brain abscess caused by ascending infection through the defect of the fovea ethmoidalis can be drained with reduced morbidity by endoscopic sinus surgery. Recently we have experienced a brain abscess that was managed by endoscopic transnasal drainage successfully.