Foreign Body of External Auditory Canal: Review of 170 Cases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Foreign bodies in the external auditory canal (EAC) are frequently encountered by otolaryngologists, emergency care physicians and pediatricians. The purpose of this study was to assess clinical characteristics, complications, as well as to investigate the proper management of foreign bodies in the EAC. SUBJECTS AND METHOD: We retrospectively reviewed and analyzed clinical records of patients who presented with foreign bodies in the EAC at the otolaryngologic department of Keimyung University Dongsan Hospital from January, 2011 to October, 2016. RESULTS: One-hundred seventy patients with aural foreign bodies were identified. The age of patients ranged from 12 months to 83 years, with 34.1% of the patients being under 10 years of age. Thirteen different types of foreign bodies were found, where insects, cottons and beads were the most common. Approximately 98% of the foreign bodies were removed without general anesthesia by using proper instruments under direct vision. Complications were observed in 5.8% of the patients: these included laceration and bleeding from the EAC (80%) and traumatic perforation of the tympanic membrane (20%). CONCLUSION: Various methods are available for foreign body removal from the EAC. In order to remove foreign bodies successfully and reduce complications, patients should be given precautions, such as, regarding adequate immobilization, prior to removing foreign bodies using proper instruments with a surgical microscope under appropriate anesthesia.

Bacterial Meningitis Initially Presenting as Labyrinthitis / 대한평형의학회지

Labyrinthitis causes damage to inner ear structure, and in turn hearing loss and vertigo. Labyrinthitis is classified as otogenic labyrinthitis and meningogenic labyrinthitis. Otogenic labyrinthitis can be diagnosed early through otoscopic examination. However, when there are no characteristic neurologic symptoms in patients with meningogenic labyrinthitis, clinicians can overlook the underlying meningitis and this may lead to the peripheral vertigo. We encountered an unusual case of meningogenic labyrinthitis that is misdiagnosed as peripheral dizziness.

The Value of PROPELLER Diffusion-Weighted Image in the Detection of Cholesteatoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study was to done to determine the value of PROPELLER diffusion-weighted imaging in detecting cholesteatoma. SUBJECTS AND METHOD: Sixty-five patients were evaluated by preoperative magnetic resonance imaging (MRI) with PROPELLER diffusion-weighted imaging. Of 65 patients, 16 patients had chronic otitis media without cholesteatoma and 49 patients with cholesteatoma. Surgical and pathologic findings were compared with the preoperative findings by PROPELLER diffusion-weighted imaging to assess the sensitivity, specificity, positive and negative predictive values. RESULTS: In 49 patients with cholesteatoma, high signal intensity compatible with cholesteatoma was found in 46 patients, whereas in 16 patients without cholesteatoma, high signal intensity was not detected in any of them. The sensitivity, specificity, positive and negative predictive values for PROPELLER diffusion-weighted imaging were 94.1%, 100%, 100%, and 84.2%, respectively. CONCLUSION: PROPELLER diffusion-weighted imaging can be a useful tool in detecting cholesteatoma.

Vestibular Paroxysmia Mimicking Benign Parxysmal Positional Vertigo / 대한평형의학회지

Vestibular paroxysmia is the name given to the syndrome caused by vascular compression of the vestibulocochlear nerve. The main symptoms of vestibular paroxysmia are recurrent, spontaneous, brief attacks of spinning, non-spinning vertigo or positional vertigo that generally last less than one minute, with or without ear symptoms (tinnitus and hypoacusis). Prior to attributing a patient's symptoms to vestibular paroxysmia, however, clinicians must exclude common conditions like benign paroxysmal positional vertigo, Menière's disease, vestibular neuritis and vestibular migraine. This is usually possible with a thorough history and bedside vestibular/ocular motor examination. Herein, we describe a patient with vestibular paroxysmia that mimicked resolved BPPV with a literature review.

A Case of Two Isolated Congenital Cholesteatomas Presented in Middle Ear Cavity / 대한이비인후과학회지

Middle ear cholesteatoma is considered to be congenital in origin when there is an intact tympanic membrane with no prior history of otorrhea, tympanic perforation or otologic procedure. However, congenital cholesteatoma is a relatively rare disease entity for which a variety of theories regarding its pathogenesis have been suggested as follows: epidermoid formation, migration of squamous epithelium, implantation, metaplasia, and acquired inclusion theory. However, the pathogenesis of congenital cholesteatoma remains unclear. There are two pathologic types of congenital cholesteatoma, "closed" and "open". We present a rare case of congenital cholesteatoma arising from middle ear cavity in a condition of two completely isolated closed congenital cholesteatomas, which were successfully removed via transcanal approach. Also we review the literature and discuss the theories on the development of two separate congenital cholesteatomas.

Objective Tinnitus Concomitant with Eye Blinking: A Case Report

Tinnitus is a common auditory phenomenon associated with many otological diseases, and is usually subjective. Objective tinnitus can be generated by para-auditory structures, usually derived from vascular or myogenic sources, or the eustachian tube. We present a rare case of intermittent unilateral tinnitus associated with eye blinking. Otoendoscopic examination showed that the external auditory canals and tympanic membranes were normal; however, rhythmic movements of both tympanic membranes, concomitant with the tinnitus, were evident whenever the patient blinked. The tympanometry and stapedial reflexes measured via impedance audiometry exhibited saw-tooth patterns; movement of the tympanic membrane was associated with eyelid blinking. The patient was managed conservatively, with reassurance and medication, and the condition became well-controlled. Here, we present this educational case and review the literature.

Change in Tinnitus after Treatment of Vestibular Schwannoma: Microsurgery vs. Gamma Knife Radiosurgery

PURPOSE: Tinnitus is a very common symptom of vestibular schwannoma, present in 45 to 80% of patients. We evaluated changes in tinnitus after translabyrinthine microsurgery (TLM) or gamma knife radiosurgery (GKS). MATERIALS AND METHODS: Among 78 patients with vestibular schwannoma who underwent TLM or GKS at Severance Hospital from 2009-2012, 46 patients with pre- or postoperative tinnitus who agreed to participate were enrolled. Pure tone audiometry, tinnitus handicap inventory (THI), visual analogue scale (VAS) scores for loudness, awareness, and annoyance were measured before and after treatment. Changes of THI and VAS were analysed and compared according to treatment modality, tumour volume, and preoperative residual hearing. RESULTS: In the TLM group (n=27), vestibulocochlear nerves were definitely cut. There was a higher rate of tinnitus improvement in TLM group (52%) than GKS group (16%, p=0.016). The GKS group had a significantly higher rate of tinnitus worsening (74%) than TLM group (11%, p<0.001). Mean scores of THI and VAS scores significantly decreased in the TLM group in contrast to significant increases in the GKS group. Tumor volume and preoperative hearing did not affect the changes in THI or VAS. CONCLUSION: GKS can save vestibulocochlear nerve continuity but may damage the cochlea, cochlear nerve and can cause worsening tinnitus. In cases where hearing preservation is not intended, microsurgery with vestibulocochlear neurectomy during tumor removal can sometimes relieve or prevent tinnitus.

The Role of Vestibular Function Tests in Patients with Sudden Sensorineural Hearing Loss Who Have Subclinical Vestibular Dysfunction / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The evaluation of vestibular function is very important for patients with sudden sensorineural hearing loss (SNHL) as it is a well-known prognostic factor. The purpose of this study was to evaluate subclinical vestibular dysfunction (SVD) and its association with prognosis in sudden SNHL patients with and without dizziness using the vestibular function tests. SUBJECTS AND METHOD: Seventy eight patients who had been diagnosed with unilateral sudden SNHL were examined by dividing them into three groups according to their clinical findings such as vestibular function and subjective symptoms: 1) normal, 2) SVD and 3) dizziness. Vestibular dysfunction and hearing recovery rates were also assessed. RESULTS: Patients with SVD accounted for 62.5% of patients even though they did not complain subjective dizziness. The extent of vestibular dysfunction in the dizziness group was greater than that in the SVD group (p=0.05). The hearing recovery rates for normal, SVD and dizziness group were 72% (13/18), 57% (17/30) and 48% (12/25), respectively. The incidence and extent of vestibular dysfunction was greater in patients with severe hearing loss than in those with moderate to severe loss. A significant correlation was noted between hearing recovery rate and vestibular evoked myogenic potential (VEMP) testing. Normal and abnormal VEMP data were associated with good and poor recovery (p=0.001). CONCLUSION: The evaluation of vestibular function is important in sudden SNHL patients with dizziness; however, SVD also explains a significant proportion of sudden SNHL in the absence of dizziness. Notably, VEMP is useful tools for evaluating prognosis of sudden SNHL.

Fibrosarcoma of the Thyroid Gland : Report of a Case / 대한이비인후과학회지

Fibrosarcoma is a malignant mesenchymal neoplasm of fibroblasts that rarely affects the thyroid gland and can cause local recurrences or metastasis. We describe a case of primary fibrosarcoma of the thyroid in a 31-year-old man. Microscopically, the tumor showed highly cellular proliferation of spindle cells with cytologic atypia and mitotic figures. Immunohistochemically, the cells only showed immunoreactivity for vimentin and negativity for S-100 protein, CK, CD31, CD34, TTF-1, desmin. Based on clinical, radiological, histological and immunohistochemical findings, the final diagnosis was intra-thyroid fibrosarcoma. The treatment of choice is radical surgery. Radiation therapy is used as adjuvant treatment. So, we review the clinical, radiologic, histologic findings and treatment modalities of the fibrosarcoma of the thyroid gland.

Effect of Topical Antibiotics to Mouse Model of Acute Rhinosinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES : Administration of antibiotics is an essential modality to treat acute rhinosinusitis. Although intranasal inoculation of antibiotics does not have definite bioavailability, it is a very effective method to treat acute rhinosinusitis. We made a mouse model of rhinosinusitis by inoculation of Streptococcus pneumoniae and administrated time-dependent antibiotics or concentration-dependent antibiotics as a topical manner and investigated their effectiveness. SUBJECTS AND METHOD : Fifty 10-week old male C57BL/6 mice were employed for acute rhinosinusitis model. Mice were inoculated with Streptococcus pneumoniae, and from the 6th to 10th day, we made the negative control group by inoculation of normal saline (Group I), the antibiotics group by inoculation of cefmenoxime & vancomycin (Group II), the ofloxacin & tobramycin group (Group III), and the positive control group (Group IV). On the 11th day, all mice were sacrificed and the effectiveness of antibiotics was evaluated by comparison of nasal lavage colony count and neutrophil count of the sinonasal tissue. RESULTS : Minimum bactericidal concentration (MBC) of each antibiotics was cefmenoxime 20 microgram/ml, ofloxacin 80 microgram/ml, tobramycin 25 microgram/ml, vancomycin 12.5 microgram/ml. By nasal lavage, antibiotics inoculation group (Group II, III) had more decreased bacterial growth than the positive control, and it was statistically significant (p=0.037). Comparision between the group administrated with concentration-dependent antibiotics and time-dependent antibiotics, clusters of neutrophil decreased in two groups compared to positive control revealed that the group administered with concentration-dependent antibiotics had fewer clusters of neutrophil than the group administered with time-dependent antibiotics, and it was statistically significant. CONCLUSION : Local inoculation of concentration dependent antibiotics could be a more effective way to treat acute rhinosinusitis induced by Streptococcus pneumoniae than time dependent antibiotics.