The Efficacy of Endoscopic Exploratory Tympanotomy in Conductive Hearing Loss Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study is to investigate the effectiveness of the endoscopic exclusive transcanalar approach for the management of conductive hearing loss. SUBJECTS AND METHOD: This was a retrospective comparative study of 106 patients who underwent exploratory tympanotomy at Chonnam National University Hospital from January 2008 to March 2016. The subjects were classified into two groups; endoscopic tympanotomy (ET, n=26) and microscopic tympanotomy (MT, n=80). Demographic data, operation time, postoperative admission days, pure tone audiometric results of pre-operation and post-operation at 3 months, and hearing success rate were evaluated. RESULTS: The mean operation time of MT (101.7±24.8 minutes) was longer than that of ET (59.8±23.2 minutes) with a statistical significance (p<0.01). The mean postoperative admission days of MT (4.4±1.3) was longer than that of ET (2.0±0.6) with a statistical significance (p<0.01). Hearing gain (air-conduction) and air-bone gap improvements were not significantly different between the groups. However, the hearing success rate of ET [partial ossicular replacement prosthesis (PORP) 85.7%, total ossicular replacement prosthesis (TORP) 81.8%] was significantly improved enormously compared to that of MT (PORP 62.9%, TORP 64.3%). CONCLUSION: With regards to conductive hearing loss, the endoscopic approach provided a better surgical view and less invasiveness compared with the microscopic approach. In conclusion, endoscopic exploratory tympanotomy had several advantages in operation time, admission days and hearing success rate.

Clinical Characteristics and Hearing Results of Sudden Sensorineural Hearing Loss in Child / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sudden sensorineural hearing loss (SSNHL) in children can occur just as can in adults; in fact, it may last throughout the entire life of a child, affecting the individual much more than when it does to an adult. As there are only a few studies that have focused on SSNHL in childhood, we investigated the clinical characteristics and hearing outcomes of pediatric SSNHL. SUBJECTS AND METHOD: A retrospective review of patients from November 2005 to May 2014 was carried out. Thirty nine patients under the age 15, who were hospitalized due to SSNHL were enrolled. Of these patients, 226 patients over the age of 15 were collected as a comparison group. Age, sex, underlying disease, site of hearing loss and duration from the onset to treatment were analyzed. We evaluated the overall recovery rate as well as the recovery rate according to accompanying diseases. RESULTS: Recovery rates were comparable between the pediatric and the adult group. Overall recovery rate was 60% in the pediatric group. Unlike for the adult group, dizziness and tinnitus were not a prognostic factor in the pediatric group. Pediatric patients showed similar overall recovery, whether the treatment initiation was under 7 days or more. Recurrence was seen in 3 patients, of which 2 showed complete recovery. CONCLUSION: The recovery rate for SSNHL was similar for the pediatric and the adult groups. A higher recurrence rate may alert clinicians to be aware of hearing changes after the recovery in pediatric patients.

Ludwig's Angina: An Autopsy Case / 대한법의학회지

Ludwig's angina is a progressive gangrenous cellulitis and edema of the soft tissues of the neck and floor of the mouth. Ludwig's angina can be fatal as a result of progressive swelling of the soft tissues of the neck and elevation and posterior displacement of the tongue, resulting in airway obstruction. We report the case of a 77-yearold man who was admitted to the dental hospital with a toothache and headache. He was diagnosed with left submandibular space abscess. Four days post-admission, the submandibular and submental abscess was incised and drained. After the operation, the patient suddenly developed dyspnea and suffered cardiopulmonary arrest and died. An autopsy was performed, and exploration of the neck revealed a submental and submandibular abscess with massive inflammation, edema, and an abscess in multiple layers of the cervical subcutaneous tissue. After autopsy, the cause of death was confirmed as Ludwig's angina with a deep neck abscess. Ludwig's angina is a rapidly progressive cellulitis that often results in death by asphyxia or sepsis and is rarely seen in a forensic autopsy practice. Here in we report a case of Ludwig's angina and present a review of the literature.

The Protective Effect of Epigallocatechin-3-Gallate Against Gentamicin Vestibular Ototoxicity in Type I Vestibular Hair Cell of Guinea Pig / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Gentamicin (GM) is well known for its vestibulotoxicity. There have been many reports about vestibulotoxicity, however, its mechanism is still unclear. So far, it is known that GM affects the voltage-dependent K+ current and nitric oxide (NO) production. Epigallocatechin-3-gallate (EGCG) is the major component of green tea and is known to have anti-oxidative and anti-toxic effect. This study was undertaken to investigate the protective effect of EGCG against gentamicin on vestibular hair cell (VHC). MATERIALS AND METHOD: White guinea pigs (200-250 g) were rapidly decapitated and the temporal bones were immediately removed. Under a dissecting microscope, the crista ampullaris was obtained. The dissociated VHCs were transferred into a recording chamber mounted onto an inverted microscope. Whole-cell membrane currents and potentials were recorded using standard patch-clamp techniques. In addition, measurements of NO production were obtained using the NO-sensitive dye, 4,5-diamino-fluorescein diacetate (DAF-2DA). RESULTS: Type I VHCs Voltage-dependent K+ current was activated from low depolarizing stimulation. As the stimulation increased, higher current was detected. Voltage-dependent K+ current in type I VHCs was decreased when GM (200 microM) was administrated and GM effects of K+ current inhibition was significantly blocked by EGCG. Extracellular GM-induced an increase in DAF-2DA fluorescence, which thus indicates NO production in VHCs. Also, the GMinduced NO production was inhibited by EGCG. CONCLUSION: GM inhibits voltage-dependent K+ current by releasing NO in isolated type I VHCs. EGCG blocks this inhibitory effects, suggesting a protective role on GM vestibulotoxicity.

Effect of Hydrogel Pad and Conventional Method on the Induction Time of Therapeutic Hypothermia in Patients with Out-of-Hospital Cardiac Arrest / 대한구급학회지

BACKGROUND: Therapeutic hypothermia has been recommended as a standard treatment of cardiac arrest patients after return of spontaneous circulation. There are various methods to drop patient's core body temperature below 33.5degrees C. We compared the cooling rate of the conventional cooling method using cold saline bladder irrigation with the commercial hydrogel pad in out-of-hospital cardiac arrest (OHCA) patients. METHODS: We collected data retrospectively from the Samsung Medical Center hypothermia database. The conventional method group was cooled with IV infusion of 2,000 ml of 4degrees C cold saline and cold saline bladder irrigation. Patients in the hydrogel pad group had their body temperature lowered with the Artic Sun(R) after receiving 2,000 ml of 4degrees C cold saline intravenously. The induction time was defined as time from cold saline infusion to the esophageal core temperature below 33.5degrees C. The esophageal temperature probe insertion to the target temperature time (ET to target BT time) was defined as the time from the esophageal probe insertion to the core temperature below 33.5degrees C. We compared these times and cooling rates between the two groups. RESULTS: Eighty one patients were enrolled. Fifty seven patients were included in the hydrogel pad group and 24 patients were in the conventional group. There were no statistical differences of baseline characteristics between the two groups. The induction time of the conventional group (138 min., IQR 98-295) was shorter than that of the hydrogel pad group (190 min., IQR 140-250). The ET to target BT time of the conventional group (106 min., IQR 68-249) was shorter than that of the hydrogel pad group (163 min., IQR 108-222). The cooling rate of the conventional group (0.93degrees C/hr., IQR 0.58-2.08) was lower than that of the hydrogel pad group (1.05degrees C/hr., IQR 0.74-1.96). However, there were no statistical differences in the induction time, the ET to target BT time and the cooling rate between the two groups. CONCLUSIONS: There was no significant statistical difference of the cooling rate of the hydrogel pad and conventional method on the induction time of therapeutic hypothermia in Patients with OHCA. The conventional cooling method can be used as an effective and efficient way to lower OHCA patient's core body temperature during the induction phase of therapeutic hypothermia.

An Immunohistochemical Study on the Expression of SUMO-2/3 in the Colorectal Carcinoma

OBJECTIVE: The incidence of colorectal carcinomas continues to rise in Korea due to the westernized life style. However, the precise colorectal carcinogenic mechanisms remain to be elucidated. The protein products of oncogenes and cancer suppressor genes play important roles in the carcinogenesis. The effects of the proteins are influenced by post-translational modifications as phosphorylation, acetylation, methylation, and ubiquitination. The aberrant sumoylation plays some roles in carcinogenesis. However, the expression pattern of small ubiquitin-related modifier (SUMO)-2/3 in the colorectal cancer has not been reported. We assessed the expression of SUMO-2/3 and evaluated the expression pattern in colorectal cancer. METHODS: The SUMO-2/3 expression was tested in one normal colon mucosal cell line and 5 colorectal cancer cell lines by Western blot. We collected 322 cases of colorectal cancer operated from January 2000 to December 2010 at Soonchunhyang University Cheonan Hospital. We fabricated the tissue microarray and the expression of SUMO-2/3 was evaluated by immunohistochemistry. The results were analyzed with clinicopathologic parameters. RESULTS: The SUMO-2/3 was not expressed in the normal colon mucosal cell line. However, it was expressed highly in all the 5 colorectal cancer cell lines as the beta-actin. The SUMO-2/3 was expressed in 68.3% of the colorectal cancers and its expression was correlated with the pathological tumor stage stage (odds ratio, 2.89; 95% confidence interval, 1.10 to 7.55; P=0.031). CONCLUSION: The SUMO-2/3 plays some roles in carcinogenesis and progression of the colorectal cancer.

Kawasaki Disease Presenting as Cervical Lymphadenitis and Retropharyngeal Abscess / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Kawasaki diseases (KD) sometimes present themselves as cervical lymphadenitis or deep neck infection. These unusual Kawasaki diseases then lead to unnecessary antibiotic therapy or surgical intervention or delaying therapy. The purpose of this study is to determine clinical characteristics of early expressions of atypical Kawasaki diseases presenting as deep neck infection. SUBJECTS AND METHOD: We reviewed the medical records of the 6 patients who had been treated for Kawasaki disease that initially presented as fever and cervical lymphadenitis between March, 2007 and December, 2008. RESULTS: The contrast neck CT scan of four of the cases revealed no ring enhancement but retropharyngeal space fluid collection suggestive of retropharyngeal abscess. The contrast neck CT scan of the other two cases showed homogenous nonsuppurative cervical lymph node enlargement. We administered intravenous antibiotics but patients did not response to them. We then immediately administered intravenous immunoglobulin and aspirin after making the diagnosis of Kawasaki disease. The clinical condition of all the cases improved dramatically with defervescence. CONCLUSION: The possibility of Kawasaki disease should be considered in the following three situations: first, if the fever is refractory to intravenous antibiotic treatment in the febrile child with cervical lymphadenopathy, secondly, if the neck CT scan reveals a soft tissue swelling with no ring enhancement, and lastly, if the fever subsides dramatically after starting intravenous immunoglobulin and aspirin. Echocardiography should be performed as early as possible.

A Case of Malignant Peripheral Nerve Sheath Tumor of the Neck Associated with Neurofibromatosis Type I / 대한이비인후과학회지

Neurofibromatosis is an autosomal dominant hereditary disorder characterized by skin abnormalities such as cafe au-lait spots, and soft tissue legion such as generalized subcutaneous neurofibroma. Malignant peripheral nerve sheath tumor is a spindle cell sarcoma that mostly arises in the soft tissue but rarely arises in the head and neck region. Malignant peripheral nerve sheath tumor can develop from the pre-existing neurofibromas or schwannomas, and from the peripheral nerves. They can also occur after radiation therapy. Malignant peripheral nerve sheath tumor is usually associated with neurofibromatosis type I. The authors recently experienced a case of malignant peripheral nerve sheath tumor associated with neurofibromatosis type I in a 20-year-old female patient who presented with a well marginated oval shape mass in the left neck.

Expression of Aquaporin-2 in the Inner Ear of Water-Deprived Guinea Pigs / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although the role of aquaporin-2 (AQP2) in the kidney has been well defined, its role in the inner ear remains to be determined. The present study was to investigate the effect of water deprivation on the expression of AQP2 in the inner ear. MATERIALS AND METHOD: Healthy male guinea pigs weighing 250 g were used. The experimental group underwent water restriction and the control underwent water loading with sucrose-containing water for 3 days. Concentrations of plasma arginine-vasopressin (AVP) were determined and electrocochleography (ECoG) recordings were made. An RT-PCR, real-time PCR and Westernblotting analysis were used for quantitative analysis of AQP2 mRNA and AQP2 protein expression. Immunohistochemistry was also used to evaluate the distribution of AQP2 water channel proteins in the inner ear. RESULTS: AQP2 was mainly expressed in the epithelium of endolymphatic sac, spiral limbus, spiral ligament and stria vascularis of scala media. The concentrations of plasma AVP were 9.2+/- 0.8 pg/mL in the experimental group and 0.78+/-0.3 pg/mL in the control. The summation potential/ action potential (SP/AP) ratio in ECoG was markedly increased in the experimental group (0.55 in the experimental and 0.29 in the control). RT-PCR and real time PCR as well as Western blot analysis showed that the level of AQP2 mRNA and protein in the cochlea and endolymphactic sac of the water-deprived group was significantly higher than those in the control group. CONCLUSION: These data suggest that AQP2 is one of the important water channels in fluid homeostasis in the inner ear. Moreover, the volume of endolymphatic space can be increased via AVP-AQP2 system in response to water deprivation.

A Study on Bioethical Consideration to Prospective Clinical Research Papers published in Journal of Korean Society of Emergency Medicine

PURPOSE: There is increasing concern about ethical conduct of human research in the field of medicine. The purpose of this study was to assess the ethical review process by institutional review boards for human research articles published in the journal of Korean Society of Emergency Medicine. METHODS: We reviewed human research papers published in the journal of Korean Society of Emergency Medicine from the 1st edition, 1990 to the 6th edition, 2006. A checklist was used to review the articles. RESULTS: The total number of prospective clinical research paper was 250. Among them, there were 63 papers (25.2%) in which the obtaining of informed consent was described in the article. Only two studies (0.8%) published in the journal were noted to have IRB approval. Invasive techniques were employed in 134 studies (53.6%). Among the 134, only 22 (16.4%) mentioned that informed consent taken was given during the study. Studies which may have involved discrimination totaled 21 (8.4%), and the number of studies that may have violated the patients' right to privacy was 20 (8%). The number of studies that may have a conflict of interest but was not declared was 12 (4.8%). CONCLUSION: There should be greater concern about the ethical conduct of research in studies with human research subjects in the journal of the Korean Society of Emergency Medicine.

A Case of Primary Sarcoidosis of the Nasal Cavity / 대한이비인후과학회지

Sarcoidosis can occur as an isolated form or a part of multisystem involvement. Sinonasal involvement in sarcoidosis is rare and the septum and inferior turbinates are most commonly involved. Symptoms are nonspecific and diagnosis of isolated sinonasal sarcoidosis is difficult because it may mimic other sinonasal granulomatous disorders. Exclusion diagnosis is made according to symptoms, laboratory findings, nasal endoscopy, sinus CT, and histopathological features. In this study, we report a case of primary sarcoidosis of the nasal cavity and discuss the clinical characteristics of sinonasal sarcoidosis with a review of literature.

Colon Interposition into Hypopharynx in a Patient with Corrosive Esophageal Stricture / 대한이비인후과학회지

A 68-year-old male visited the hospital presenting swallowing difficulty that persisted for 30 years. In the military service, the patient accidentally ingested glacial acetic acid and esophageal obstruction was developed. Transverse and left colon was used for reconstruction for esophagus. The colon was pulled up via substernal route and anastomosed to pyriform sinus proximally and body of stomach distally. Partial resection of the manubrium and clavicular head was performed to avoid interference with the passage of the esophageal substitute. There was no operative complication except vocal cord palsy. Under fluoroscopy, the swallowing time of barium from the pharynx to the level of the diaphragm was 4 to 6 seconds. The patient could swallow solid food without aspiration, obstruction, or significant regurgitation 2.5 months after the surgery.

Rosai-Dorfman Disease in the Neck and Subglottis / 대한이비인후과학회지

Rosai-Dorfman disease is a systemic disease and its etiology is not well understood. It is very rare but established disease. We report a case of Rosai-Dorfman disease occurring in the neck and subglottis. A 18-year-old female had visited with a complaint of bilateral neck mass. Subglottic mass was also detected by flexible laryngoscopy. Lymph node excision and laryngeal microsurgery were performed. The histopathologic findings demonstrated proliferative large histiocytes with clear cytoplasm and rounded nuclei, and lymphagocytosis (emperiopolesis), which were the features of Rosai-Dorfman disease. Rosai-Dorfman disease has various clinical courses. Definitive diagnosis is needed for the appropriate management.

Pitfalls and Management of Mandible Angle Reduction

In general, orientals have a round and broad facial contour. In case of females with prominent mandible angles, the facial contour may look very square-like and unnatural with a masculine image. Recently, due to western aesthetic standards, there tends to be an increase of mandible angle reductions for an oval shaped face. The two methods for mandible angle reduction are curved horizontal ostectomy and angle splitting ostectomy depending on the layer of bone excision. The curved horizontal method may improve the lateral view of the patient but limited improvement is shown on the frontal view due to the lack of reduction of the mandible bone width. The angle splitting ostectomy improves the frontal view by decreasing the mandible bone width but there is limited change on the lateral view due to minimal change of the mandible angle contour. Currently, there are no specific protocols to determine the ideal operation methods for patients with prominent mandible angles. The authors measured the degree of mandible angles of 35 patients with prominent mandible angles and divided them into 3 types; severe 125. Patients with severe type angles showed best results with both operations combined due to not just the prominence of the angle but the width of the mandible bone. Patients with mild type angles obtained satisfactory results only with angle splitting ostectomy because they could have a natural lateral view. In case of moderate type angles, patients with angles closer to 105 should undergo curved horizontal ostectomy and those with angles closer to 125 should be operated with angle splitting ostectomy for satisfactory results.

The Case-Control Study on the Risk Factors of Cerebrovascular Diseases and Coronary heart Diseases / 예방의학회지

Cerebrovascular disease and coronary heart disease are the first and the fourth common causes of death among adults in Korea. Reported risk factors of one of these diseases may prevent other diseases. Therefore, we tried to compare and discriminate the risk factors of these diseases. We recruited four case groups and four control groups among the inpatients who were admitted to Wonju Christian Hospital from March, 1994 to November, 1995. Four control groups were matched with each of four case groups by age and sex. The number of patients in each of four case and control groups were 106 and 168 for acute myocardial infarction(AMI), 84 and 133 for subarachnoid hemorrhage(SAH), 102 and 148 for intracerebral hemorrhage(ICH), and 91 and 182 for ischemic stroke(IS) respectively. Factors whose levels were significantly higher in AMI and IS than in responding control group(RCG) were education, economic status, and triglyceride. Factors whose levels were significantly lower in hemorrhagic stroke than in RCG were age of menarch, and prothrombin time. The factor whose level was higher in AMI than in RCG was uric acid. The factor whose level was higher in AMI, ICH, and SAH than in RCG was blood sugar. Factors whose levels were significantly higher in all the case groups than in RCG were earlobe crease, Quetelet index, white blood cell count, hemoglobin, hematocrit, and total cholesterol. The list of risk factors were somewhat different among the four diseases, though none of the risk factors to the one disease except prothrombin time acted as a preventive factor to the other diseases. The percent of grouped cases correctly classified was higher in the discrimination of ischemic diseases(AMI and IS) from hemorrhagic diseases(SAH and ICH) than in the discrimination of cerebrovascular disease from AMI. The factors concerned in the discrimination of ischemic diseases from hemorrhagic diseases were prothrombin time, earlobe crease, gender, age uric aci, education, albumin, hemoglobin, the history of taking steroid, total cholesterol, and hematocrit according to the selection order through forward selection.

The Role of Prostaglandins in Surgically Induced Miosis

In cataract surgery, the surgically induced miosis complicate the removal of lens materials and implantation of a posterior chamber intraocular lens, which increase the risk of ocular trauma and its associated complication. The refore maintenance of mydriasis during cataract syrgery makes the operation easier and brings a good results. This study was performed in rabbit and human eyes to assess the role of the prostaglandins in surgically induced miosis by observing the reduction of pupillary constriction and by measuring the amount of prostaglandins in aqueous humor when the 1.0% suprofen, cyclo-oxygenase inhibitor, was used, and to assess the effect of suprofen in intraocular pressure. In the results, suprofen inhibits syrgically induced miosis (p value: <0.01, human <0.01) without intraocular pressure change, and for this miosis, prostaglans and for this miosis, prostaglandins are at least partially responsible.

A Case of Mobius Syndrome

Mobius syndrome is rare congenital disturbance characteristically causing limitat ion of the horizontal eye movements and bilateral facial diplegia and variety of abnormalities of the other tissues such as auricle, tongue, heart and extremities. The authors experienced a case of Mobius syndrome which was associated with limitation of abduction with right esodeviation, facial diplegia, atrophy of the right side of tongue, congenital clubfoot and prominant auricle.