A Case of Ceruminous Syringocystadenoma in the External Auditory Canal / 대한이비인후과학회지

It is rare to find tumor of the ceruminous gland, which is a modified apocrine gland located within the skin of external auditory canal (EAC). Syringocystadenoma papilliferum (SCAP) is a benign adnexal tumor that occurs in the head and facial area in forms of infiltrative macules, papules, or keratinous nodules, but rarely in the EAC. To date, fewer than 150 case reports of SCAP have been reported, with SCAP in the EAC being extremely rare. We report a case of 51-year-old male with 2 year-history of a left EAC mass arising from the superior wall of the EAC. We performed a microscopic surgery, with the mass resected via retro-auricular approach under general anesthesia. The histopathological examination confirmed the specimen as SCAP. There were no complications or recurrence during the 4 months follow-up period.

Comparison of the Effects of Intratympanic Steroid Injection at Different Intervals in Sudden Sensorineural Hearing Loss

Background and Objectives@#Systemic steroid therapy (SST) and intratympanic steroid injection (ISI) have been the treatment of choice for sudden sensorineural hearing loss (SSNHL). We studied the effect of ISI administered at different intervals on hearing outcomes in patients with SSNHL. @*Subjects and Methods@#We performed a retrospective study of 427 patients diagnosed with SSNHL at Bundang Jesaeng Hospital, of whom 51 patients with SSNHL who received SST and four ISIs were included in this study. Patients were treated with four ISIs either every day for 4 days (group 1) or at intervals (mean duration of interval: 2.21 days) (group 2). Hearing outcomes were evaluated using the pure-tone test before the injection and 14 days, 1 month, and 3 months after the final injection. Recovery rates were classified based on Siegel’s criteria. @*Results@#The amount of improvement was 27.67 dB (±20.45) in group 1 and 32.79 dB (±21.42) in group 2. However, there were no significant differences between the two groups (p= 0.714). The recovery rates based on Siegel’s criteria were 18/27 (66.7%) and 16/24 (66.7%) in groups 1 and 2, respectively, with no significant difference (p=1.000). Considering only complete recoveries in hearing recovery, the recovery rates were 15/27 (55.6%) and 14/24 (58.3%) in groups 1 and 2, respectively, with no significant difference (p=0.842). @*Conclusions@#There were no significant differences in hearing outcomes or recovery rates after ISI administration every day or at intervals of 2-3 days.

Hearing Preservation with the Transcrusal Approach to the Skull Base Lesion Combined with Other Transcranial Approach: Results of Consecutive Series of 5 Cases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study reviewed our experience and outcomes of surgery via transcrusal approach to the skull base lesions. SUBJECTS AND METHOD: We performed transcrusal approach technique on five patients with skull base lesions (Cavernous malformation, Petroclival meningioma, Craniopharyngioma, Anaplastic astrocytoma, and Trigerminal epidermoid cyst) aiming at preserving hearing. Pre-and post-operative pure tone audiometry (PTA) and caloric test were performed in all patients. The transcrusal approach technique was performed as reported in the previous references. The approach included trephination of the superior and posterior semicircular canals from the ampullae to the common crus. The main outcome of this study was preserving hearing and the vestibular function after surgery, which was determined by PTA and caloric test. RESULTS: The average diameter of skull base lesion of the five patients was 3.68 cm. The mean follow up period was 114.2 days. The pre-operative mean PTA of five patients was 11 dB. The mean PTA of five patients within seven days after surgery was 28 dB. The last measured mean PTA was 29.8 dB. The pre and post-operative caloric results measured revealed vestibular function deficit in all of the patients after surgery (mean decreased value: 64%). All patients were stable during the surgery. Complications included two cerebrospinal fluid leak (40%) and one cranial VI nerve deficit (20%). CONCLUSION: Transcrusal approach is a method that can simultaneously preserve hearing and afford enough exposure of the skull base lesion if appropriately combined with other transcranial approach. We performed transcrusal approach targeting skull base lesion with hearing preservation, and we found excellent hearing result with this technique.

Analysis of Bacterial Biofilms on a Cochlear Implant Following Methicillin-Resistant Staphylococcus Aureus Infection

To demonstrate biofilm formations on a cochlear implant magnet of a pediatric patient suffering from a methicillin-resistant Staphylococcus aureus (MRSA) infection. The appearance of biofilm colonies was analyzed on different magnet sections. The appearance of MRSA biofilms on the surface of an explanted cochlear implant was analyzed by scanning electron microscopy (SEM), focusing on the pattern of extracellular polymeric substances (EPS) within the biofilms. SEM revealed unique biofilms with a three-dimensional EPS complex and tower-like formations. Biofilm configurations changed from the margin to the center of the magnet. Biofilms were solitary and scattered at the margin; large and plate-like in the center; and stacked in layers, forming towers and water channels, in the middle region. After a MRSA infection, biofilm formations were observed on the surface of a magnet. Bacterial biofilms provide optimal conditions for bacterial growth and antibiotic resistance and can cause intractable infections that lead to device failure.

Hearing and Facial Function After Surgical Removal of Cholesteatomas Involving Petrous Bone

OBJECTIVES: The purpose of this study was to inspect the clinical characteristics, surgical approaches, functional preservation, and complications of petrous bone cholesteatoma and to propose appropriate surgical approaches based on long-term follow-up cases and previous reports in the literature. METHODS: The medical records of 31 patients who underwent surgery for petrous bone cholesteatoma between 1990 and 2011 at two tertiary referral hospitals were retrospectively analyzed with regard to the classification, type of surgical approach, preservation of facial and auditory function, and recurrence. RESULTS: Of 31 cases, 16 were supralabyrinthine (class I), 1 was infralabyrinthine-apical (class III), 13 were massive (class IV), and 1 was apical (class V). Facial nerve palsy was found in 35.5% of the cases (11 cases). Hearing was preserved in 11 of 22 patients who had better than a 50-dB hearing level of bone conduction pure tone average preoperatively. Preoperative hearing was preserved in only four of the patients in class I (supralabyrinthine). Facial function was preserved or improved in 29 patients (93.5%). CONCLUSION: Complete removal of cholesteatoma of petrous bone can be achieved by choosing the appropriate approach based on location and extent. Facial function was preserved postoperatively in most reviewed cases. Auditory function could not be preserved postoperatively in some cases, but preserving residual hearing levels can be accomplished mostly in supralabyrinthine cholesteatomas with the appropriate surgical approach.

Preoperative Voice Parameters Affect the Postoperative Speech Intelligibility in Patients with Cochlear Implantation

OBJECTIVES: Verbal communication depends on a good function of voice and speech organs. Some of the voice characteristics of deaf people differ considerably from those of speakers with normal hearing. After cochlear implantation (CI), auditory control of voice production is possible and the quality of the voice is improved. CI improves quality of voice, speech and hearing with deafness. The aim of our study was to investigate the relationship between acoustic analysis before CI and the speech intelligibility before and after CI. METHODS: Twelve prelingually deafened children implanted unilaterally at the age of 3.4-9 years were included in the study. For all of the children an acoustic analysis of the Slovene vowel 'a' was performed before CI. The fundamental frequency (F0), jitter, shimmer and noise-to-harmonic ratio (NHR) were studied before the implantation. For all of the children the speech intelligibility was performed before and 12 months after CI. Preoperative hearing was divided on existing residual hearing. The results of the acoustic analyses and speech intelligibility before and after CI were compared for preoperative hearing. The results of the speech intelligibility were compared for the age of operation and preoperative acoustic analysis (F0, jitter, shimmer, NHR). RESULTS: Preoperative hearing had no influence on preoperative voice analysis. The children with residual hearing had a high grade of speech intelligibility before and after CI. The preoperative shimmer had positive correlation with postoperative 12 month speech intelligibility (r=0.618, P=0.032). The preoperative jitter had positive correlation with postoperative 12 month speech intelligibility, but was not statistically significant (r=0.479, P=0.116). CONCLUSION: Shimmer on preoperative voice analyses had influence on speech intelligibility after CI.

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.

Petrous Apex Cholesterol Granuloma Presenting as Endolymphatic Hydrops: A Case Report

A petrous apex cholesterol granuloma (PACG) is the most common lesion of the petrous apex mass. Affected patients present with various symptoms such as hearing loss, vertigo, headache, tinnitus, facial spasms, and diplopia. We report the case of a 32-yr-old man with a PACG, who was first misdiagnosed with Meniere's disease. He was placed on a low-salt diet, and prescribed medication from another hospital, for several months, but the symptoms persisted and worsened. The patient presented to the emergency room complaining of left facial twitching and numbness. To rule out a central neurological lesion, temporal bone magnetic resonance imaging was carried out and a 2.5 cm mass with high signal intensity on T1- and T2-weighted imaging, without gadolinium enhancement, was found. Because of the hearing and facial problems, we drained cholesterol-bearing material via an infralabyrinthine approach using a computer aided image-guided surgical device, the BrainLAB(R). After the operation, the vertigo and hearing loss were no longer present. It is likely that the patent's Meniere's disease-like symptoms were due to the compression of the endolymphatic sac by a PACG.

The Effect of Cigarette Smoking on the Expression of MMP-9, TIMP-1 and VEGF in Nasal Polyp Epithelial Cells and Fibroblasts

BACKGROUND AND OBJECTIVES: It has been known that MMP-9, TIMP-1, and VEGF play an important role in the formation of nasal polyps (NPs). The aim of this study is to investigate the effect of smoking on the expression of MMP-9, TIMP-1 and VEGF in the epithelial cells and fibroblasts of NPs. MATERIALS AND METHODS: The epithelial cells and fibroblasts of NPs obtained from 10 patients who underwent endoscopic sinus surgery were cultured and used. The prepared CSE concentrations were 5%, 1%, 0.5% and 0.1%. In the control group, cells were cultured for 9 hours in the media containing 1 ml of AEGM and DMEM/F-12K. In the CSE group, cells were treated with 5%, 1%, 0.5% and 0.1% CSE for 9 hours. After washing with PBS, cells were cultured in medium for 24 hours. ELISA was performed to measure the secretion of MMP-9, TIMP-1 and VEGF proteins and real-time PCR was performed to assay their mRNAs. RESULTS: The production of MMP-9, TIMP-1 and VEGF proteins did not change significantly in comparison with the control group in epithelial cells and fibroblasts after exposure to CSE. CONCLUSION: These results suggest that CSE does not appear to have an effect on the expression of MMP-9, TIMP-1 and VEGF for developing and growth of nasal polyposis.