Effects of Medical Treatment on Meniere's disease

OBJECTIVES: In Meniere's disease, medical treatment using diuretics has been the mainstream of management. But the effects of medical treatment are very difficult to evaluate because of many variables. Authors tried to investigate the effects of diuretics on Meniere's disease through the change of symptoms. MATERIALS AND METHOD: From January, 1995 to December, 2000, the twenty patients with definite Meniere's disease who has been followed up over 24 months were retrospectively reviewed. They had no history of previous medication, and were managed with diuretics for the first time. The change of frequency of vertigo, the threshold of pure tone audiometry, type of audiogram were analyzed at each period during 6 month before treatment, during 6 month at 1, 2 and 4 years after treatment. RESULTS: The ratio of sex was 1:1(male 10, female 10), the average age of diagnosis was 53.9 year old, and the average follow up duration was 39.3 month. By medical treatment, vertigo symptom was significantly controlled in 56.2% at 2 year after treatment. Among 20 patients, 5 patients failed to medical treatment and underwent the sac decompression (N=1) and intratympanic gentamicin injection (N=4). The change of pure tone audiometry was from 34.5 dB before treatment to 38 dB at 24 months and 44.2 dB at 48 months after treatment. The most type of audiometry was flat type and flat type was increased with time. CONCLUSION: In Meniere's disease, the medical treatment controlled significantly the vertigo frequency in 50~60%. But the hearing threshold was aggravated with time after treatment despite of medical treatment.

Thyrotracheal End-to-End Anastomosis for Severe Laryngotracheal Stenosis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Management of a severe (Cotton-Myer grade III &IV) laryngotracheal stenosis (LTS) between the subglottis and upper trachea is not easy. Resection of stenotic segments and anastomosis of the resected margins, i.e. thyrotracheal anastomosis (TTA), would be one of the most physiologic treatment options for severe LTS. However, this procedure is not widely popularized because of the fear of technical difficulties and/or associated dreadful complications. Authors aimed to analyze the treatment outcomes and related complications of TTA that we have recently experienced. MATERIALS AND METHOD: We retrospectively analyzed 9 cases with severe LTS, who were treated by TTA between May 1999 and August 2002. We reviewed the direct causes of LTS, pathologic findings of the resected specimens, early and delayed postoperative complications, and the success rate of TTA. RESULTS: Decannulation without significant aspiration was achieved in 8 cases (88.9%). A 3 year-old girl failed to be decannulated because of recurring scar tissues in the posterior cricoid. Several types of early complications occurred in 4 cases (44.4%);of these, 2 cases involved airway obstruction due to mucosal edema or redundant mucosa, 1 case involved wound infection, 1 case involved transient vocal cord palsy. Two cases (22.2%) experienced delayed granulation formation, which were endoscopically managed at 3-4 weeks after TTA. CONCLUSION: High-success and low-major complication rates warrant TTA as a relatively safe and useful treatment option for a severe LTS. To accomplish the better treatment outcome with TTA approach, viable mucosa must be secured at the resection margin, infection has to be minimized before the surgery, mucosa should be carefully handled to prevent postoperative edema or redundancy, and prolonged attention needs to be paid against a possible delayed granulation formation.

A Case of Oculostapedial Synkinesis Following Bell's Palsy / 대한이비인후과학회지

Oculostapedial synkinesis following Bell's palsy, Ramsay Hunt syndrome and traumatic facial nerve paralysis is a rarely reported phenomenon. Oculostapedial synkinesis accompanying with hemifacial spasm also has been reported. We experienced a 51-year-old woman with persistent loud rumbling noise from her left ear related with voluntary left eye closure compatible with oculostapedial synkinesis after Bell's palsy. We objectively proved this oculostapedial synkinesis with impedance audiometry. The patient was successfully treated by transmeatal tenotomy of the left stapedius muscle tendon under local anesthesia.

Whirling Vertigo as a Prognostic Factor in Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Presence of whirling vertigo accompanied by sudden sensorineural hearing loss has been known to give negative effects on the hearing recovery. But the effect of whirling vertigo on the recovery of hearing cannot be simply evaluated because prognosis is related with other several variables, such as severity of hearing loss, onset of treatment and age. This study sets out to investigate the impact of whirling vertigo on the severity and recovery of hearing loss by multivariant analysis to exclude the effects of other variables. MATERIALS AND METHOD: A total of 176 patients who were admitted to Samsung Medical Center from March 1997 to March 2001 were entered into our study. All patients were divided into three groups according to the presence of dizziness: with whirling vertigo (39 ears), with non-whirling dizziness (36 ears), without dizziness (101 ears). To investigate the impact of whirling vertigo on the severity of hearing loss, each group was divided into four groups according to the severity of hearing loss. Each group was analyzed respectively by the presence of whirling vertigo. Secondly, the effect of whirling vertigo on hearing recovery was investigated by multivariant analytic technique to exclude the effect of the other probable prognostic factors. Thirdly, the effect of other variables (severity of hearing loss, onset of treatment, age) on the prognosis was investigated. RESULTS: The presence of whirling vertigo was not statistically related with the severity of hearing loss (p=0.063). The results of the multivariant analysis showed that the recovery of hearing loss was related with the presence of whirling vertigo (p=0.02), severity of hearing loss (p=0.001), onset of treatment (p=0.034) and age (p=0.034). CONCLUSION: Hearing loss in the group with whirling vertigo was not more severe than that in the other two groups. According to the multivariant analytic technique, whirling vertigo in sudden sensorineural hearing loss has a negative effect on the prognosis of hearing recovery.

A Case of Paradoxical Vocal Fold Motion with Dyspnea and Stridor / 대한이비인후과학회지

Paradoxical vocal fold motion (PVFM) is a rare disorder, characterized by episodic glottic obstruction in which the vocal folds are adducted on respiration. The disorder may aggravate airway obstruction and result in respiratory failure; therefore, a proper diagnosis by the otolaryngologist is critical to subsequent treatment. A review of literature shows that the effective treatment is psychotherapy, breathing education, biofeedback, anti-reflux medications, and most importantly, botulinum toxin injection to both vocal folds. We report a case with PVFM, effectively treated with above modalities.