Frequency-Limiting Effects on Speech and Environmental Sound Identification for Cochlear Implant and Normal Hearing Listeners

BACKGROUND AND OBJECTIVES: It is important to understand the frequency region of cues used, and not used, by cochlear implant (CI) recipients. Speech and environmental sound recognition by individuals with CI and normal-hearing (NH) was measured. Gradients were also computed to evaluate the pattern of change in identification performance with respect to the low-pass filtering or high-pass filtering cutoff frequencies. SUBJECTS AND METHODS: Frequency-limiting effects were implemented in the acoustic waveforms by passing the signals through low-pass filters (LPFs) or high-pass filters (HPFs) with seven different cutoff frequencies. Identification of Korean vowels and consonants produced by a male and female speaker and environmental sounds was measured. Crossover frequencies were determined for each identification test, where the LPF and HPF conditions show the identical identification scores. RESULTS: CI and NH subjects showed changes in identification performance in a similar manner as a function of cutoff frequency for the LPF and HPF conditions, suggesting that the degraded spectral information in the acoustic signals may similarly constraint the identification performance for both subject groups. However, CI subjects were generally less efficient than NH subjects in using the limited spectral information for speech and environmental sound identification due to the inefficient coding of acoustic cues through the CI sound processors. CONCLUSIONS: This finding will provide vital information in Korean for understanding how different the frequency information is in receiving speech and environmental sounds by CI processor from normal hearing.

Hearing Outcomes and Prognostic Factors in Idiopathic Sudden Sensorineural Hearing Loss Patients with Combined Intratympanic and Systemic Steroid Therapy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Hearing outcomes and prognostic factors of idiopathic sudden sensorineural hearing loss (SSNHL) were investigated in patients who underwent combined intratympanic and systemic steroid therapy. SUBJECTS AND METHOD: This study was performed by retrospective chart review. Clinical outcomes and prognostic factors were evaluated in 147 patients who received intratympanic steroid plus systemic steroid therapy. RESULTS: Complete hearing recovery was achieved in 36.7% (n=54) of the patients, partial recovery in 12.9% (n=19), slight recovery in 12.3% (n=18), and total recovery in 61.9% (n=91). Age was identified as an independent, negative prognostic factor for hearing recovery. The recovery rates of the down sloping and profound types were poorer than those of the up sloping type as determined by audiography. CONCLUSION: The results of this study suggest that the combined treatment of intratympanic and systemic steroids for idiopathic SSNHL results in high hearing recovery rates, and that the down-sloping and profound types of audiogram patterns and age are negative prognostic factors.

Spondylodiscitis with Epidural Abscess Caused by Klebsiella pneumoniae / 대한정형외과학회잡지

Spondylodiscitis is very rare complication caused by Klebsiella pneumoniae. Among those, few cases of spondylodiscitis concomitant with epidural abscess due to Klebsiella pneumoniae have been reported. We present a case of lumbar pyogenic spondylodiscitis with epidural abscess caused by Klebsiella pneumoniae that successfully treated with administration of cefotaxime, surgical drainage and intermittent closed continuous saline irrigation.

Traumatic Atlantoaxial Unifacetal Joint Dislocation Associated with Fractures of Ipsilateral C2 Body and Contralateral Pars / 대한정형외과학회잡지

The traumatic C1-C2 unifacetal joint dislocation associated with oblique fractures of the C2 body and arch is a rare injury that can be effectively treated with gentle closed reduction under fluoroscopic guidance followed by halo vest immobilization. To our knowledge, however, there are only a few reported cases of this injury. Recognition of associated conditions including vertebral artery compromise, concomitant cervical spine fractures, and life-threatening injuries is paramount to the successful treatment of these patients. A 29-year-old patient, who presented a unifacetal dislocation at C1-C2 with associated oblique fractures of the C2 body and arch, is reported. Closed reduction with Gardner-Wells tong and halo vest application was performed. After 3 months of application of halo vest, the fractures of C2 body and arch had the complete union and the C1-2 dislocation had the good reduction. He had no pain and discomfort in his neck for about 2 years after halo vest removal.

A Case of a Spontaneous Hemoperitoneum as the Presentation of a Gastric Arteriovenous Malformation / 대한소화기내시경학회지

Spontaneous hemoperitoneum is rare. The most common etiologies are gynecologic, splenic, and hepatic. Gastric arteriovenous malformations are commonly associated with intraluminal bleeding, but gastric arteriovenous malformations are an unusual cause of spontaneous intraperitoneal hemorrhage. A 54-year-old man presented with acute onset of epigastric pain. The patient was given an operation and pathology confirmed that it was a gastric arteriovenous malformation.

A Case of Argon Plasma Trimming of a Biliary Metallic Stent Causing a Duodenal Obstruction / 대한소화기내시경학회지

Metallic stents are being widely used in patients with a malignant obstruction of the biliary tract. The advent of metallic stents was heralded as a solution to the problem of plastic stent occlusion. Metallic stents prolong stent patency by lowering occlusion rates, but they may malfunction for several reasons, including occlusion from tumor ingrowth or migration after the procedure. Distal migration or impaction of metallic stents against the duodenal wall may cause severe complications, including duodenal obstruction, perforation and acute upper gastrointestinal bleeding. Several techniques have been developed to manage distal migration of a biliary metallic stent and remove the malfunctioning stent endoscopically. We report on a 43-year-old male who underwent endoscopic palliative biliary drainage because of obstructive pancreatic head cancer. We transected the distal end of the metallic stent using an argon plasma coagulator, treating the duodenal obstruction without any complications.

A Case of Capillary Hemangioma in the Jejunum Detected by Single Balloon Enteroscopy in a Patient with Anemia / 대한소화기내시경학회지

Hemangiomas are uncommon benign vascular tumors that account for up to 10% of all small bowel tumors. The jejunum is the most common location, and gastrointestinal bleeding is a frequent clinical presentation. Histologically, hemangiomas are classified as cavernous, capillary, or mixed types. Capillary hemangiomas are dense collections of capillaries usually with a hyperplastic endothelium. There have been a few cases of small bowel capillary hemangioma revealed by capsule endoscopy and confirmed after surgical resection. But preoperative detection of hemangiomas in the small intestine has not been reported, as far as we know, associated with the use of balloon-assisted enteroscopy. This report describes a 44-year-old male with a small bowel mass considered to be a cause of severe iron deficiency anemia. In this case, we performed capsule endoscopy and single balloon enteroscopy to examine the lesion. The patient then underwent a segmental resection of the jejunum, which confirmed the presence of a capillary hemangioma with surface ulceration.

Reliability of Triggered EMG for Prediction of Safety during Pedicle Screw Placement in Adolescent Idiopathic Scoliosis Surgery

STUDY DESIGN: We performed a prospective study to evaluate the reliability of using triggered electromyography (EMG) for predicting pedicle wall breakthrough during the placement of pedicle screw in adolescent idiopathic scoliosis surgery. PURPOSE: We wanted to correlate pedicle wall breakthrough with the triggered EMG threshold of stimulation and the postoperative computed tomography (CT) findings. OVERVIEW OF LITERATURE: Pedicle wall breakthrough has been reported to be difficult to evaluate by radiographs. Triggered EMG had been found to be a more sensitive test to detect this breakthrough. METHODS: Seven patients who underwent the insertion of 103 pedicle screws were evaluated. The triggered EMG activity was recorded from several muscles depending on the level of screw placement. The postoperative CT scans were read by a spine surgeon who was a senior fellow in orthopedics, and a musculoskeletal radiologist. RESULTS: The mean age at surgery was 12.6 years (range, 11 to 17 years). The preoperative mean Cobb angle was 54.7degrees (range, 45 to 65degrees). There were 80 thoracic screws and 23 lumbar screws. All the screws had stimulation thresholds of > or = 6 mA, except 3 screws with the stimulation threshold of or = 6 mA were safe, with 90.3% reliability, as was assessed on the postoperative CT scans.

A case of idiopathic granulomatous hepatitis in an HIV-infected patient / 대한내과학회지

Patients infected with human immunodeficiency virus (HIV) may develop various liver diseases, including viral hepatitis, granulomatous inflammation, malignancies, vascular disease, drug-induced hepatitis and, sometimes, diseases of unknown origin. In this case, a 35-year-old HIV-infected man presented with fatigue, myalgia, elevated liver enzymes, and multiple skin lesions for 3 months. Since the abdominal computed tomography (CT) and viral marker tests failed to explain the cause of his symptoms and signs, a liver biopsy was performed. This revealed a granuloma consisting of epithelioid cells without necrosis. His symptoms, skin lesions, and abnormal liver enzymes improved without changing his management, including the anti-retroviral agents. He was diagnosed with idiopathic granulomatous hepatitis based on the pathologic findings of the liver and clinical course. Aggressive diagnostic methods, such as a liver biopsy, should be considered for HIV-infected patients with liver disease.

A Case of Gastro-colic Fistula with Peritonitis Due to Ingested Magnets / 대한소화기내시경학회지

The ingestion of a foreign body is common in children. But in adults, especially in those who have a mental illness, dysphagia, and consciousness disorders often occur. If a patient ingests more than two magnets, he can develop numerous complications such as bowel necrosis, perforation, and fistula formation. Here we report a case of a 32-year-old patient with gastro-colic fistula and peritonitis following ingestion of multiple magnets. In accidental ingestion of multiple magnets, early exploration should be considered.

Survival of Spiral Ganglion / 대한이비인후과학회지

Survival and regeneration of spiral ganglion neuron (SGN) following deafening carries critical implication for cochlear implantation as well as reinnervation of restored hair cells. Survival and development of SGN depend on neurotrophic factors supplied by hair cells glial cells and other targets. The membrane electrical activity of spiral ganglion neurons also support their survival. Cell death inhibitors can also preserve spiral ganglion neurons. Recent studies of spiral ganglion survival including stem cell transplantation have identified several neurotrophic factors which protect neurons from death following hair cell loss. Although these experimental results are still preliminary, progression in study of strategy for SGN survival should be an important part of future neurobiology.

Multicanal Benign Paroxysmal Positional Vertigo: Concurrent Bilateral Posterior Canalolithiasis and Unilateral Lateral Cupulolithiasis / 대한평형의학회지

Multicanal BPPV (benign paroxysmal positional vertigo), especially BPPV affecting both labyrinths, is uncommon. A review of the literature revealed that the majority of reported cases of multiple BPPV either involved a combination of two different canals limited to one labyrinth or two different canals in both labyrinths, although one case of multicanal BPPV was reported to involve three canals bilaterally. Here, the authors report a case of bilateral posterior canalolithiasis and unilateral horizontal canal cupulolithiasis in a 54-year-old man, and include a review of the literature.

Autoantibodies and Complements in Acute Peripheral Vestibulopathy / 대한평형의학회지

BACKGROUND AND OBJECTIVES The etiology and pathophysiology of acute peripheral vestibulopathy are largely unknown. The purpose of this study is to evaluate the manifestation of the autoantibodies and complements in patients with acute peripheral vestibulopathy. MATERIALS AND METHODS We checked anti-ds-DNA, rheumatoid factor, anti phospholipid IgG and IgM, anti nuclear antibody (ANA), C3, C4 in 72 patients who were diagnosed as acute peripheral vestibulopathy on physical examination and the caloric test. The results of the patients with unilateral acute peripheral vestibulopathy were compared to those of the patients with bilateral acute peripheral vestibulopathy. RESULTS Twelve patients (16.6%) in anti-ds-DNA, 4 patients (5.5%) in C3, 10 patients (13.8%) in C4, 2 patients (2.7%) in anti-phospholipid IgG and 13 patients (18%) in antinuclear antibody (ANA) showed abnormal findings among patients with acute peripheral vestibulpahty. There was no difference in the manifestation of the autoantibodies and complements between the patients with unilateral and bilateral acute peripheral vestibulopathy. CONCLUSION The autoimmune diseases may be one of etiologic factors in acute peripheral vestibulopathy.

Bone Transport Over the Intramedullary Nail for Defects of Long Bone

PURPOSE: To evaluate the results of bone transport using external fixator over an intramedullary nail for defects of long bone. MATERIALS AND METHODS: We treated 14 cases of bone defect after chronic osteomyelitis or trauma of tibia (12 cases) and femur (2 cases) using this method. The mean age of index procedure was 46.9 years, and all of them had follow-up study for a mean of 3 years. After the corticotomy and insertion of intramedullary nail, bone transport was done by external fixators. Then, the segment was moved and bone graft was done at docking site. RESULTS: The mean transported amount was 5.8 cm, and the external fixator was removed after 141 days. The mean external fixation index was 25.6 days/cm. Primary union of distraction and docking site was achieved in all, but one had failure in union of docking site. According to the Mekhail's functional criteria, there were 5 excellent, 6 good, and 3 fair results. Among 15 complications, there were 2 major complications with residual sequelae, and they were 1 recurred osteomyelitis and 1 flexion contracture of knee. CONCLUSION: Bone transport using external fixator over an intramedullary nail, can successfully solve defects of long bone. Since this method can remove external fixators earlier than the conventional method, it has fewer complications and makes patients to return to daily life earlier.

Efficacy of Rotating Chair Test And Caloric Test For The Diagnosis of Acute Unilateral Vestibular Neuritis

BACKGROUND AND OBJECTIVES: The acute unilateral vestibular neuritis is fairly a common disease and the precise diagnostic tool is needed for the selection of effective treatments. Therefore, we studied the clinical usefulness of the rotatory chair test and caloric test which have been commonly used in patient of acute unilateral vestibular neuritis. MATERIALS AND METHODS: One hundred and sixty four patients who were diagnosed with acute unilateral vestibular neuritis from August of 2004 to June of 2007 were included. Their medical records of the rotating chair test and caloric test were reviewed retrospectively to study the correlation of the two tests. RESULTS: Of 164 patients, 101 patients (61.6%) and 88 patients (53.7%) showed significant canal paresis (CP) and directional preponderance (DP) on the caloric tests that corresponded with the physical exam. 130 patients (79.3%) and 84 patients (51.2%) showed significant asymmetry and time constant (Tc) on the rotating chair test that corresponded with the predictive direction with spontaneous nystagmus. CONCLUSIONS: For acute unilateral vestibular neuritis patients, the asymmetry of the rotatory chair test showed the highest correlation with clinical findings. But physical exam should be preceded because neither rotator chair test nor caloric test yields a specific correlation with the physical exam. Especially, single test only may too many false negative results. For these tests can reduce false positive cases of the physical exam and raise the specificity of the diagnosis, the planning of proper treatments should be followed thereafter.

A case of perihepatic abscess associated with intrahepatic bile duct stones and intrahepatic adenosquamous carcinoma / 대한내과학회지

Perihepatic abscess is a serious complication of bile duct or hollow viscus injury, with significant morbidity and mortality rates. Perihepatic abscess due to non-traumatic rupture of the biliary tree usually occurs in the presence of biliary stones. In contrast, perihepatic abscess as a result of spontaneous rupture of cholangiocarcinoma is very rare; cholangiocarcinoma generally forms a hard tumor with abundant fibrous stroma, making them difficult to rupture. Here, we describe a case of perihepatic abscess associated with intrahepatic bile duct stones and ipsilateral cholangiocarcinoma. Although it is unclear whether the etiology of perihepatic abscess was rupture of the biliary tree or cholangiocarcinoma, this association is very rare and has never before been reported in the literature.

Correlation between the Pure Tone Audiometry Results and the Subjective Hearing Benefit of Tympanoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Measuring the therapeutic effect of tympanoplasty is usually dependent on the surgeon's view-point and the results of pre- and post-operative pure tone audiometry (PTA). But there is considerable discrepancy between the subjective hearing benefit and the PTA, so the aim of this study is to evaluate the correlation between them among the patients who had tympanoplasty for chronic suppurative otitis media. SUBJECTS AND METHOD: One hundred patients who had tympanoplasty between 2000 and 2001 were studied. Patients were divided into two groups, improved and not-improved group, according to their answers to the questionnaire asking his or her subjective hearing benefit. The pre and postoperative air conduction threshold (AC), bone conduction threshold (BC), air-bone gap (ABG) and the amount of increment or decrement of these parameters were compared between the two groups. RESULTS: Analysis of the data showed significant differences between the two groups with respect to preoperative ABG, postoperative AC, postoperative ABG, AC decrement and ABG decrement. Especially, when the amount of AC decrement was more than 10 dB or the ABG decrement was more than 20 dB, the rate of improved subjective hearing group was increased very strongly. CONCLUSION: Among the pre- and post-tympanoplasty PTA results, the most useful indicators of patient's subjective hearing benefit are the amount of AC decrement (more than 10 dB) and ABG decrement (more than 20 dB).

A Case of Mycoplasma Pneumonia Presenting with RUL Collapse / 결핵및호흡기질환

Mycoplasma pneumoniae is a common pathogen of community-acquired pneumonia. Mycoplasma pneumonia causes upper and lower respiratory tract symptoms in all age groups, with the highest attack rates in subjects 5 to 20 years old. In patients with mycoplasma pneumonia, the most common radiographic findings may be reticulonodular or interstitial infiltration, which have a predilection for the lower lobes. Findings that show lung collapse on a chest X-ray are very rare. We report a case of mycoplasma pneumonia that showed right upper lobe collapse.

A Case of Mycoplasma Pneumonia Presenting with RUL Collapse / 결핵및호흡기질환

Mycoplasma pneumoniae is a common pathogen of community-acquired pneumonia. Mycoplasma pneumonia causes upper and lower respiratory tract symptoms in all age groups, with the highest attack rates in subjects 5 to 20 years old. In patients with mycoplasma pneumonia, the most common radiographic findings may be reticulonodular or interstitial infiltration, which have a predilection for the lower lobes. Findings that show lung collapse on a chest X-ray are very rare. We report a case of mycoplasma pneumonia that showed right upper lobe collapse.

Bilateral Simultaneous Bell's Palsy-Two Case Studies / 대한이비인후과학회지

Bilateral simultaneous Bell's palsy is extremely rare and occurs in about 0.3-2.0% of the facial palsy cases. In contrast to the unilateral form of facial palsy, which often has an unknown cause, bilateral facial palsy is increasingly recognized as secondary to a variety of other disorders, including neurological, infectious, traumatic, metabolic, vascular, neoplastic, and degenerative disorders. Yet, bilateral simultaneous Bell's palsy is by definition, not associated with any demonstrable disease along the course of the facial nerve or elsewhere in the body. So, as usual, it is important to make an early diagnosis for the best treatment. We report our experience with two cases of bilateral simultaneous Bell's palsy recently seen in our practice.