Introduction of Cybersickness / 대한이비인후과학회지

With an introduce of virtual reality (VR) technology, the issue of unpleasant side effect of VR immersion has been raised as “cybersickness.” Although exact mechanism of cybersickness is still elusive, sensory conflict theory has been generally accepted as in classic motion sickness. The absence of expected correlated vestibulo-proprioceptive sensory information during VR experience causes sensory conflict, which leads to dizziness, disorientation, nausea and fatigue. Herein, we review the recent literature to build the conceptual scheme for understanding cybersickness. From the brief description of motions sickness, assessment and management of cybersickness is also outlined.

Introduction of Cybersickness / 대한이비인후과학회지

With an introduce of virtual reality (VR) technology, the issue of unpleasant side effect of VR immersion has been raised as “cybersickness.” Although exact mechanism of cybersickness is still elusive, sensory conflict theory has been generally accepted as in classic motion sickness. The absence of expected correlated vestibulo-proprioceptive sensory information during VR experience causes sensory conflict, which leads to dizziness, disorientation, nausea and fatigue. Herein, we review the recent literature to build the conceptual scheme for understanding cybersickness. From the brief description of motions sickness, assessment and management of cybersickness is also outlined.

Treatment Outcomes and Prognostic Factors of Nasopharyngeal Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nasopharyngeal carcinoma is an uncommon disease that is usually found in the advanced stage becuase its anatomical location makes early detection difficult. Radiation therapy or concurrent chemoradiation therapy is mainstay for treatment of nasopharyngeal carcinoma. We evaluated clinical characteristics and treatment outcomes of nasopharyngeal carcinoma and assessed prognostic factors related to survival. SUBJECTS AND METHOD: We retrospectively reviewed medical records of 87 patients who were treated for nasopharyngeal carcinoma from 1994 to 2013. Clinical characteristics, pathologic type, stage, treatment modality, recurrence and survival were investigated. RESULTS: The mean follow-up period was 66.7 (12-232) months. Recurrence rates were not significantly different between the radiation therapy group and combined chemoradiation groups in the early stage (27.3% vs. 21.6%, p=0.644) and the advanced stage (21.4% vs. 31.3%, p=0.496). Five-year overall survival and disease free survival rate was 74.0% and 58.9%, respectively. Five-year overall survival rate of the combined chemoradiation therapy group was significantly lower than that of the radiation therapy group (64.4% vs. 94.1%, p=0.001). Distant metastasis was significantly correlated with survival in multivariate analysis. CONCLUSION: In this study, the five-year overall survival rate was better in the radiation therapy group than in the combined chemoradiation group. This might be related to the fact that advanced stage disease was more common in the combined chemoradiation group. Further studies with larger study samples and longer follow-up are necessary to verify these results and determine optimal modalities for the treatment of nasopharyngeal carcinoma.

Clinical Characteristics of Traumatic Benign Paroxysmal Positional Vertigo Compared with Idiopathic Benign Paroxysmal Positional Vertigo / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) is one of the most common diseases in patients with dizziness after head trauma. The aim of the study was to investigate the clinical characteristics of the traumatic BPPV (tBPPV) compared with idiopathic BPPV (iBPPV). SUBJECTS AND METHOD: From January 2008 to June 2015, a retrospective review was performed on 572 patients diagnosed with BPPV and treated with appropriate canalith reposition maneuver. Clinical characteristics of patients, such as age, sex, affected semicircular canal, and number of reposition maneuver were evaluated and compared between iBPPV and tBPPV. Canal change and recurrence rate were also assessed. RESULTS: Among 572 BPPV patients, 509 were iBPPV and 63 were tBPPV. The male to female ratio was higher in tBPPV (26/37) than in iBPPV (142/367) (p=0.028). Posterior semicircular canal (PSCC) was more commonly affected than lateral semicircular canal in the tBPPV group compared with the iBPPV group (38/18 vs. 244/257). Also multiple canal was more commonly affected in the tBPPV group than in the iBPPV group (11.11/3.54%) (p=0.001). The tBPPV group needed fewer number of canalith reposition maneuver for symptom relief than the iBPPV group did (1.35 vs. 1.53, p=0.048). The side of affected canal was more frequently changed in tBPPV than in iBPPV (22.22% vs. 11.98%, p=0.023). There was no significant difference in recurrence rate between tBPPV and iBPPV (18.87% vs. 19.25%, p=0.518). However, the tBPPV group had a tendency of earlier recurrence than the iBPPV patients (1.33 month vs. 2.86 month, p=0.050). CONCLUSION: tBPPV was more common in male and PSCC was usually affected. The tBPPV patients had a tendency of frequently changing the canal type and an earlier recurrence than the iBPPV patients. These distinguished clinical features would be useful in diagnosing and managing tBPPV patients.

Tinnitus: Overview / 한양의대학술지

No abstract available.

A Case of Salivary Gland Choristoma Mimicking Glomus Tympanicum / 대한이비인후과학회지

Salivary gland choristoma is defined as the architecturally normal salivary gland tissues found in abnormal locations. Middle ear salivary gland choristoma usually presents with conductive hearing loss. We present a case of middle ear mass with conductive hearing loss in a 6-year-old boy. A reddish mass was incidentally found behind the normal tympanic membrane. Magnetic resonance image showed the markedly enhancing lesion which was in accordance with glomus tympanicum. Preoperative angiography was performed, but supplying artery and mass was not identified. Surgical exploration was made and the mass was dissected easily without profuse bleeding. Final diagnosis was salivary gland choristoma by histopathology. We discuss the clinical features and management of middle ear salivary choristoma with the review of literature.

Role of Cochlear Microphonic in Newborn Hearing Test / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cochlear microphonic (CM) is an electrical potential generated by outer hair cells in response to acoustic stimulation. The aim of this study is to evaluate the significance of CM in neonatal hearing loss. SUBJECTS AND METHOD: From April 2013 to April 2014, 64 neonates hospitalized in neonatal intensive care unit were enrolled. Subjects underwent transient evoked otoacoustic emission (TEOAE), auditory brain stem response (ABR) and CM. We analyzed the results of hearing tests and the correlation between CM and the other test modalities. RESULTS: Ninety two ears showed normal ABR waves whereas the other 36 ears had abnormal ABR. There were two neonates who were suspected of auditory neuropathy because of the presence of TEOAE and CM. Among 14 ears who showed abnormal OAE results, 12 ears (86%) were identified as having CM. The amplitudes of CMs were correlated with the reproducibility of TEOAE (p<0.005). Between the ears with positive TEOAE and others with negative TEOAE, the amplitudes of CMs were significantly different (p<0.005). CONCLUSION: Many ears were identified with the presence of CM without TEOAE response because of the the vulnerability of OAE from middle ear status and environment. We suppose that CM might provide information on outer hair cell function to complement the OAE in neonatal hearing test.

A Case of Metastatic Auricle Cancer from Gastric Adenocarcinoma / 대한이비인후과학회지

Auricle cancers are relatively uncommon head and neck neoplasm and most of them are squamous cell carcinoma. Metastatic auricle cancer is extremely rare; metastases from internal organ have not been reported so far. We recently experienced a case of metastatic auricle cancer from adenocarcinoma of stomach. Seventy years old man who had undergone gastrectomy for stomach cancer 10 years ago visited our hospital complaining painless auricle mass. Biopsy of the auricle mass revealed a metastatic adenocarcinoma that is same as that of the stomach cancer. Patient underwent excision of auricle mass and adjuvant chemotherapy. Here we report this case with the review of related literatures.

Clinical Characteristics and Prognosis of Idiopathic Sudden Sensorineural Hearing Loss in Old Age / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In aging society, interest in idiopathic sudden sensorineural hearing loss (ISSNHL) in elderly have been increased. However, as there has been little discussion about prognostic factors of ISSNHL in old age, this study aims to investigate clinical factors related with prognosis of ISSNHL in elderly and compare with that in adults. SUBJECTS AND METHOD: A retrospective medical chart review was performed in patients over 19 years old who diagnosed with ISSNHL from Jan. 2010 to Dec. 2012. Patients were categorized into the old age group (over 65 years old, n=62) and the control group (aged 19 to 64 years old, n=218). Clinical findings, audiological result and treatment outcomes were compared between two groups. And possible prognostic factors of SSNHL in elderly were also investigated. RESULTS: Significant difference of hearing recovery was identified between the old age group (33.9%, 21/62) and control group (50.9%, 111/218) according to Siegel's criteria (p=0.021). Multivariate analysis concluded that delayed treatment and low speech discrimination score (SDS) might lead to poor prognosis in elderly. The presence of tinnitus or dizziness, audiometric configurations, hypertension and diabetes mellitus did not affect the treatment results of ISSNHL in the old age group. CONCLUSION: Onset of treatment and initial SDS could be possible prognostic factors of ISSNHL in elderly. Early diagnosis and urgent treatment are more important in old age.

A Case of Otogenic Brain Abscess Causing Loss of Consciousness

Acute or chronic otitis media can cause intracranial complications, one of the most serious being brain abscess. Empirical antibiotic treatment and proper surgical management should be considered to avoid fatal consequences. However, proper extent and optimal timing of surgical intervention are still matters of debate. We present a case of a 31-year-old man who presented with acutely altered mental status, caused by otogenic brain abscess who we treated successfully with antibiotics and otologic surgery and no neurosurgical treatment.

Hypoparathyroidism after Thyroidectomy and the Effect of Parathyroid Autotransplantation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To preserve the parathyroid gland during thyroidectomy, understanding of its anatomy and physiology is essential. Parathyroid autotransplantation can be performed to restore the function of parathyroid gland. However, the efficacy of parathyroid autotransplantation is still debatable. The aim of this study was to analyze the frequency of hypoparathyroidism following thyroidectomy and evaluate the efficacy of parathyroid autotransplantation. SUBJECTS AND METHOD: We analyzed 449 patients who underwent thyroidectomy from January 2006 to June 2010. A total of 419 patients underwent total thyroidectomy, while 30 patients underwent unilateral lobectomy. Among the total thyroidectomy group, 96 patients underwent unilateral central neck dissection and 186 patients underwent bilateral central neck dissection. We analyzed the frequency of hypoparathyroidism according to the extent of thyroidectomy and central neck dissection, and parathyroid gland autotransplantation. RESULTS: Transient hypoparathyroidism occurred in 20% of lobectomy patients and 54.6% of the entire thyroidectomy group. Permanent hypoparathyroidism occurred only in 7.2% of the entire thyroidectomy group. Transient and permanent hypoparathyroidism occurred in 47.4% and 6.5%, respectively, of the patients without central neck dissection, in 54.0% and 7.3%, respectively, of the patients with unilateral central neck dissection, and 60.2% and 7.5%, respectively, of the patients with bilateral central neck dissection. Parathyroid autotransplantation was performed in 29 patients of 105 patients whose one or more parathyroid glands were removed inadvertently, and permanent hypoparathyroidism did not occur among those patients. CONCLUSION: The frequency of transient hypoparathyroidism was increased according to the extent of thyroidectomy and central neck dissection. Parathyroid autotransplantation might be effective in minimizing permanent hypoparathyroidism.

Radiological Predictors of Difficult Laryngeal Exposure in Laryngomicrosurgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Laryngeal microsurgery (LMS) is a common procedure for diagnosis and treatment of various laryngeal diseases. Sometimes, laryngeal exposure is poor and LMS may be impossible. The aim of this study was to investigate factors related to difficult laryngeal exposure in LMS. SUBJECTS AND METHOD: Three hundred patients who underwent LMS were enrolled in this study. The patients were categorized into 3 subgroups (easy exposure group, moderate exposure group, and difficult exposure group) according to the glottic visualization under suspension laryngoscopy. The 14 parameters on lateral extension neck X-ray in the closed and open mouth view were analyzed to evaluate laryngeal exposure. RESULTS: The study included 168 males and 132 female patients with the mean age of 48.36+/-12.39 (10-79) years. Of 300 patients, 244 patients were classified as the easy exposure group, 41 as the moderate exposure group, and 15 as the difficult exposure group. Patients with difficult laryngeal exposure were significantly higher in males (p<0.001). Among 14 radiologic parameters, thyroid incisor angle in closed mouth view (p=0.003) and sternum-mentum distance in open mouth view (p=0.04) were significantly related with difficult laryngeal exposure on the multivariate analysis. CONCLUSION: Being a male, having a narrow thyroid incisor angle in the closed mouth view and having a short sternum-mentum distance in the open mouth view are useful patient indications that serve to predict difficult laryngeal exposure in LMS.

Auditory Brainstem Response in Newborns with Hyperbilirubinemia / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Neonatal hyperbilirubinemia is one of the important causative factors of sensorineural hearing loss including auditory neuropathy. The auditory brain stem response (ABR) is widely used as a screening or diagnostic tool for newborn hearing loss. This study aimed to analyze serial ABR results of newborns with severe hyperbilirubinemia. SUBJECTS AND METHOD: This study examined 120 full term infants treated for hyperbilirubinemia in the neonatal intensive care unit. The first ABR was performed within one month after birth. Follow-up tests were conducted in patients with abnormal results (25 cases). The control group was composed of 21 healthy newborns who passed the newborn hearing screening. RESULTS: The mean ABR threshold was higher in the newborns with hyperbilirubinemia than in the control group (43.8 dB nHL versus 30.0 dB nHL, p<0.001). Of the 25 newborns who underwent follow-up ABR, 15 newborns demonstrated recovery of the hearing threshold up to 30 dB nHL. The hearing threshold did not improve below 50 dB nHL for five newborns, of whom one was diagnosed with auditory neuropathy spectrum disorder. There was no difference in the mean ABR interwave latency between newborns with hyperbilirubinemia and the control group. CONCLUSION: Neonates with hyperbilirubimenia might suffer transient or permanent hearing loss. Serial ABR tests might be essential for the diagnosis of sensorineural hearing loss in patients with neonatal hyperbilirubinemia.

Clinical Application of 3D-FIESTA Image in Patients with Unilateral Inner Ear Symptom

BACKGROUND AND OBJECTIVES: Unilateral auditory dysfunction such as tinnitus and hearing loss could be a warning sign of a retrocochlear lesion. Auditory brainstem response (ABR) and internal auditory canal magnetic resonance image (MRI) are suggested as novel diagnostic tools for retrocochlear lesions. However, the high cost of MRI and the low sensitivity of the ABR test could be an obstacle when assessing patients with unilateral ear symptoms. The purpose of this study was to introduce the clinical usefulness of three-dimensional fast imaging employing steady-state acquisition (3D-FIESTA) MRI in patients with unilateral ear symptoms. SUBJECTS AND METHODS: Two hundred and fifty-three patients with unilateral tinnitus or unilateral hearing loss who underwent 3D-FIESTA temporal bone MRI as a screening test were enrolled. We reviewed the abnormal findings in the 3D-FIESTA images and ear symptoms using the medical records. RESULTS: In patients with unilateral ear symptoms, 51.0% of the patients had tinnitus and 32.8% patients were assessed to have sudden sensory neural hearing loss. With 3D-FIESTA imaging, twelve patients were diagnosed with acoustic neuroma, four with enlarged vestibular aqueduct syndrome, and two with posterior inferior cerebellar artery aneurysm. Inner ear anomalies and vestibulocochlear nerve aplasia could be diagnosed with 3D-FIESTA imaging. CONCLUSIONS: 3D-FIESTA imaging is a highly sensitive method for the diagnosis of cochlear or retrocochlear lesions. 3D-FIESTA imaging is a useful screening tool for patients with unilateral ear symptoms.

Audiologic Characteristics of Unilateral Tinnitus Patients without Subjective Hearing Disturbance / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tinnitus is an audiologic sensation without external sound stimuli. The aim of this study is to assess characterisistics in unilateral tinnitus patients without subjective hearing loss by analyzing their audiologic test results. SUBJECTS AND METHOD: We used results of audiologic tests including pure tone audiogram (PTA), tinnitogram and distortion products of otoacoustic emissions (DPOAE) from 96 unilateral tinnitus patients without subjective hearing loss. We compared the results of tinnitus ear with non-tinnitus ear individually, and also analyzed these data according to their age, symptom and duration. RESULTS: The hearing level of PTA of tinnitus ears compared to non-tinnitus ears was statistically significant at 4000 Hz and 8000 Hz, and it was more prominent at age over forty. DPOAE results were significantly low at 4000 Hz level in tinnitus ears compared to non-tinnitus ears. Loudness and duration of symptoms were louder and longer when hearing loss was accompanied. CONCLUSION: In unilateral tinnitus patients without subjective hearing disturbance, a pattern of high frequency hearing loss was found in PTA and DPOAE. The patients with hearing loss above 25 dB HL at any frequency are older and have longer duration with high pitch-louder tinnitus. Therefore, even though tinnitus patient has no subjective hearing loss, it is important to make treatment plan by sufficient audiologic evaluation.

Epistaxis in Patients Taking Oral Anticoagulant and Antiplatelet Medication / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Epistaxis can be caused or exacerbated by anticoagulant and antiplatelet medication. The use of these medications has been increasing markedly in Korea over the recent years due to it becoming an aging society. This retrospective study assessed the proportion of patients taking anticoagulant and antiplatelet in epistaxis patients and monitored differences in patients' clinical courses. SUBJECTS AND METHOD: A retrospective chart review was performed for consecutive patients referred to the ENT department with epistaxis from the emergency room over a one-year period. RESULTS: One hundred eighty eight patients presented to the emergency room with epistaxis, representing 0.6% of all emergency attendances. Of these patients, 143 (76%) were referred to the ENT department: of these referred to us, 24% had been taking anticoagulant or antiplatelet medication. There were 5 taking Warfarin, 32 Aspirin, 3 Clopidogrel, and six more than one medication simultaneously. Patients that were taking these medications were older and had higher prevalent rate of hypertension. There was no difference in the bleeding site, the recurrence rate, hospitalization and duration of in-patient stay, and method of treatment between groups. CONCLUSION: Patients with epistaxis in ENT emergency taking anticoagulant and antiplatelet medication have been increasing recently, so an understanding of the action of such medication may enable health care personnels to provide more effective management of these patients.

Comparative Analysis of the Expression of Involucrin, Filaggrin and Cytokeratin 4, 10, 16 in Cholesteatoma

BACKGROUND AND OBJECTIVES: The aim of this study is to determine whether the hyperproliferative and hyperkeratotic characters of cholesteatoma are associated with differentiation of keratinocytes in cholesteatoma by examining the localization of marker proteins, such as involucrin, filaggrin, and cytokeratins. MATERIALS AND METHODS: Immunohistochemical study was carried out in 30 cholesteatoma tissues and 10 retroauricular skins to examine the expression of involucrin, filaggrin, cytokeratin 4, 10 and 16. The staining results were graded as negative, weakly positive (70%). RESULTS: Involucrin was strongly expressed in upper spinous, granular, and corneal layer of cholesteatoma. Filaggrin was strongly expressed in granular and corneal layer of cholesteatoma. Cytokeratin 4 was expressed in basal layer of retroauricular skin, but occasionally expressed in suprabasal layer of cholesteatoma. Cytokeratin 10 was homogenously expressed in all suprabasal layer of retroauricular skin, whereas pattern of shift to surface layer was showed in cholesteatoma. Cytokeratin 16 was moderately expressed at suprabasal layer in cholesteatoma. CONCLUSIONS: It can be suggested that early differentiation of suprabasal layer may lead to hyperdifferentiation and hyperkeratosis. Different expression of cytokeratins possibly indicates the altered differentiation of cholesteatoma.

Comparative Analysis of the Expression of Involucrin, Filaggrin and Cytokeratin 4, 10, 16 in Cholesteatoma

BACKGROUND AND OBJECTIVES: The aim of this study is to determine whether the hyperproliferative and hyperkeratotic characters of cholesteatoma are associated with differentiation of keratinocytes in cholesteatoma by examining the localization of marker proteins, such as involucrin, filaggrin, and cytokeratins. MATERIALS AND METHODS: Immunohistochemical study was carried out in 30 cholesteatoma tissues and 10 retroauricular skins to examine the expression of involucrin, filaggrin, cytokeratin 4, 10 and 16. The staining results were graded as negative, weakly positive (70%). RESULTS: Involucrin was strongly expressed in upper spinous, granular, and corneal layer of cholesteatoma. Filaggrin was strongly expressed in granular and corneal layer of cholesteatoma. Cytokeratin 4 was expressed in basal layer of retroauricular skin, but occasionally expressed in suprabasal layer of cholesteatoma. Cytokeratin 10 was homogenously expressed in all suprabasal layer of retroauricular skin, whereas pattern of shift to surface layer was showed in cholesteatoma. Cytokeratin 16 was moderately expressed at suprabasal layer in cholesteatoma. CONCLUSIONS: It can be suggested that early differentiation of suprabasal layer may lead to hyperdifferentiation and hyperkeratosis. Different expression of cytokeratins possibly indicates the altered differentiation of cholesteatoma.

Mucoepidermoid Carcinoma in The External Auditory Canal: A Case Report / Journal of the Korean Cancer Association, 대한암학회지

Mucoepidermoid carcinoma in the external auditory canal is extremely rare. Strategies used for treatment of mucoepidermoid carcinoma remain controversial. We present a case of mucoepidermoid carcinoma of the external auditory canal. The patient underwent lateral temporal bone resection and the surgical defect was obliterated with temporal muscle. He is currently disease-free, four years after surgery. Proper diagnostic measures and strategy for treatment of mucoepidermoid carcinoma are discussed.

A Case of Linear Scleroderma Involving Cerebellum with Vertigo

Linear scleroderma is a kind of disease that can cause complication of the central nervous system. Sometimes, ipsilateral intracerebral or white matter lesions in the brain magnetic resonance imaging are noted. Nystagmus is important for the differential diagnosis of dizziness. Positional nystagmus was classified into regular direction nystagmus, direction changing positional nystagmus (DCPN) and irregular nystagmus by their character. DCPN is defined as a nystagmus that changes its direction with different head and body positions, and it can be the sign of lesion in the central vestibular system. Recently, we experienced a 17-year-old woman who had a scalp linear scleroderma, treated for about 10 years and showed DCPN induced by positional nystagmus test. We report a case of linear scleroderma accompanied by cerebellar lesion with a brief review of literature.