Valuation of Transient Evoked Otoacoustic Emissions and Distortion Product Otoacoustic Emissions in Tinnitus Patients with Normal Hearing / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study aims to verify that one of the causes of tinnitus is the malfunction of outer hair cells and, on the basis of this, to investigate the usefulness of otoacoustic emissions by performing transient evoked otoacoustic emissions (TEOAE) and distor-tion product otoacoustic emissions (DPOAE). SUBJECTS AND METHOD: Included in the study were forty-one patients who had normal hearing in the range from 0.5 to 8 kHz, and complained of unilateral tinnitus. In these patients, hearing in bilateral ears, TEOAE, DPOAE, as well as the frequency & amplitude of their tinnitus were measured. RESULTS: No statistically significant difference was found in bilateral hearing in patients who complained of unilateral tinnitus. However, TEOAE and DPOAE showed a statistically significant difference with their p-values at 0.04 and 0.004, respectively. CONCLUSION: The results of this study suggested that TEOAE testing and DPOAE testing provide an important clue for verifying that the loss of outer hair cells contributed to the development of symptoms suffered by tinnitus patients with normal hearing.

Is Surgical Drain Useful for Lumbar Disc Surgery?

OBJECTIVE: Surgical drains are commonly used after the spine surgeries for minimizing hematoma formation, which can delay wound healing and may become a source of fibrosis, infection, and pain. The drain, however, may provide a direct route for infection if it is contaminated. Our objective was to survey the relationship between surgical drains and infection. METHODS: The 70 patients who had undergone single-level lumbar discectomy from April 2011 to March 2012 were retrospectively analyzed. Each patient's medical chart and magnetic resonance image were thoroughly reviewed after all the patients had been divided into the drainage and the nondrainage groups. The amounts and durations of the surgical drains in the drainage group were analyzed. Additionally, the levels of C-reactive protein, rates of infection, scores of preoperative and postoperative visual analog scale (VAS), and lengths of hospital stay after operation were compared between the 2 groups. RESULTS: In this study, 70 patients were retrospectively analyzed; out of which, 42 and 28 patients were included in the drainage and the nondrainage groups, respectively. Two of the postoperative infection cases in the nondrainage group required to undergo repeated operations. The frequency of the postoperative infection cases was higher in the nondrainage group than in the drainage group; however, there was no significant statistical difference between the 2 groups (p=0.157). CONCLUSION: Surgical drains did not elevate postoperative infection. Furthermore, drain tip cultures allowed us to detect postoperative infection at an early stage, and it led to faster initiation of antibiotics treatment.

Solitary Metastasis of Gastric Carcinoma to the Cerebellopontine Angle

Internal auditory canal (IAC) and cerebellopontine metastases are very rare lesions and their diagnosis is very difficult due to their similarity to vestibular schwannoma in clinical characteristics and radiologic findings. Our case is peculiar and differs from previously reported cases of malignant metastasis to the IAC in two aspects: 1) solitary IAC metastasis occurred without distant metastasis and 2) symptoms due to IAC metastasis preceded outbreak of primary lesion symptoms or diagnosis of primary lesion. In our literature search, no correlating cases have been reported. In this peculiar case, rapid progression of otologic symptoms, short duration of onset from hearing impairment to facial palsy, and laterally eccentric contrast enhancement in gadolinium-enhanced T1-weighted magnetic resonance imaging may have been clues for metastatic lesion.

Retraction: Molecular Genetic Analysis of Connexin 26 in Korean Congenital Hearing Loss / 대한이비인후과학회지

No abstract available.

Two Cases of Intralabyrinthine Schwannoma / 대한이비인후과학회지

Intralabyrinthine schwannoma is a rare tumor that arises from the distal portion of either the vestibular or cochlear nerve. Consequently, the cochlear, the semicircular canals, the vestibule, or a combination of these structures may become involved. Clinically, intralabyrinthine schwannoma mimics the clinical features of many other neurotologic conditions that might be often misdiagnosed as Menere's disease, sudden deaf and so on. Therefore, a high index of suspicion and precise imaging are often required to detect this tumor. We report two cases of intralabyrinthine schwannomas which was diagnosed with high resolution, gadolinium-enhanced magnetic resonance imaging (MRI) and removed by transmastoid labyrinthectomy.

A Case of Salvage Operation in Radiation-Failed Squamous Cell Carcinoma Transformed from Bowen's Disease / 대한이비인후과학회지

Bowen's disease was first described by Bowen in 1912 as a precancerous dermatosis. It is believed that its main causes are exposure to UV and a history of arsenic ingestion. Bowen's disease are precursor lesions, 5 percent of which is believed to develop into squamous cell carcinoma. It is stated in the literature that those patients in whom invasive cell carcinoma develops, 13 per cent of the lesions metastasize and death eventually occurs in 10 per cent of them. Therefore, elective lymphadenectomy is rarely indicated and is usually reserved for recurrent, histologically aggressive, deeply invasive and large (greater than 2 cm) tumors. Deeply invasive tumors of the preauricular and mandibular area frequently require parotidectomy to provide an adequate deep margin, to remove the primary echelon lymph nodes and to protect the facial nerve. We report a case of salvage operation on squamous cell carcinoma that had transformed from Bowen's disease.

Proposal for Classification of Isolated Congenital Ossicular Anomalies / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There are many different types of congenital ossicular anomalies, which may be broadly divided into major ear anomalies and minor ear anomalies. Minor congenital anomalies are restricted to the middle ear, while major congenital anomalies are malformations of the middle ear and external meatus and sometimes the auricle. The great diversity of anomalies of the middle ear described in the literature makes it difficult to compare and analyze it. The objective of this study is to review and analyze the isolated congenital ossicular anomalies published in the Korean literatures with special reference to the pattern of anomalies and surgical treatment results, and to propose a new systematic classification of isolated congenital ossicular anomalies. SUBJECTS AND METHOD: We reviewed retrospectively 10 Korean literatures concerning isolated congenital ossicular anomalies, which included 117 cases. We also reviewed 9 cases of isolated congenital ossicular anomalies from Ajou University Hospital from Jan 2002 to June 2003, which were not reported in the literature. Among the total 126 cases of isolated congenital ossicular anomalies, follow-up on the hearing results was possible in 112 ears. RESULTS: We proposed a new classification of isolated congenital ossicular anomalies using 5 types based on the stapes status. Twenty-six anomalous patterns were detected out of 126 cases of isolated congenital ossicular anomalies. Using the new classification, the more severe anomaly stapes could be displayed, and the worse postoperative hearing gain could be also predicted. CONCLUSION: Ossicular anomalies were detected without a certain rule of pattern, and big variety of those patterns could be detected in the future. Our proposed new classification will be helpful to analyze the pattern and surgical result of congenital ossicular anomalies.

A Case of Cochlear Implantation in a Postlingual Deaf Patient with Behcet Disease / 대한이비인후과학회지

Recurrent iritis and oral/genital ulcers have been described for the first time as a separate pathological entity by the Turkish dermatologist Hulusi Behcet. Behcet disease is a chronic, multi-systemic disorder, which affects many organs as a result of vasculitis. The clinical manifestations are divided into two groups: major (oral ulcers, eye lesions, genital ulcerations, and skin lesions) and minor (arthritis, gastrointestinal lesions, epididymitis, thrombophlebitis, and central nervous system involvement) criteria. The incidence of hearing loss in Behcet disease has been reported as 12% to 80% in several studies. A 37-year-old man diagnosed as Behcet disease was admitted to our department with complaints of profound right hearing loss and dizziness. He was treated with steroid without improvement. After one year, he suffered from complete hearing loss on the left side. A temporal bone CT scan revealed right cochlear ossification. Cochlear implantation was performed within 4 weeks after the completion of steroid therapy in the left cochlea, which was partially obstructed by fibrotic tissue. However, the electrode was fully inserted without resistance. Wound healing complications were not encountered in the postoperative period. The hearing threshold was restored to 30 dBHL, while speech discrimination did not improve as much as expected. We propose that the routine hearing examinations be employed in the evaluation and management of Behcet disease. According to our experience, we find that cochlear implantation should be carried out at an early stage, before the development of labyrinthine ossification.

Analysis of Body Sway and Nystagmus with Galvanic Stimulation in Normal Subjects

BACKGROUND AND OBJECTIVES : The purpose of this study is to evaluate the possibility of clinical application of 'vestibular function test by electrical stimulation' measuring nystagmus and body sway which are generated by electrical stimulation. MATERIALS AND METHODS : Twelve normal subjects for measurement of nystagmus and eight for body sway volunteered to participate as subjects of the experiment. We used continuous direct current from 1mA to 3mA, and its polarity could be switched through the surface electrode on the bilateral mastoid process. Videooculogram was used to measure the nystagmus. Lateral body sway was recorded by using Computerized Dynamic Posturography. RESULTS: When stimulating the positive electrode over the right mastoid, left nystagmus and body sway toward right are observed. When stimulating the negative electrode over the right mastoid, right nystagmus and body sway toward left are observed. The nystagmus occurred 42% at 1mA, 75% at 1.5mA, 92% at 2mA, and 100% at more than 2.5mA. The slow phase velocity of the nystagmus were increased from an average of 1.9 deg/sec at 1mA to an average of 3.6 deg/sec at 3mA. However, they were variable from minimum of 0.1 deg/sec to maximum of 4.8 deg/sec even stimulated with fixed amount of current. Also, the asymmetry of the nystagmus on the each direction was observed over 27% at the stimulation of 2.5mA and 3mA. The body sway was observed on the 7 subjects except one. Among them, body sway occurred on stimulation of 1mA in 5 subjects. CONCLUSIONS : Evaluation of nystagmus with galvanic stimulation revealed high right-left asymmetry in normal subjects and needed more electrical stimulation. Evaluation of body sway with galvanic stimulation is more feasible as a vestibular function test, because it has higher manifestation rate, less asymmetry, and it need less electrical amplitude which cause less discomfort to the subjects.

The Comparison of Benign Paroxysmal Vertigo of Childhood and Migraine Related Vertigo in Children

BACKGROUND AND OBJECTIVES: Benign paroxysmal vertigo of childhood (BPVC) and migraine related vertigo (MRV) are most common causes of vertigo in children. Some authors suggested that BPVC may be an early manifestation of migraine. However there is few articles about relationship between BPVC and MRV. The purpose of this study is to compare the clinical characteristics, audiological and vestibular findings, treatment and prognosis of BPVC and MRV and to provide the helpful information for relationship between BPVC and MRV. MATERIALS AND METHOD: The twenty four children (less than 16 years old) with BPVC and 23 children with MRV, who visited the Dizziness Clinic in the Department of Otolaryngology, Ajou University Hospital, Suwon, Korea between January 2001 and August 2003 were selected for this study. These excluded the patients with abnormal eardrums/tympanograms or those that did not perform questionnaires, audiological, or vestibular evaluations. They were retrospectively analyzed for clinical symptoms, audiograms, vestibular functions, and treatment results. RESULTS: BPVC was frequently detected in younger children than MRV. Spinning sensation was frequently associated with BPVC. Aural symptoms, headache, photophobia, phonophobia, and visual symptoms were frequently associated with MRV. Abnormalities in vestibular function tests were 14 (58%) in BPVC and 15 (62%) in MRV. BPVC & MRV had good prognosis. But medication was sometimes more needed in MRV than in BPVC. CONCLUSIONS: BPVC and MRV show some different features in the age of onset, clinical features, treatment and prognosis, but also have some features of MRV. Further studies are needed to find their relationship between them.

Congenital Ossicular Anomaly with Intact Tympanic Membrane / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A nonprogressive and conductive hearing loss in the range of 40 to 60 dB with normal tympanic membrane which has no history of trauma or infection is highly suggestive of a congenital ossicular malformation. Stapes anomaly is the most common among such ossicular anomalies and it is clinically important because hearing loss can be corrected by appropriate procedures. In this study, we attempted to describe the patterns of ossicular anomalies encountered in patients who have a normal eardrum. We also analyzed the surgical result with special reference to the pattern of ossicular anomaly. MATERIALS AND METHOD: We experienced 28 ears (23 patients) of congenital ossicular anomalies which were confirmed through the exploratory tympanotomy at Ajou University Hospital between September 1994 and December 2001. The preoperative and postoperative audiologic findings, operative findings and CT findings were analyzed. RESULT: There were 7 patterns of ossicular anomalies among which stapes footplate fixation was the most common anomaly. We could get 64.3% of hearing improvement after ossiculoplasty with several kinds of prosthesis. CONCLUSION: There was a great diversity of patterns of ossicular anomalies without certain rule. Stapes anomaly was the most commonly detected. Stapes footplate fixation was the most common type which was usually bilateral. Anomalies associated with incus and malleus were usually unilateral. The surgical result of congenital ossicular anomaly was generally good.

Analysis of Lymph Nodes Number according to Various Modifications of Neck Dissection / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The type of neck dissection performed for head and neck cancers depends on the experience of the surgeon and the status of the neck metastasis. The purpose of this study was to quantify the extent of lymphadenectomy achieved according to the various modifications of neck dissection based on microscopic pathologic analysis and to analyze the difference in the number of lymph nodes between the types of neck dissection. MATERIALS AND METHODS: Charts and pathologic finding of patients who underwent neck dissection from June 1994 to October 1999 were reviewed. Patients who received selective neck dissection or preoperative radiotherapy to the neck were excluded. The samples were 65 necks and were divided into four groups based on Medina's classification: radical neck dissection (group 1), Type I modified radical neck dissection (group 2), Type II modified radical neck dissection (group 3), and Type III modified neck dissection (group 4). The number of lymph nodes was counted by a pathologic microscopic examination for each region of specimens. The intergroup difference was analyzed by a one-way between-group analysis of variance (ANOVA). RESULTS: The mean number of dissected lymph nodes per specimen was 43.6 in group 1, 38.8 in both groups of 2 and 3, and 30.3 in group 4. Group 4 was significantly different from group 1 (p<0.05). Especially, the number of dissected lymph nodes from level II, III, IV of group 4 was significantly different from those of group 1 (p<0.05). There was no significant difference between other groups. CONCLUSIONS: The number of dissected lymph nodes decreases as the number of preserved non-lymphatic tissue structures increases. Level II, III, IV are less completely operated regions in functional neck dissection.

Molecular Genetic Analysis of Connexin 26 in Korean Congenital Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Congenital deafness is a relatively common disorder and its' incidence is as high as 1 per every 1, 000 newborn infants. In developed countries, genetic hearing loss accounts for 50% of all hearing losses. A least 20 autosomal recessive loci had been identified, and in 1997, Connexin 26, one of the gap-junction proteins, was found to be the main mutant gene of non-syndromic congenital sensorineural hearing loss. The objective of this study is the investigation of the clinical features and characteristics of connexin 26 mutation in congenital deaf patients in Korea. MATERIALS AND METHODS: Fifty-one patients who have visited the out-patient department of Ajou University Hospital and 125 patients attending two special schools for deafness were physically examined. Family history of each patient was also examined. One hundred normal hearing infants who were audiologically approved were selected as a control group. With their blood samples, we performed DNA extraction and sequenced PCR products. RESULTS: Among 176 patients, 53 patients had family history of hearing impairment, and 16 patients actually showed syndromic features. We sequenced Connexin 26 in 121 patients who have congenital non-syndromic sensorineural hearing loss. Two heterozygotes of 35delG, three heterozygotes, four homozygotes of 235delC, 35 heterozygotes, and four homozygotes of E114G were observed. CONCLUSION: Family history of deafness was relatively common among the patients and therefore it was an important factor in deciding that hearing loss was due to genetic origin. Syndromic hearing loss occupies a relatively minor portion of congenital deafness. With regard to Connexin 26 mutation, 35delG is reported as the major gene mutation in the western countries, but in our study, only 2 patients had this type of mutation. Therefore, 235 delC. and E114G can be considered as race specific gene mutations, even though further studies are need.

Measurement of Speech Reception Threshold by Picture Identification in Young Children / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Young children response more readily to speech than to pure tone stimuli. Although there are several reports on modification of speech Reception Threshold Testing by picture identification in the States, none has been reported in Korea. MATERIALS AND METHODS: In this study, we investigated the testing of SRT-PI in 102 young children of normal development between 24 and 36 months. All subjects were tested not only with SRT-PI but also with play audiometry in the same condition. RESULTS: Overall success rate of SRT-PI was 80.3% while only 3.9% of subjects were successful in play audiometry. The success rate of SRT-PI was significantly higher in the 29-36 months group than in the 24-28 months group. Test time and threshold did not show significant differences between in sex and age of subjects with regard to SRT-PI. CONCLUSION: SRT-PI is a simple, efficient and very useful test battery for audiologic evaluation in young children.