Expert's Consensus on Terminology of Auditory Perceptual Assessment in Voice Disorder / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study was to conduct a preliminary study to develop a standardized guideline for terminology necessary to describe auditory perception qualitatively and quantitatively in voice disorders in the Korean language. SUBJECTS AND METHOD: At first, a subjective questionnaire for Korean translation and definition of 25 auditory perceptual assessment terms proposed by Titze was answered by six speech-language pathologists. Secondly, a new questionnaire that was reconstructed with objective items based on the responses to the first questionnaire was completed by 14 experts who had experience on voice disorder for more than 10 years in Korea. In both questionnaires, the necessity of 32 auditory perceptual assessment terms selected from the 25 terms defined by Titze, GRBAS and CAPE-V was surveyed. RESULTS: The consensus on the Korean translation of auditory perceptual assessment terms was moderate (52.6%) between experts. The terms ‘ rough’ and ‘ shimmer’ demonstrated highest consensus of 85.7%. The consensus on Korean definition of auditory perceptual assessment terms was also moderate (61.6%). The term ‘ yawny’ showed complete consensus (100%). The necessity of auditory perceptual assessment terms varied with terms, but showed high consensus. CONCLUSION: It is necessary to develop and apply various standardized vocabulary terms for clinical evaluation so that they can express pathology and physiological characteristics during vocalization. In addition, despite the fact that there are a lot of auditory-perceptual terms, there is a lack of knowledge about voice quality terms, suggesting the need to promote and educate the developed voice quality terms.

Liver cirrhosis leads to poorer survival in patients with end-stage renal disease

BACKGROUND/AIMS: Liver cirrhosis (LC) is an important problem in patients withend-stage renal disease (ESRD). Few studies have investigated the inf luence ofLC on mortality in patients with ESRD. This study investigated the associationbetween LC and mortality among patients with ESRD and compare mortality betweentwo dialysis modalities. METHODS: Adult patients (≥ 18 years of age) starting dialysis for ESRD were enrolledin the present study from 2000 to 2011. We analyzed 1,069 patients withESRD; of these, 742 patients were undergoing hemodialysis (HD) and 327 patientswere undergoing peritoneal dialysis (PD). RESULTS: The prevalence of LC was 44 of 1,069 patients (4.1%). The cumulative 1-,3-, and 5-year survival rates of noncirrhotic patients were 93%, 83%, and 73%, respectively,whereas the equivalent survival rates of cirrhotic patients were 90%,68%, and 48%, respectively (p = 0.011). After adjustment, LC was an independentrisk factor for death in patients with ESRD. No difference in mortality associatedwith LC was found between the HD and PD subgroups. CONCLUSIONS: Of the patients with ESRD, cirrhotic patients had poorer survivalthan noncirrhotic patients. Among patients with ESRD and LC, survival of patientsundergoing PD may be comparable with that of patients undergoing HD.

Usefulness of Objective Hearing Tests for Screening Patients with Partial Deafness / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: 'Partial deafness' characterized by normal or slightly impaired hearing in the low frequency band and nearly total deafness in the high frequency range, is difficult to assess with conventional behavioral tests in infants and young children. Therefore, this study aimed to assess the usefulness of objective hearing tests, such as auditory brainstem response (ABR) and auditory steady state response (ASSR) in evaluating patients with partial deafness. SUBJECTS AND METHOD: One hundred thirty three patients who underwent ASSR in Ajou University Hospital from January 2008 to January 2013 were enrolled to this study. Correlations between ASSR, ABR and pure tone audiometry (PTA) thresholds were analyzed. RESULTS: ASSR thresholds of 133 patients were highly correlated with both ABR and PTA thresholds in majority of the tested frequencies. Partial deafness was detected in 9 out of 133 patients, based on the results of PTA and ASSR. ASSR thresholds of patients with partial deafness were significantly correlated with PTA thresholds in all frequencies, with especially high correlation found at 1 and 4 kHz. However, there was no significant correlation between ASSR and ABR thresholds. ABR thresholds of partial deafness patients were measured at 65 dB in one patient, 70-90 dB in 3 patients, and no response at 90 dB in 5 patients, respectively. In 8 (6%) out of 124 patients, ABR thresholds were measurable with profound hearing loss and residual hearing was observed at low frequencies. CONCLUSION: ASSR is useful for predicting residual hearing at low frequencies of infants and young children for whom assessment of hearing is difficult using conventional behavioral tests.

Functional Listening Performance of Children with Sequential Bilateral Cochlear Implantation in Daily Life / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study aims to identify whether the sequential bilateral cochlear implantation in children with a long inter-implant interval provides functional benefits in everyday situation. SUBJECTS AND METHOD: Seventeen children with sequential bilateral cochlear implants (BiCIs) (mean age at first implantation, 2.6 years; mean age at second implantation, 8.5 years; mean inter-implant interval, 6.0 years) and 17 children with unilateral cochlear implants (UniCIs) were included in this study. The questionnaire SSQ (The Speech, Spatial, and Qualities of hearing scale for parents of children with impaired hearing, Galvin, 2007) was used to evaluate the performance of two groups by individually interviewing the parents of the subjects. For the BiCIs, anecdotal reports of the performance in everyday listening situation and device use were also collected in interviews. RESULTS: The BiCI group showed significantly better performance in all three areas (speech perception, spatial hearing, and other qualities of hearing) of the SSQ than did the UniCI group. The differences between the two groups were significantly larger in performance on 'spatial hearing' and 'other qualities of hearing' than on 'speech perception'. All subjects with bilateral cochlear implants had a positive attitude on bilateral hearing. Anecdotal reports indicated that bilateral hearing has positive effects such as reduced repeated questions, increased participation in conversation, facilitated language and learning acquisition, and improved concentration. CONCLUSION: Children who received sequential bilateral cochlear implantation with a long inter-implant interval could obtain functional benefits in daily life. Also it turned out that these benefits have positive effects on children's communication, language, learning, and socio-emotional areas.

IgG4-Related Systemic Disease Can Be Easily Mistaken as a Uroepithelial Tumor / 전남의대학술지

Immunoglobulin G4-related disease (IgG4-RD) is a newly recognized systemic syndrome characterized by elevated serum IgG4 concentrations and tumefaction or tissue infiltration by IgG4-positive plasma cells. We experienced a case of IgG4-RD involving multiple organs in a 64-year-old female who was referred for a suspected uroepithelial tumor. A mass biopsy confirmed dense lymphoplasmacytic infiltration with an increased number of IgG4-positive plasma cells. We discuss this case and review the literature to bring IgG4-RD to the attention to clinicians because it responds dramatically well to steroid therapy and should be kept in mind as a differential diagnosis to avoid unnecessary surgery.

IgG4-Related Systemic Disease Can Be Easily Mistaken as a Uroepithelial Tumor / 전남의대학술지

Immunoglobulin G4-related disease (IgG4-RD) is a newly recognized systemic syndrome characterized by elevated serum IgG4 concentrations and tumefaction or tissue infiltration by IgG4-positive plasma cells. We experienced a case of IgG4-RD involving multiple organs in a 64-year-old female who was referred for a suspected uroepithelial tumor. A mass biopsy confirmed dense lymphoplasmacytic infiltration with an increased number of IgG4-positive plasma cells. We discuss this case and review the literature to bring IgG4-RD to the attention to clinicians because it responds dramatically well to steroid therapy and should be kept in mind as a differential diagnosis to avoid unnecessary surgery.

Alcohol Drinking Increased the Risk of Advanced Colorectal Adenomas

BACKGROUND/AIMS: Age, sex, gene and life style are modulating risks for colon cancer. Although alcohol intake may impact on colorectal adenoma, clear association has not been established yet. We aimed to investigate effects of alcohol consumption on the characteristics of colorectal adenoma. METHODS: Patients who underwent colonoscopic polypectomy of colorectal adenoma in the department of gastroenterology of Eulji hospital through 2005 to 2012, having both blood tests and ultrasound or abdominal CT examination were enrolled. The alcohol drinking patients were subdivided into normal or abnormal laboratory group, and alcoholic liver diseases group. RESULTS: 212 patients with colorectal adenoma were analyzed; advanced adenoma and multiple adenoma were found in 68 (32.0%) and 79 (37.2%) patients. When compared to the nondrinker group (120/212 patients), the alcohol drinker group (92/212 patients) represented significantly high odds ratios (ORs) for advanced adenoma (OR, 2.697; P=0.002), and multiple adenoma (OR, 1.929; P=0.039). Among alcohol drinker (92 patients), the ORs of advanced adenoma were 6.407 (P=0.003) in alcoholic liver diseases group (17 patients), 3.711 (P=0.002) in the alcohol drinker with abnormal lab (24 patients), and 2.184 (P=0.034), in the alcohol drinker with normal lab (51 patients) compared to nondrinker group. CONCLUSIONS: This study showed that alcohol drinking may influence on the development of advanced colorectal adenoma and multiplicity. Especially in the group with alcoholic liver diseases and with abnormal lab presented significantly higher ORs of advanced adenoma.

IgG4-Related Systemic Disease Can Be Easily Mistaken as a Uroepithelial Tumor / 전남의대학술지

Immunoglobulin G4-related disease (IgG4-RD) is a newly recognized systemic syndrome characterized by elevated serum IgG4 concentrations and tumefaction or tissue infiltration by IgG4-positive plasma cells. We experienced a case of IgG4-RD involving multiple organs in a 64-year-old female who was referred for a suspected uroepithelial tumor. A mass biopsy confirmed dense lymphoplasmacytic infiltration with an increased number of IgG4-positive plasma cells. We discuss this case and review the literature to bring IgG4-RD to the attention to clinicians because it responds dramatically well to steroid therapy and should be kept in mind as a differential diagnosis to avoid unnecessary surgery.

Successful Pregnancy in a Patient with Autosomal Dominant Polycystic Kidney Disease on Long-Term Hemodialysis

Recent advances in dialysis and a multidisciplinary approach to pregnant patients with advanced chronic kidney disease provide a better outcome. A 38-yr-old female with autosomal dominant polycystic kidney disease (ADPKD) became pregnant. She was undergoing hemodialysis (HD) and her kidneys were massively enlarged, posing a risk of intrauterine fetal growth restriction. By means of intensive HD and optimal management of anemia, pregnancy was successfully maintained until vaginal delivery at 34.5 weeks of gestation. We discuss the special considerations involved in managing our patient with regard to the underlying ADPKD and its influence on pregnancy.

Clinical Significance of beta-Tricalcium Phosphate and Polyphosphate for Mastoid Cavity Obliteration during Middle Ear Surgery: Human and Animal Study

OBJECTIVES: Mastoid obliteration is used to obliterate the mastoid cavity following a mastoidectomy or to prevent the formation of a retraction pocket. This study evaluated the effectiveness of beta-tricalcium phosphate and polyphosphate (beta-TPP) for mastoid obliteration in middle ear surgeries in prospective human and animal studies. METHODS: Twenty patients with chronic otitis media underwent mastoid obliteration using beta-TPP after a intact canal wall mastoidectomy or simple mastoidectomy. The clinical data were prospectively evaluated including: the diagnosis, temporal bone computed tomography (TBCT), otoscopic findings, pure tone audiogram, and complications. In the animal experiment, beta-TPP was applied into the right bulla in five rats, and the opposite bulla was used as the control in the non-obliterated state. The skulls of five other rats were drilled out and the holes were obliterated with beta-TPP. TBCT were obtained at 3, 6, and 9 months after the obliteration and histologic analysis was done at 3 and 9 months after surgery. RESULTS: In the human study, fourteen TBCTs were obtained at 12 months after the surgery. All demonstrated no bone resorption in the obliterated mastoids. Among the 15 cases displaying retracted tympanic membranes preoperatively, 11 showed no retraction, 2 showed retraction postoperatively, 1 was lost to follow-up and 1 was a case of postoperative wound infection. Among 20 cases, one case developed a postoperative infection that necessitated a second operation. Sixteen underwent ossiculoplasty; hearing improvements were obtained in 15 cases and 1 case showed decreased hearing. In the animal study, new bone formation without significant bone resorption in the radiologic and histologic findings were noted in both the skull and bulla groups. CONCLUSION: Although beta-TPP is a foreign material having the possibility of infection, mastoid obliteration with it can be a treatment option in middle ear surgeries to prevent retraction pockets or the recurrence of diseases.

Acute generalized exanthematous pustulosis due to hydroxychloroquine in a rheumatoid arthritis patient

Acute generalized exanthematous pustulosis (AGEP) is characterized by acute nonfollicular sterile pustules on a background of edematous erythema. Hydroxychloroquine (HCQ), an antimalarial drug, widely used to treat rheumatic and dermatologic diseases. HCQ has been reported to be an uncommon cause of AGEP. We report a 60-year-old woman with rheumatoid arthritis requiring the use of HCQ presented fever and erythematous eruption on the trunk with sterile pustules. Leukocytosis and elevated erythrocyte sedimention rate noted on laboratory examination. On the histopathological examination of the skin biopsy specimen showed neutrophilic infiltration and scattered eosinohpils. The lesions were resolved with removal of HCQ. The clinical course was consistent with the diagnosis of AGEP associated with HCQ. We reported a case of typical AGEP associated with HCQ in a patient with Rheumatoid arthritis. The patient presented resolution from cutaneous lesions with withdrawal of culprit drug, without the need of systemic steroid.

Emphysematous Pyelonephritis Caused by Citrobacter freundii in a Patient with Type 2 Diabetes and Neurogenic Bladder

Emphysematous pyelonephritis (EPN) is a rare, life-threatening complication of upper urinary tract infections that is characterized by the presence of gas in the renal parenchyma and perirenal space. It commonly occurs in diabetic patients. Escherichia coli are the most common causative organisms, with few reports implicating Citrobacter freundii as the etiologic agent in EPN. A 57-year-old woman with diabetes and neurogenic bladder visited at our department with confused mentality, myalgia, and general weakness. Further investigation revealed that the patient suffered from unilateral EPN with sepsis caused by C. freundii. The patient's condition was improved considerably with percutaneous drainage and use of intravenous antibiotics for several weeks. However, renal function eventually deteriorated to permanent renal failure, which required hemodialysis. In conclusion, C. freundii may be the causative pathogen of EPN in a patient with type 2 diabetes and neurogenic bladder.

Primary Hyperparathyroidism with Ectopic Parathyroid Adenoma Detected by Both 99mTc-MIBI SPECT and Contrast-Enhanced Neck CT / 대한내과학회지

An ectopic parathyroid gland is a major cause of persistent and recurrent hyperparathyroidism. Surgical success depends on accurate preoperative localization of the parathyroid adenoma. We herein report the case of a 52-year-old male patient who suffered from primary hyperparathyroidism for several years. He initially presented with urinary frequency, hypercalcemia, and a ureter stone. Ultrasonography and a 99mTc-sestamibi scan were performed, but failed to localize the parathyroid lesion. Four years later, the patient revisited our hospital, complaining of general weakness, headache, dyspepsia, and recurrent urinary symptoms secondary to persistent primary hyperparathyroidism. In addition, renal function was decreased and severe osteoporosis was found. We performed a 99mTc-sestamibi scan with single photon emission computed tomography (99mTc-MIBI SPECT) and contrast-enhanced neck CT, and detected an ectopic parathyroid adenoma in the upper anterior mediastinum. In conclusion, the combination of both 99mTc-MIBI SPECT and neck CT could permit better preoperative parathyroid localization, especially for mediastinal adenomas.

Clinical Usefulness of Modified Bondy Operation for Management of Cholesteatomas

BACKGROUND AND OBJECTIVES: Bondy operation is a type of modified radical mastoidectomy whose operation window is through an external auditory canal via removal of superior and posterior walls without management of the middle ears. However, the usefulness of this operation is unclear. This study aimed to review our clinical experience of modified Bondy operations and to clarify its usefulness. MATERIALS AND METHODS: Fifteen patients underwent a modified Bondy operation at the Department of Ajou University Hospital between 1996 and 2010. Their clinical data were retrospectively reviewed including age, gender, chief complaint, diagnosis, pure tone average (PTA, a mean threshold of 0.5, 1, 2, and 3 kHz before and 3 months after the operation), otoscopic finding, temporal bone computed tomography, and recurrence rate. RESULTS: The mean age of the 15 patients was 35.3+/-14 (range 18-65) years. Post-operative diagnosis of all cases was cholesteatoma (nine attic, three external auditory canal, one sinus, and two recurrent). Pre- and postoperative PTAs were 27.4+/-18.3 dBHL and 26.0+/-10.7 dBHL, respectively (p=0.72). No postoperative recurrence or complications were noted over at least a 3-month follow-up. CONCLUSIONS: Modified Bondy operation is a good option to preserve hearing and prevent recurrence after operations in cases of cholesteatoma with relatively preserved middle ears.

Clinical Usefulness of Modified Bondy Operation for Management of Cholesteatomas

BACKGROUND AND OBJECTIVES: Bondy operation is a type of modified radical mastoidectomy whose operation window is through an external auditory canal via removal of superior and posterior walls without management of the middle ears. However, the usefulness of this operation is unclear. This study aimed to review our clinical experience of modified Bondy operations and to clarify its usefulness. MATERIALS AND METHODS: Fifteen patients underwent a modified Bondy operation at the Department of Ajou University Hospital between 1996 and 2010. Their clinical data were retrospectively reviewed including age, gender, chief complaint, diagnosis, pure tone average (PTA, a mean threshold of 0.5, 1, 2, and 3 kHz before and 3 months after the operation), otoscopic finding, temporal bone computed tomography, and recurrence rate. RESULTS: The mean age of the 15 patients was 35.3+/-14 (range 18-65) years. Post-operative diagnosis of all cases was cholesteatoma (nine attic, three external auditory canal, one sinus, and two recurrent). Pre- and postoperative PTAs were 27.4+/-18.3 dBHL and 26.0+/-10.7 dBHL, respectively (p=0.72). No postoperative recurrence or complications were noted over at least a 3-month follow-up. CONCLUSIONS: Modified Bondy operation is a good option to preserve hearing and prevent recurrence after operations in cases of cholesteatoma with relatively preserved middle ears.

The Usefulness of Ambulatory Phonation Monitoring(APM) / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The use of voice can be a cause of common voice disorders but may also affect the course of treatment. The information of voice use has been limited by relying on the subjective patient self-report in the past. In this study, however, we tried to determine the effectiveness of ambulatory phonation monitoring, which can provide objective vocal use parameters such as phonation time, fundamental frequency and sound pressure level. SUBJECTS AND METHOD: Four subjects (2; normal, 2; vocal disease) were recorded with Ambulatory Phonation Monitor Model 3,200 (KayPENTAX) during a working day. Ambulatory Phonation Monitor (APM) is an unobtrusive, portable device consisting of a small accelerometer, a microprocessor and the APM software. All subjects were instructed to wear APM during the entire day of normal activities and write an activity diary according to time. RESULTS: APM data displays 5 graphs which reveal important characteristics of each subject's phonatory behavior throughout the day. The patient's diary can provide the person's schedule and the correlation between subject's self recognition and the objective data analyzed by APM. CONCLUSION: APM is an overall useful device for measuring phonation parameters and evaluating voice behaviors in natural conditions. It can be used not only for the diagnosis of vocal diseases but also as a voice therapy for feedback on voice use.

Pindborg Tumor on Hard Palate / 대한이비인후과학회지

Pindborg tumor occurs rarely, with a frequency ranging from 0.17% to 1.8% of all odontogenic tumor. It typically presents as a painless asymptomatic expansile mass, but it can result in mechanical effects. The treatment of Pindborg tumor in the past has varied, ranging from enucleation or curettage, to hemimandiblectomy or hemimaxillectomy. We experienced a case of Pindborg tumor treated by marsupialization with sufficient results. But since recurrence has been reported from 10% to 14%, we plan on close observation over at least 5 years.

Conjunctivochalasis Surgery: Amniotic Membrane Transplantation with Fibrin Glue

PURPOSE: We evaluated the effect of amniotic membrane transplantation with fibrin glue after redundant conjunctival resection. METHODS: After enchelon-shaped resection of inferior redundant conjunctiva, an amniotic membrane was transplanted using fibrin glue in symptomatic conjunctivochalasis. Conjunctiva was fixed to the episclera with 10-0 nylon. RESULTS: The subjects were 18 eyes of 9 patients (two males=4 eyes, seven females=14 eyes) with an average age of 67.9+/-7.7 years (range: 54-79 years). Mean operation time was 35.6+/-5.6 minutes/eye (range: 30-45 minutes/eye) and mean numbers of sutures were 8+/-0.76 (range: 7-9). The mean follow-up period was 10.4+/-3 months (range: 6-14 months) and the mean time to full epithelization was 14.5+/-3.4 days (range: 11-20 days). At postoperative days 1-2, the lower tear meniscus was reconstructed. There were no recurrences or any postoperative complications observed. CONCLUSIONS: Amniotic membrane transplantation after redundant conjunctival resection in conjunctivochalasis resulted in reconstruction of the lower tear meniscus with stable conjunctival surface and marked improvement of subjective symptoms. Operation time and early postoperative irritation symptoms could be reduced with the use of fibrin glue.

Optical Coherence Tomography and Multifocal Electroretinography in a Patient with Choroidal Osteoma

PURPOSE: We present a case of choroidal osteoma and report a pattern of optical coherence tomography and multifocal electroretinography with a literature review. CASE SUMMARY: Using B-scan and CT, we performed OCT and MF-ERG in a patient diagnosed with choroidal osteoma. OCT revealed serous retinal detachment in the macula and a thick, irregular plate-like structure with high reflectivity in the choroidal mass lesion. MF-ERG demonstrated that Trace arrays show suppression of central and peripheral signals, especially in central lesions. Ring averages show reduced amplitudes in all locations, and 3D-topography of the response density shows marked suppression of the central signal and no foveal peak in comparison with the unaffected left eye. CONCLUSIONS: In patients with choroidal osteoma, OCT can reveal thick plate-like high reflectivity with an irregular outer surface, and MF-ERG can predict retinal dysfunction.

The Usefulness of Rectified VEMP

OBJECTIVES: For a reliable interpretation of left-right difference in Vestibular evoked myogenic potential (VEMP), the amount of sternocleidomastoid muscle (SCM) contraction has to be considered. Therefore, we can ensure that a difference in amplitude between the right and left VEMPs on a patient is due to vestibular abnormality, not due to individual differences of tonic muscle activity, fatigue or improper position. We used rectification to normalize electromyograph (EMG) based on pre-stimulus EMG activity. This study was designed to evaluate and compare the effect of rectification in two conventional ways of SCM contraction. METHODS: Twenty-two normal subjects were included. Two methods were employed for SCM contraction in a subject. First, subjects were made to lie flat on their back, lifting the head off the table and turning to the opposite side. Secondly, subjects push with their jaw against the hand-held inflated cuff to generate cuff pressure of 40 mmHg. From the VEMP graphs, amplitude parameters and inter-aural difference ratio (IADR) were analyzed before and after EMG rectification. RESULTS: Before the rectification, the average IADR of the first method was not statistically different from that of the second method. The average IADRs from each method decreased in a rectified response, showing significant reduction in asymmetry ratio. The lowest average IADR could be obtained with the combination of both the first method and rectification. CONCLUSION: Rectified data show more reliable IADR and may help diagnose some vestibular disorders according to amplitude-associated parameters. The usage of rectification can be maximized with the proper SCM contraction method.