Effects of Particulate Matter Exposure on the Eustachian Tube and Middle Ear Mucosa of Rats

Objectives@#. Particulate matter (PM) is a risk factor for various diseases. Recent studies have established an association between otitis media (OM) and PM exposure. To confirm this relationship, we developed a novel exposure model designed to control the concentration of PM, and we observed the effects of PM exposure on the Eustachian tube (ET) and middle ear mucosa of rats. @*Methods@#. Forty healthy, 10-week-old, male Sprague-Dawley rats were divided into 3-day, 7-day, 14-day exposure, and control groups (each, n=10). The rats were exposed to incense smoke as the PM source for 3 hours per day. After exposure, bilateral ETs and mastoid bullae were harvested, and histopathological findings were compared using microscopy and transmission electron microscopy (TEM). The expression levels of interleukin (IL)-1β, IL-6, tumor necrosis factor-α, and vascular endothelial growth factor (VEGF) in the middle ear mucosa of each group were compared using real-time reverse transcription polymerase chain reaction (RT-PCR). @*Results@#. In the ET mucosa of the exposure group, the goblet cell count significantly increased after PM exposure (P=0.032). In the middle ear mucosa, subepithelial space thickening, increased angio-capillary tissue, and inflammatory cell infiltration were observed. Moreover, the thickness of the middle ear mucosa in the exposure groups increased compared to the control group (P<0.01). The TEM findings showed PM particles on the surface of the ET and middle ear mucosa, and RT-PCR revealed that messenger RNA (mRNA) expression of IL-1β significantly increased in the 3-day and 7-day exposure groups compared to the control group (P=0.035). VEGF expression significantly increased in the 7-day exposure group compared to the control and 3-day exposure groups (P<0.01). @*Conclusion@#. The ET and middle ear mucosa of rats showed histopathologic changes after acute exposure to PM that directly reached the ET and middle ear mucosa. Therefore, acute exposure to PM may play a role in the development of OM.

Surgical Result of Resection of Benign Neoplasm on the External Auditory Canal Using Transcanal Endoscopic Ear Surgery / 대한이비인후과학회지

Various benign neoplasms such as osteoma, cholesteatoma, and cartilaginous choristoma can occur in the external auditory canal. The treatment method for these benign neoplasms is surgical excision. Previously, surgery had been performed using a microscope, but recently, a transcanal endoscopic ear surgery (TEES) method has been attempted. As a surgical method, it provides a better surgical view, enables rapid recovery and reduces pain through a minimally invasive approach. In this article, we introduce this endoscopic removal surgical method for benign neoplasms of the external auditory canal and the usefulness of the method.

Transcanal Endoscopic Ear Surgery for The Management of Pediatric Perilymphatic Fistula Caused by Trauma / 대한이비인후과학회지

Perilymphatic fistula (PLF) is caused by leakage of perilymph through an abnormal communication between the inner and middle ear. Conservative treatment is considered in the initial stages; however, exploratory tympanotomy is performed if hearing does not improve or if dizziness persists. Transcanal endoscopic ear surgery (TEES) is considered an appropriate treatment option and is gaining popularity. We report a rare case of traumatic PLF in a 7-year-old male patient, in whom pneumolabyrinth without temporal bone fracture was diagnosed and treated by exploratory tympanotomy using TEES, and review the related research to discuss the usefulness of management using TEES for PLF.

Effect of Action Observation Physical Training for Chronic Stroke Patients on the Stairs Walking Ability and Self-Efficacy

Purpose@#This study examined the impacts of action observational physical training related to stair walking on the stair walking ability and self-efficacy of chronic stroke patients. @*Methods@#This study was conducted on 24 chronic stroke patients, who were assigned randomly to an action observational physical training group (12 persons) and a landscape observation physical training group (12 persons). To the action-observational physical training group, five videos related to stair walking were presented, and after observing them, physical training was carried out. The landscape observation physical training group observed the videos consisting of landscape, where there were no humans and animals, and then underwent physical training. This study measured the rectus femoris, biceps femoris, tibialis anterior, and gastrocnemius to examine the muscle activity of the lower limb. A timed up and go and step test was performed to examine the balance ability, and a timed stair test was conducted to examine their stair walking ability. A self-efficacy scale was measured to examine the degree of their confidence of performing stair walking. The assessment was conducted three times in total: pre-, post-, and follow-up surveys. @*Results@#As a result of this study, the action observational physical training group significant improvement after the intervention than in the landscape observation physical training group. Moreover, the follow-up study four weeks after the intervention showed significant improvements in the action observational physical training group (p<0.05). @*Conclusion@#These results show that the action observational physical training had a positive impact on the stair walking ability and self-efficacy of chronic stroke patients.

Effect of Action Observation Physical Training for Chronic Stroke Patients on the Stairs Walking Ability and Self-Efficacy

Purpose@#This study examined the impacts of action observational physical training related to stair walking on the stair walking ability and self-efficacy of chronic stroke patients. @*Methods@#This study was conducted on 24 chronic stroke patients, who were assigned randomly to an action observational physical training group (12 persons) and a landscape observation physical training group (12 persons). To the action-observational physical training group, five videos related to stair walking were presented, and after observing them, physical training was carried out. The landscape observation physical training group observed the videos consisting of landscape, where there were no humans and animals, and then underwent physical training. This study measured the rectus femoris, biceps femoris, tibialis anterior, and gastrocnemius to examine the muscle activity of the lower limb. A timed up and go and step test was performed to examine the balance ability, and a timed stair test was conducted to examine their stair walking ability. A self-efficacy scale was measured to examine the degree of their confidence of performing stair walking. The assessment was conducted three times in total: pre-, post-, and follow-up surveys. @*Results@#As a result of this study, the action observational physical training group significant improvement after the intervention than in the landscape observation physical training group. Moreover, the follow-up study four weeks after the intervention showed significant improvements in the action observational physical training group (p<0.05). @*Conclusion@#These results show that the action observational physical training had a positive impact on the stair walking ability and self-efficacy of chronic stroke patients.

Hearing Outcome According to the Intratympanic Steroid Injection Starting Timing in Combined Intratympanic and Oral Steroid Treatment for Idiopathic Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

Background and Objectives@#The combined intratympanic and oral steroid treatment has been accepted as effective treatment strategy for idiopathic sudden sensorineural hearing loss (ISSNHL). However, the treatment protocol of combined treatment for ISSNHL has not been established. In this study, we investigated whether hearing outcome differed according to different starting timing of intratympanic steroid injection (ITSI) in combined treatment for ISSNHL.Subjects and Method Tertiary academic referral center-based retrospective medical records of idiopathic 144 ISSNHL patients who received combined treatment from January 2015 to April 2018 were reviewed. All patients underwent a 2-week oral systemic steroid treatment and multiple ITSI. The hearing results of 3 months after treatment were compared according to the timing of ITSI. @*Results@#The mean pure tone audiogram gain was 24.3±23.6 dB. When Siegel’s criteria was applied, the overall rate of hearing improvement was 63.9% (92/144). The rate of hearing improvement was significantly higher in women (p=0.043) statistically, and there was a statistically significant lower rate of recovery in the former history of hearing loss (p＜0.01) or otitis media (p＜0.01). Moreover, the shorter the delay between symptom onset and initial ITSI, greater the statistical significance of hearing recovery rate became (p＜0.01). @*Conclusion@#The result of this study suggests that early ITSI during combined intratympanic and oral steroid treatment increases the chance of hearing recovery.

Development of a Korean-Type Qualitative Case History Tinnitus Questionnaire / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Qualitative and quantitative data of tinnitus are both important to obtain necessary information for assessing tinnitus evaluation. But contrary to quantitative questionnaire, qualitative data is not standardized in Korea. This study aimed to standardize the qualitative data of tinnitus by developing a Korean-type integrated qualitative tinnitus questionnaires. SUBJECTS AND METHOD: A cross-sectional survey of Korean otolaryngologists was performed. The questionnaires were administered to otologists who were registered as participants in the tinnitus study group of otology research interest group (ORIG). RESULTS: Most of the otologists (100% of responders) have used the quantitative tinnitus questionnaire measurement (90.5%), but only 76% have used qualitative tinnitus questionnaire. From the responses of otologists who regularly use qualitative questionnaire, 25 items were adopted from the 35 item list. Questionnaire items were selected according to the frequency of listed items in the individual lists. CONCLUSION: We made a qualitative questionnaire consisting of 25 items that were essential and widely accepted. We expect this work will integrate and standardize qualitative tinnitus questionnaires in Korea.

A Case of Osteoblastoma Accompanied with Concha Bullosa of the Inferior Turbinate / 대한이비인후과학회지

Osteoblastoma is a rare benign tumor, representing less than 1% of all bone tumors. Most cases occur in the vertebrae and in the long bones. Intranasal or paranasal osteoblastoma is particularly rare and only one case of osteoblastoma in the inferior turbinate has been reported in the world literature. Treatment is intralesional curettage or en bloc resection. Since the tumor is benign, conservative surgery is curative in about 80-90% of the cases. Concha bullosa is an abnormal pneumatization of the intranasal turbinates and inferior concha bullosa is a very rare condition. We report an unusual case of osteoblastoma occurring together with inferior concha bullosa. The tumor and inferior concha bullosa were removed by endoscopic submucosal inferior turbinoplasty, with favorable results. Related articles are reviewed and brief discussions are presented in regards to the case findings.

In vivo Evaluation of Human Embryonic Stem Cells Isolated by 57-C11 Monoclonal Antibody

BACKGROUND: The normal cells derived from human embryonic stem cells (hESCs) are regarded as substitutes for damaged or dysfunctional adult cells. However, tumorigenicity of hESCs remains a major challenge in clinical application of hESC-derived cell transplantation. Previously, we generated monoclonal antibody (MAb) 57-C11 specific to the surface molecule on undifferentiated hESCs. The aim of this study is to prove whether 57-C11-positive hESCs are pluripotent and tumorigenic in immunodeficient mice. METHODS: Undifferentiated hESCs were mixed with retinoic acid (RA)-differentiated hESCs at different ratios prior to 57-C11-mediated separation. To isolate 57-C11-positive hESCs from the mixture, biotinylated 57-C11 and streptavidin-coated magnetic beads were added to the mixture. Unbound 57-C11-negative hESCs were first isolated after applying magnet to the cell mixture, and 57-C11-bound hESCs were then released from the magnetic beads. In order to measure the efficiency of separation, 57-C11-positive or -negative hESCs were counted after isolation. To evaluate the efficiency of teratoma formation in vivo, 57-C11-positive or negative cells were further injected into left and right, respectively, testes of nonobese diabetic/severe combined immunodeficiency (NOD/SCID) mice. RESULTS: Approximately 77~100% of undifferentiated hESCs were isolated after applying 57-C11-coated magnetic beads to the mixed cell populations. Importantly, teratomas were not observed in NOD/SCID mice after the injection of isolated 57-C11-negative hESCs, whereas teratomas were observed with 57-C11-positive hESCs. CONCLUSION: 57-C11-positive hESCs are pluripotent and tumorigenic. The combination of 57-C11 and magnetic beads will be useful to eliminate remaining undifferentiated hESCs for the safe cell transplantation.

The Effect of Standing and Different Sitting Positions on Lumbar Lordosis: Radiographic Study of 30 Healthy Volunteers

STUDY DESIGN: Radiographic review of healthy volunteers. PURPOSE: To determine the ideal sitting positions by measuring changes in lumbar lordosis (LL) and pelvic parameters (PPs) in various positions. OVERVIEW OF LITERATURE: Prolonged sitting is generally accepted as an important risk factor for low back pain (LBP). It is now recognized that spinopelvic alignment is important for maintaining an energy-efficient posture. METHODS: Lateral spine radiographs of thrirty healthy volunteers (male participants) were taken in standing and five sitting positions. Radiographic measurement of LL and PPs was performed in each position. Statistical analysis was performed to identify a correlation between changes in the LL and PPs in each positions. RESULTS: LL in standing was 48.5degrees+/-8.7degrees. Sitting significantly decreased LL and segmental angle when compared with standing (p<0.05). The lower lumbar segmental angles (L4-5 and L5-S1) significantly decreased in all sitting positions (p<0.05), but the decrease was relatively less on the chair with lumbar support and in the 90degrees-angled chair. The sacral slope (SS) decreased and the pelvic tilt increased with decreasing LL in the sitting positions. CONCLUSIONS: Sitting causes a reduction in LL and SS when compared with standing. It might cause a spinopelvic imbalance and result in chronic LBP. Our study showed that sitting on a chair with back support induced minimal changes to LL. Consequently, it is proposed that sitting on a chair with back support would be a much more ideal position than sitting on other types of chairs.

Diagnosis and Current Trends of Medial Meniscus Posterior Root Tear / 대한정형외과학회잡지

Medial meniscal root tears with extrusion result in the loss of transmission of circumferential hoop stresses, leading to significantly increased tibiofemoral contact pressure and changes in knee biomechanics and kinematics. Therefore, medial meniscal root tears have attracted attention in recent years with regard to their early diagnosis. With the remarkable development of magnetic resonance imaging and arthroscopy, early diagnosis of medial meniscal root tears is on the rise. This report includes diagnosis and current trends of medial meniscal root tears.

Common Bleeding Sites of Posterior Epistaxis: Nasal Endoscopic Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Typically, posterior epistaxis means that the bleeding point cannot be visualized with anterior rhinoscopy, and it is difficult to find a localized bleeding point. Although bleeding point identification is the key to efficient management, debate and uncertainty remain around the actual location and distribution of the bleeding sites in posterior epistaxis. SUBJECTS AND METHOD: This study was designed to clarify bleeding points of the posterior epistaxis using nasal endoscopy. In 121 of the total 150 (80.7%) cases, we could see the posterior nasal cavity in more detail and find the bleeding point precisely. RESULTS: The most common sites of the bleeding were the posterior portion of the inferior meatus, the posterior portion of middle meatus, and the posterior septum medial to the middle turbinate in order of frequency. A total of 113 cases, corresponding to 93.4% (113/121), showed that epistaxis could be controlled very efficiently by electrocauterization and localized small packing with the help of endoscopes. In the majority of cases, non-surgical interventions were sufficient. CONCLUSION: Bleeding could be stopped more rapidly and with less discomfort if checking the 3 most common sites early.

A Case of Supernumerary Tooth in Tonsil / 대한이비인후과학회지

The supernumerary teeth mean excessive teeth that appear in addition to the regular number of teeth and occur in a wide variety of sites. Mesiodens, which is a malformed, peg like tooth that occurs between the maxillary central incisor is most common. The next common site is the fourth molar and lateral incisors. Tonsil as a site of supernumerary teeth is rare, however, we experienced one such case of an ectopic supernumerary tooth embedded in tonsil.

Non Blood Transfusion Limb Salvage Operation in the Distal Femur Osteosarcoma Patient: A Case Report / 대한골관절종양학회지

Limb salvage operations for osteosarcoma of the extremity usually consist of wide excision and skeletal reconstruction. Most osteosarcoma patients are anemic prior to the surgery as majority of them undergo preoperative neo-adjuvant chemotherapy; thus, it is necessary to treat anemia before and after the surgery since limb salvage operation tends to accompany significant blood loss. Despite the fact that blood transfusion has bad influence on prognosis, complication, and postoperative outcome of cancer patients, it is still considered as a standard management to fix anemia for limb salvage operations. We would like to present a case report in which the authors succeeded in performing limb salvage operations on patients with distal femur osteosarcoma without transfusion.

Comparative Analysis for the Surgical Outcomes of Uvulopalatal Flap and Palatal Muscle Resection in Patients with Obstructive Sleep Apnea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study was to compare the surgical outcomes of uvulopalatal flap (UPF) and palatal muscle resection (PMR) techniques in the treatment of obstructive sleep apnea (OSA). SUBJECTS AND METHOD: Forty-three consecutive patients (40 men and 3 women) with OSA were included. Only patients with Fujita type I obstruction were enrolled in this study. Patients with macroglossia or retrognathia were excluded from the study. Twenty patients underwent a UPF and twenty-three patients underwent a PMR. In both groups, nasal surgery was performed if necessary. Questionnaires based on Visual Analogue Scale (VAS) about snoring, apnea, morning headache, tiredness, daytime sleepiness and Epworth Sleepiness Scale (ESS) were analyzed before and after each surgical treatment. Preoperative and postoperative polysomnography (PSG) were completed by every patient. RESULTS: In UPF group, every aspect of VAS except morning headache was significantly improved after surgery. In PMR group, every aspect of VAS and ESS were significantly improved after surgery. Comparing the surgical outcomes between two groups, every VAS and ESS showed much better result in PMR than UPF group. In both UPF and PMR group, the mean apnea-hypopnea index decreased significantly after surgery. However, there's no significant difference between two groups in the PSG findings. CONCLUSION: PMR could be a better surgical technique than UPF with respect to subjective outcome although both UPF and PMR are effective surgical techniques for the treatment of OSA with Fujita type I obstruction.

A Case of Granular Cell Tumor of Postauricular Area / 대한이비인후과학회지

Granular cell tumor (GCT) is a relatively rare tumor. GCT can originate from any site of human body, including subcutaneous tissue, skin, breast, digestive system and respiratory system. It occurs mostly in the head and neck region, especially in the oral cavity and tongue. Histopathologically, GCT consists of polymorphic and polygonal cells. The cytoplasm of cells has abundant eosinophilic granules. In immunohistochemical studies, these eosinophilic granules appear positive for S-100 protein. Surgical excision is the first choice of treatment of GCT; recurrence is rare when proper excision is done with a sufficient margin. We have experienced a case of GCT that originated from the postauricular area, and report this case with a review of literatures.

A Case of Primary Olfactory Neuroblastoma of the Sphenoid Sinus

Olfactory neuroblastoma is a rare malignant tumor of the nasal cavity arising from the olfactory neuroepithelium. It usually present as a polypoid mass in the superior nasal cavity including the cribriform plate, superior turbinate, and superior portion of nasal septum. The development of olfactory neuroblastoma outside of the region, in which olfactory epithelium exists, is exceedingly rare. In this report, we present an interesting case of an isolated sphenoid sinus olfactory neuroblastoma with a brief review of the literature.

Tracheal Intubation using Remifentanil and No Muscle Relaxants: the Effect of Thiopental, Propofol, or Etomidate on Tracheal Intubating Conditions and Hemodynamic Changes / 대한마취과학회지

BACKGROUND: Many studies have suggested that propofol in combination with remifentanil may provide adequate conditions for tracheal intubation without the use of muscle relaxants. Other hypnotic drugs have not been thoroughly investigated in this regard. The goal of our study was to evaluate the effect of thiopental, propofol or etomidate on tracheal intubating conditions and hemodynamic changes using remifentanil in the absence of muscle relaxants. METHODS: A total of 45 healthy adults were divided randomly into three groups. After iv lidocaine 1.5 mg/kg, thiopental 5 mg/kg (thiopental group) or propofol 2.5 mg/kg (propofol group), or etomidate 0.4 mg/kg (etomidate group) were injected. After the injection of study drugs, remifentanil 2 mcg/kg was administered. Ninety seconds after the administration of remifentanil, laryngoscopy and intubation were attempted. Intubating conditions were assessed and the mean arterial pressure and the heart rate was measured. RESULTS: There were no significant differences in intubating conditions between patients in the three groups. The heart rate was significantly lower in the propofol and etomidate group patients when compared to the thiopental group patients after anesthetic induction. The mean arterial pressure was significantly lower in the propofol group patients when compared to the thiopental and etomidate group patients. Both heart rate and mean arterial pressure after tracheal intubation were significantly elevated in etomidate group patinets when compared to their preintubation value. CONCLUSIONS: The use of thiopental 5 mg/kg, propofol 2.5 mg/kg, and etomidate 0.4 mg/kg did not differ in effect under intubating conditions for tracheal intubation using remifentanil in the absence of muscle relaxants. Thiopental provided the best hemodynamic conditions.

Spinal Anesthesia of a Patient with Brugada Syndrome: A case report / 대한마취과학회지

Brugada syndrome is an arrhythmic syndrome characterized by right bundle branch block, ST segment elevation in the precordial lead (V1-3), and sudden death caused by ventricular fibrillation, but with no evidence of an underlying structural heart disease. We report one case of spinal anesthesia for an appendectomy in a 44-year-old male patient diagnosed as having Brugada syndrome by characteristic ECG findings without untoward cardiovascular events.

Massive Subcutaneous Emphysema and Hypercarbia during Endoscopic Thyroidectomy: A case report / 대한마취과학회지

Endoscopic thyroidectomy is being performed increasingly, because it is less invasive and more cosmetically advantageous, and thus improves the postoperative quality of life. However, the technical aspects of this procedure can increase the risk of certain complications, which include subcutaneous emphysema, hypercarbia, pneumothorax, and pneumomediastinum. This report describes the case of a 37-year-old female patient who had subcutaneous emphysema and hypercarbia due to increased carbon dioxide absorption during endoscopic thyroidectomy. After increasing minute ventilation, paying cautious attention to signs of other complications, the operation proceeded and blood gas findings improved. The operation ended successfully and she showed no further problems.