Protrusion of Implant after Surgical Wall Reconstruction due to Temporomandibular Joint Herniation / 대한이비인후과학회지

Herniation of the temporomandibular joint (TMJ) into the external auditory canal is rare as TMJ and external auditory canal are separated by an anterior bony wall of external auditory canal. The bony defect of the anterior external auditory canal can be caused by trauma, otologic procedure, neoplasm, inflammation and a rare congenital bony defect. Conservative treatment is available if the severity of the symptom is mild or asymptomatic. However, surgical procedure is considered if the patient experiences severe distress. There have been no reported cases of surgical-related complications and recurrence during postoperative follow-up period. Herein we report the very first case of foreign body prolapse involving herniation from TMJ extending into the external auditory canal.

A Case of Squamous Cell Carcinoma in Situ Occurredin the External Auditory Canal / 대한이비인후과학회지

Primary malignant lesions in the external auditory canal are rare. While squamous cell carcinoma is the most common of these lesions, there are also basal cell carcinoma, malignant melanoma and adenocarcinoma, etc. However, squamous cell carcinoma in situ of the external auditory canal is extremely rare since its first report in the English literature in 1953 and has not been reported in Korea. Its clinical manifestations are very similar to chronic ear disease. For treatment, local wide resection of the lesions is preferred. We recently encountered a 54-year-old female, who presented with intermittent irritating sensation in the external auditory canal. Otoscopic examination showed a scaly plaque with the irregular surface on the anteroinferior portion of the left external auditory canal. Excisional biopsy revealed a squamous cell carcinoma in situ. We report this very rare and unique case with a literature review.

Losartan Prevents Maladaptive Auditory-Somatosensory Plasticity After Hearing Loss via Transforming Growth Factor-β Signaling Suppression

OBJECTIVES: Hearing loss disrupts the balance of auditory-somatosensory inputs in the cochlear nucleus (CN) of the brainstem, which has been suggested to be a mechanism of tinnitus. This disruption results from maladaptive auditory-somatosensory plasticity, which is a form of axonal sprouting. Axonal sprouting is promoted by transforming growth factor (TGF)-β signaling, which can be inhibited by losartan. We investigated whether losartan prevents maladaptive auditory-somatosensory plasticity after hearing loss. METHODS: The study consisted of two stages: determining the time course of auditory-somatosensory plasticity following hearing loss and preventing auditory-somatosensory plasticity using losartan. In the first stage, rats were randomly divided into two groups: a control group that underwent a sham operation and a deaf group that underwent cochlea ablation on the left side. CNs were harvested 1 and 2 weeks after surgery. In the second stage, rats were randomly divided into either a saline group that underwent cochlear ablation on the left side and received normal saline or a losartan group that underwent cochlear ablation on the left side and received losartan. CNs were harvested 2 weeks after surgery. Hearing was estimated with auditory brainstem responses (ABRs). Western blotting was performed for vesicular glutamate transporter 1 (VGLUT1), reflecting auditory input; vesicular glutamate transporter 2 (VGLUT2), reflecting somatosensory input; growth-associated protein 43 (GAP-43), reflecting axonal sprouting; and p-Smad2/3. RESULTS: Baseline ABR thresholds before surgery ranged from 20 to 35 dB sound pressure level. After cochlear ablation, ABR thresholds were higher than 80 dB. In the first experiment, VGLUT2/VGLUT1 ratios did not differ significantly between the control and deaf groups 1 week after surgery. At 2 weeks after surgery, the deaf group had a significantly higher VGLUT2/VGLUT1 ratio compared to the control group. In the second experiment, the losartan group had a significantly lower VGLUT2/VGLUT1 ratio along with significantly lower p-Smad3 and GAP-43 levels compared to the saline group. CONCLUSION: Losartan might prevent axonal sprouting after hearing loss by blocking TGF-β signaling thereby preventing maladaptive auditory-somatosensory plasticity.

Bilateral Hearing Loss in Wernicke Encephalopathy

Wernicke encephalopathy is a syndrome caused by thiamine deficiency whose three typical symptoms are ophthalomoplegia, ataxia, and confusion. There are also rare reports of bilateral hearing loss, which can be caused by damage to the bilateral inferior colliculus or thalamic lesions, or by energy failure of the cochlea. This case suggests that thiamine should be administered based on the possibility of Wernicke encephalopathy occurring in malnourished or alcoholic patients with sudden bilateral hearing loss.

A Case of Epidermal Cyst Occurred in the Bony External Auditory Canal Misdiagnosed as External Auditory Canal Carcinoma / 대한이비인후과학회지

Epidermal cysts are generally benign tumors that usually originate from the skin caused by inflammation of hair cortex and proliferation of epidermal cells within the dermis; however, for these cysts to occur in the bony external auditory canal (EAC) is rare. They are often present as a solitary, painless lesion and usually asymptomatic and the diagnosis depends on the results of the histological examination. In treatment, the cyst wall must be completely removed surgically. We recently encountered a 82-year-old male with a mass in the right EAC. An otoscopic examination showed a polypoid mass on the bony EAC, which was finally diagnosed as epidermal cyst after an initial misdiagnosis as EAC carcinoma. We report the rare, unique case with literature review.

Comparison of the Effects of Middle Ear Implants and Conventional Hearing Aids on Cognitive Function / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The association between hearing impairment and cognitive function has been established in previous studies. The aim of this study was to compare the effects of conventional hearing aids and middle ear implants on cognitive function. SUBJECTS AND METHOD: This study included 22 participants who underwent middle ear implantation between October 2013 and September 2016. Their mean age at surgery was 70 years. Using Pure tone audiometry (PTA), the Speech discrimination test (SDT), and the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire, we compared audiologic benefits of three conditions [without hearing aids, with conventional hearing aids, or with Vibrant Sound bridge (VSB)]. Cognitive ability was evaluated using neuropsychological testings (Seoul Neuropsychological Screening Battery) at intervals of approximately eight weeks. RESULTS: The results of PTA showed a 7.96 dB HL gain with conventional hearing aids and a 10.00 dB HL gain with the use of VSB. SDT results showed a 4.10% gain with conventional hearing aids and a 10% gain with the use of VSB. Results of the APHAB questionnaire showed a significant increase with the use of VSB compared to conventional hearing aids. In the Korean Mini-Mental State Examination, a slight improvement was observed after middle ear implantation. In the Digit Span Test and Korean-Boston Naming Test, a significant improvement was seen with the use of VSB compared to conventional hearing aids. CONCLUSION: The use of middle ear implants in rehabilitation of hearing communication in patients showed improvements in cognitive abilities, compared to the use of conventional hearing aids.

Unilateral Sudden Deafness Accompanied by Short Circumferential Pontine Artery Territorial Infarction

No abstract available.

Factors Affecting Stigma Resistance in Patients with Bipolar Disorder / 신경정신의학

OBJECTIVES: Stigma resistance is an individual capacity to fight the stigma of mental illness and is an issue of ongoing research regarding the stigma. The aim of this study was to evaluate predictors of stigma resistance in patients with bipolar disorder. METHODS: Demographic, clinical, and psychosocial data were collected from 102 bipolar patients in a university mental hospital. Stigma resistance was measured using a subscale of the Internalized Stigma of Mental Illness Scale. Patients completed self-reported questionnaires including items on self-esteem, hopelessness, social support, and social conflict. RESULTS: Stigma resistance showed positive association with functioning, self-esteem, and social support, and showed negative association with depressive symptoms, hopelessness, and social conflict. In multivariate analysis, stigma resistance was predicted by sex, education, and self-esteem. Self-esteem was the strongest predictive factor of stigma resistance. CONCLUSION: In accordance with previous studies, self-esteem was a central role of predicting stigma resistance. A program for improving self-esteem and its related psychosocial factors will be helpful to enhancing stigma resistance in bipolar patients.

Two Cases of Fungus Ball in Bilateral Paranasal Sinuses / 대한이비인후과학회지

Fungus ball of the paranasal sinuses is usually found in only one sinus, most frequently in the maxillary sinus. It may produce symptoms of chronic rhinosinusitis, such as purulent rhinorrhea, nasal obstruction, headaches, and sensation of pressure. However, cases involving bilateral paranasal sinuses are rarely reported. Herein we report two cases of fungus ball in bilateral paranasal sinuses with a review of this disease entity.

Change of Psychological Characteristics after Joining the Army According to Internet Addiction Tendency in Young Male Army Recruits

OBJECTIVES: The aim of this study was to find out the psychological changes associated with internet addiction between before and after the military drill among the young male army recruits. METHODS: All 1091 participants were army recruits aged from 19 to 22 years who participated in the 5-week military drill. They were assessed with some self-reported questionnaires [Sociodemographic questionnaires, Young's Internet Addiction Scale (IAS), the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory (BDI), the Barratt Impulsiveness Scale (BIS), the Attention-Deficit/Hyperactivity Disorder Self-Rated Scale (ASRS)]. They were divided into two groups, One is the internet addiction tendency group and the other is non-addiction group according to the IAS score. And the severity of the internet addiction tendency, depression, anxiety and impulsiveness were evaluated by the IAS, the STAI, the BDI, the BIS, the ASRS before and after military drill. RESULTS: The result of the paired t-test shows that the IAS, the STAI, the BDI, the BIS, the ASRS scores decreased after military drill in both non-addiction group and internet addiction tendency group. The result of the repeated measures ANOVA shows that there is an interaction effect between the changes of ASRS-hyperactivity (F = 23.437, p < 0.001), ASRS-impulsiveness (F = 4.896, p = 0.027), BIS-total (F = 4.057, p = 0.044), BIS-motor impulsiveness (F = 13.609, p < 0.001) scores and groups. The result of the generalized estimating equation shows that internet addiction tendency is associated with ASRS-inattention (beta = 0.075, p < 0.001), ASRS-hyperactivity (beta = 0.092, p = 0.002), STAI-trait anxiety (beta = 0.046, p < 0.001), BIS-motor impulsiveness (beta = 0.119, p = 0.028). CONCLUSIONS: The results show that psychopathologies such as internet addiction tendency, depression, anxiety, impulsiveness may improve after military drill regardless of the groups. Internet addiction tendency may be related to the ASRS-inattention, ASRS-hyperactivity, STAI-trait anxiety, motor-impulsiveness. So these findings may be considered in the treatment of internet addiction in terms of the impulsiveness control.

Anatomical Characteristics through Computed Tomography Analysis in Patients Undergoing Revision Endoscopic Sinus Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the non-dissected anatomic structures and abnormal computed tomographic findings that contribute to the recurrence of chronic rhinosinusitis (CRS) or the trail of revision endoscopic sinus surgery (ESS). SUBJECTS AND METHOD: The medical records of 34 subjects who were diagnosed with recurrent chronic rhinosinusitis, and required to undergo revision endoscopic sinus surgery were collected retrospectively. The subjects' computed tomography results were examined by a radiology specialist. RESULTS: The most common anatomic factors associated with the revision ESS for recurrence of CRS or retained inflammation were residual uncinate process (47.0%) and residual anterior ethmoidal cells followed by undissected posterior ethmoidal cells (38.2%) and obstructed sphenoid sinus ostium (32.3%). In addition, the uncorrected septal deviation, retained agger nasi cells or Haller cells and lateralized middle turbinate were also identified in the patients. CONCLUSION: From these data, we analyzed anatomical structures and CT findings related to the failure of primary ESS. We suggest that careful attention be given to these structures after primary ESS so as to reduce the failure rate and increase successful outcomes.

Antipsychotic Polypharmacy in the Treatment of Patients with Related Psychoses at a University Hospital / 대한정신약물학회지

OBJECTIVE: The practice of antipsychotic polypharmacy is common, despite lack of supporting evidence. The aims of this study were to estimate the prevalence of antipsychotic polypharmacy in a psychiatric university hospital in Korea and find out the clinical factors associated with antipsychotic polypharmacy. METHODS: We reviewed medical records of the patients discharged from Severance Mental Health Hospital (SMH) for the period of 1, January to 31, December 2010. Patients should be diagnosed as having schizophrenia, schizoaffective disorder, schizophreniform disorder, brief psychotic disorder, delusional disorder or psychotic disorder not otherwise specified. RESULTS: In 2010, 260 patients in SMH were prescribed with antipsychotics and 47.3% (n=123) of them were discharged under antipsychotic polypharmacy treatment. The most commonly prescribed antipsychotics for combination therapy was quetiapine (n=64). The most prevalent combination of drugs was risperidone plus quetiapine (n=20). Logistic regression analysis showed that the use of high-dose antipsychotics, first-generation antipsychotics, and long hospital duration were significantly associated with antipsychotic polypharmacy. CONCLUSION: Although the controlled evidence for efficacy and safety as a strategy remains inconclusive, antipsychotic polypharmacy is a common pharmacological strategy as it is illustrated in our study. Considering high antipsychotic doses related with antipsychotic polypharmacy, careful monitoring of side effect and efficacy is needed.

Pros and Cons of Various Research Designs in Clinical Psychiatry

An appropriate research design for hypotheses and purposes leads to a good quality of research results. In this review article, we summarized the types of research methods and described the characteristics of clinical trials. Research designs are categorized into observational studies and experimental ones, depending on data collecting methods. In an observational study, there are cross-sectional, cohort and case-control studies. Parallel groups design and crossover trial studies are representative designs in a randomized controlled trial study, a kind of experimental study. Clinical researchers should understand the characteristics of clinical research designs including advantages and disadvantages and choose the suitable design according to their study purposes and the nature of collected data or subjects.

Autobiographical Memory in Patients with Bipolar Disorder

OBJECTIVES: Autobiographical memory (ABM) is a special type of episodic memory, containing events that have occurred in a personal life. Overgeneral tendency of ABM refers to the retrieval of memory with only general and categorical descriptions rather than specific events. ABM specificity in depression and posttraumatic stress disorder is a robust finding with relation to cognitive vulnerability, affect regulation, problem-solving ability. It is also implicated in bipolar disorder with frequent relapses. In this study, we investigated whether ABM specificity was related to manic or euthymic mood states in patients with bipolar disorder. METHODS: Forty bipolar patients with manic and euthymic episodes and 25 healthy controls participated in this study. Prompted by 5 positively and 5 negatively valenced emotional cue words, each participant was instructed to recall positive or negative memories and describe them in detail. The one-way ANOVA was used to compare ABM scores and post-hoc analyses were done. RESULTS: Comapred to the healthy persons, the bipolar patients reported significantly more general than specific negative memories in both manic and euthymic episodes (p = 0.003). However, there was no significant difference between manic and euthymic patients (p = 0.074). CONCLUSIONS: These results suggest that overgeneral tendency of negative ABM may be a trait abnormality in bipolar disorder. Moreover, this phenomenon might be related to underlying cognitive deficits or affect regulation irrespective of the mood state.

Association of the Brain-derived Neurotrophic Factor Gene and Clinical Features of Bipolar Disorder in Korea

OBJECTIVE: Brain-derived neurotrophic factor (BDNF) plays an important role in cell survival, differentiation, and cell death as well as in neural plasticity. Recent studies have suggested that BDNF is involved in the pathogenesis of bipolar disorder. The aim of this study was to investigate the association of the genetic variations of the BDNF gene with bipolar disorder in Korea. We also studied the possible association of these genetic variants with clinical features. METHODS: The allelic and genotypic distributions of Val66Met polymorphism of the BDNF gene were analyzed using a polymerase chain reaction-based method in 184 bipolar patients and 214 controls. Analysis was performed to investigate an association of the Val66Met polymorphism of the BDNF gene and the clinical features in bipolar patients. RESULTS: No significant difference was found between bipolar patients and controls in the genotype and allele frequencies for the investigated BDNF polymorphism. However, the age of onset of bipolar disorder among the Val/Val (25.57), Val/Met (30.42) and Met/Met (32.45) genotype groups were significantly different (p=0.037). CONCLUSION: This study suggests that Val66Met polymorphisms are unlikely to contribution to the genetic predisposition to bipolar disorder as a whole. But Val66Met polymorphism may be associated with age of onset of the disorder, further studies designed to investigate the relationship in a larger population may be warranted.

Reward Learning in Euthymic Patients with Bipolar Disorder Using a Probabilistic Reward Task / 대한정신약물학회지

OBJECTIVE: Bipolar disorder patients often show excessive goal-directed and pleasure-seeking behavior during manic episodes and reduced hedonic capacity during depressive episodes, indicating that bipolar disorder might involve altered reward processing. As such, bipolar disorder subjects have been reported to show impaired reward learning in situations requiring integration of reinforcements over time. In this study, we examined characteristics of reward learning in euthymic patients with bipolar disorder using a probabilistic reward task. METHODS: We recruited 23 euthymic patients with bipolar disorder and 47 healthy subjects for the probabilistic reward task. This task is a reward-based paradigm to produce a response bias, in which correct identifications of two ambiguous stimuli are differently rewarded. The other dependent measures were the discriminability, hit rate and reaction time. RESULTS: Relative to comparison subjects, bipolar patients showed a reduced acquisition of response bias toward the more frequently rewarded stimulus (p<0.01). The overall reward learning was positively correlated with state and trait anxiety levels in bipolar patients (p<0.01). No significant differences of discriminability, hit rates, and reaction time were found between bipolar patients and controls. CONCLUSION: These findings suggest that euthymic patients with bipolar disorder may have deficits in reward learning related to anxiety.

A Case of Bilateral Postauricular Sinuses

Preauricular sinuses are common congenital malformations that usually occur at the anterior margin of the ascending limb of the helix. There are rare cases in which the location of the preauricular sinus is posterior to the tragus, and the direction of the sinus tract is toward the posterior. This variant type of preauricular sinus is called, 'postauricular sinus'. Postauricular sinus is uncommon. Thus, diagnosis and treatment may be delayed due to its location of its opening and atypical clinical symptoms. Typical treatment is a single stage operation through bidirectional skin incision. However, we found out that according to the length and invasion depth of the sinus tract, there was an option between unidirectional and bidirectional skin incisions that we may choose from.

Verbal and Visual Memory Impairments in Bipolar I and II Disorder

OBJECTIVE: To compare verbal and visual memory performances between patients with bipolar I disorder (BD I) and patients with bipolar II disorder (BD II) and to determine whether memory deficits were mediated by impaired organizational strategies. METHODS: Performances on the Korean-California Verbal Learning Test (K-CVLT) and the Rey-Osterrieth Complex Figure Test (ROCF) in 37 patients with BD I, 46 patients with BD II and 42 healthy subjects were compared. Mediating effects of impaired organization strategies on poor delayed recall was tested by comparing direct and mediated models using multiple regression analysis. RESULTS: Both patients groups recalled fewer words and figure components and showed lower Semantic Clustering compared to controls. Verbal memory impairment was partly mediated by difficulties in Semantic Clustering in both subtypes, whereas the mediating effect of Organization deficit on the visual memory impairment was present only in BD I. In all mediated models, group differences in delayed recall remained significant. CONCLUSION: Our findings suggest that memory impairment may be one of the fundamental cognitive deficits in bipolar disorders and that executive dysfunctions can exert an additional influence on memory impairments.

Clinical Case Conference / 신경정신의학

No abstract available.

Initial Depressive Episodes Affect the Risk of Suicide Attempts in Korean Patients with Bipolar Disorder

PURPOSE: Suicide is a major concern for increasing mortality in bipolar patients, but risk factors for suicide in bipolar disorder remain complex, including Korean patients. Medical records of bipolar patients were retrospectively reviewed to detect significant clinical characteristics associated with suicide attempts. MATERIALS AND METHODS: A total of 579 medical records were retrospectively reviewed. Bipolar patients were divided into two groups with the presence of a history of suicide attempts. We compared demographic characteristics and clinical features between the two groups using an analysis of covariance and chi-square tests. Finally, logistic regression was performed to evaluate significant risk factors associated with suicide attempts in bipolar disorder. RESULTS: The prevalence of suicide attempt was 13.1% in our patient group. The presence of a depressive first episode was significantly different between attempters and nonattempters. Logistic regression analysis revealed that depressive first episodes and bipolar II disorder were significantly associated with suicide attempts in those patients. CONCLUSION: Clinicians should consider the polarity of the first mood episode when evaluating suicide risk in bipolar patients. This study has some limitations as a retrospective study and further studies with a prospective design are needed to replicate and evaluate risk factors for suicide in patients with bipolar disorder.