The Relationship between Subjective Ocular Discomfort and Blepharitis Severity in Dry Eye Patients

PURPOSE: Although a number of clinical parameters are well known to affect dry eye (DE) disease, it is unknown which factor mostly affects the discomfort of DE. Blepharitis is recognized as one of the leading causes of evaporative-type DE disease, but there have been no large-scale study to investigate the effect of blepharitis on DE symptoms. The purpose of this study was to evaluate the factors influencing subjective ocular discomfort in DE patients with blepharitis and to determine which parameter is most highly related to severity of blepharitis. METHODS: This investigation was a cross-sectional, clinical study. The test population consisted of DE patients suffering from moderate blepharitis. Seventy-three subjects aged 22 to 81 years (mean age 56.36) were enrolled, 49 of whom completed the investigation on a total of 49 eyes. A detailed assessment was conducted, including history taking, visual analog scale (VAS) pain scoring, ocular surface disease index (OSDI) questionnaire, blepharitis severity grading (score 0-4), conjunctival, corneal fluorescein staining (score 0-4), and tear break up time (TBUT) assessment. RESULTS: The results revealed significant correlations between subjective symptoms and blepharitis severity. Significant increases in overall VAS score, OSDI score (p = 0.031, p = 0.006) were recorded in DE patients with severe blepharitis. Conjunctival erosion was significantly related to VAS score (p = 0.016). Other parameters were not significantly related with VAS and OSDI scores. Additionally, conjunctival erosion was related with blepharitis severity (p < 0.0001), and corneal erosion was not correlated with blepharitis severity. TBUT also did not show any statistical correlation with blepharitis. CONCLUSIONS: Our results showed that blepharitis severity is the main factor influencing subjective pain and discomfort in DE patients, although blepharitis severity was not related with the known clinical parameters of DE such as corneal erosion and TBUT. This study indicates that targeting treatment for blepharitis can significantly improve quality of life for patients suffering from DE disease.

Result of Intracapsular Partial Tonsillectomy Using CO2 Laser and Radiofrequency for Treatment of Tonsillolith / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Among the treatment methods used for tonsilloliths, tonsillectomy has a high cure rate but also the disadvantage of adverse effects that include severe postoperative pain and relatively frequent postoperative bleeding. In contrast, CO2 laser cryptolysis causes less pain and bleeding, but also has the disadvantage of the occasional requirement for additional operations. To identify a tonsillolith treatment method that would cause less pain and bleeding as well as decreased rate of recurrence, we used intracapsular partial tonsillectomy under local anesthesia for the treatment of tonsillolith and analyzed the results. SUBJECTS AND METHOD: The subjects were 82 tonsillolith patients who had undergone intracapsular partial tonsillectomy with radiofrequency and CO2 laser under local anesthesia between October 2011 and March 2012. RESULTS: Tonsilloliths were commonly found in the upper half of palatine tonsil. When selective partial tonsillectomy was performed on the area where the tonsillolith had occurred, a 92.7% success rate was obtained with just a single operation. Postoperative bleeding that needed treatment occurred in 1.2% of the patients. In the case of postoperative pain, moderate pain was most common with significant differences in intensity depending on the depth of the crypt and the extent of the operated area. CONCLUSION: Good results were achieved by treating tonsillolith with intracapsular partial tonsillectomy, utilizing CO2 laser and radiofrequency under local anesthesia, which selectively removed the crypt where the tonsillolith occurred.

Tinnitus Masking Effects Using Various Kinds of Sound and Music / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Even though various methods have been tried to diagnose and treat tinnitus, researchers have fallen short of providing the accurate characteristics since most tinnitus are presented as a subjective symptom. A few researchers have tried to assimilate tinnitus using computer and music synthesizers, however, their efforts have not yet been developed as generalized treatment modalities. In this study, we attempted to induce not only tinnitus masking but also psychological stability with various kinds of sound and music and to analyse its treatment effects. The aim of this study is to make a step toward developing tinnitus treatment. MAERIALS AND METHODS: The subjects were 28 patients with constant tinnitus, who visited the otolaryngology department of Seoul Paik Hospital, Medical College of Inje University from June to December of 1997. We tried to objectify the tinnitus as close to the actual sound as possible by synthesizing the modulation of the broad band noises and recording not only the existing pure tones and broad band noises but also the natural and artificial sounds which the patients could easily hear from their surroundings. And then we tried to mask tinitus with various natural, artificial and synthetic sounds, including its frequency band. We also let them hear the tapes for contemplation and various music. RESULTS: The results were as follows. 1) As for the quality of tinnitus, 13 patients reported similarity to the pure tone (46.4%), seven to narrow band noise (25%), eight to natural environmental sounds (21.4%), one each to artificial environmental sound and white noise (3.6%) and no one to synthetic sound. 2) The sound that masked tinnitus well was three octave broad band noise including the tinnitus frequency. 3) Twenty four patients (85.7%) chose music as the most comfortable sound to listen to. 4) Three patients (10.7%) replied that their tinnitus were decreased in amplitude and 15 patients (53.6%) reported that it was easier to stand the tinnitus even though their tinnitus persisted. CONCLUSION: Based on these results, it can be concluded that music therapy provides psycological stability in addtion to inducing masking effect, even though it can't directly decrease nor completely remove tinnitus. Thus we believe that a more effective result can be obtained if music therapy is implemented on a gradual basis as a part of the whole treatment process.

Three Cases of Fungal Sinusitis with Orbital Complication / 대한이비인후과학회지

The most commonly involves observed in the fungal infection of sinus is the maxillary sinus, followed by ethmoid sinus. On the other hand, sphenoid sinus is only occasionally affected. In the sphenoidal fungal sinusitis, however, its complication may cause fatal outcome when the adjacent vital structures are involveed. The orbital involvement of invasive fungal sinusitis has been rarely reported, which may occur via the direct spread of invasive disease or through the communicating veins despite intact sinus walls. The invasive fungal sinusitis needs aggressive therapy, including endoscopic sinus surgery. But, when there is evidence of spread to the adjacent structure, adjuvant antifungal chemotherapy can be used. We recently experienced three cases of fungal sinusitis with orbital complication. The first case was limited to the left sphenoid sinus and treated with surgery. Adjuvant antifungal chemotherapy was tried but discontinued due to poor general condition. The other two cases involved the ethmoid and sphenoid sinus have been treated with surgery and adequate antifungal chemotherapy. The orbital complication in the first case was improved, but the patient died after 3 months due to poor gerneral condition. In the other two cases, patients completely recovered from fungal sinusitis and the orbital complication.

A Case of Jugular Bulb Diverticulum Accompanied with Pulsatile Tinnitus / 대한이비인후과학회지

Pulsatile tinnitus is perceived as sounds that vary in frequency, intensity and duration. It is also characterised by its unique feature of rhythmicity that is synchronous with the human pulse. Clinically, it is a serious disorder because it is associated with other life threatening or curable diseases. Pulsatile tinnitus may originate from several sites including the arterial, arteriovenous, venous vessels and the myoclonus. Jugular bulb diverticulum, one of the causes of venous pulsatile tinnitus, is observed as a protrusion of the jugular vein lumen with a waist like margin. It may extend either laterally in the tympanic cavity or medially towards the petrous pyramid close to the inner ear. This leads to pulsatile tinnitus, sensorineural or conductive hearing loss and vertigo. In this paper we report a recent case in which we confirmed jugular bulb diverticulum in a 59 years-old woman whose complaint of pulsatile tinnitus was spontaneously disappeared during the follow up.

Comparative Analysis on Anatomical Measurements of Paranasal Sinuses Using Nasal Endoscope and CT / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is rare to find any studies reporting on the practical measurements of landmarks in the paranasal sinuses that are done intraoperatively as well as comparative analysis on the anatomical and radiological measurements of the paranasal sinuses. The aim of this study was to analyze the anatomical measurements of the paranasal sinuses using nasal endoscope and CT scout films to determine the statistical significance. MATERIALS AND METHODS: In 130 patients the authors used bayonet forceps and seekers to measure the distances from the anterior nares to some of the intranasal structures, such as the uncinate process, bulla ethmoidalis, basal lamella, maxillary ostium, posterior wall of ethmoid sinus, anterior wall of sphenoid sinus and posterior wall of sphenoid sinus. Then, using the CT scout films, we measured the distances between the anterior nasal spine and the basal lamella (B.L.), the anterior wall of sphenoid sinus (A.W.S.), and the posterior wall of sphenoid sinus (P.W.S.). We analyzed the mean values of the basal lamella, the anterior and posterior wall of sphenoid sinus from all the available data in order to compare the endoscopic and radiologic measurements, and carried out a paired t-test. RESULTS: There was a statistically significant discrepancy in the comparative analysis of the CT scout film and the endoscopic measurements of the basal lamella, anterior wall of sphenoid sinus and posterior wall of sphenoid sinus, althought there were no significant discrepancy for basal lamella in female patients (p>0.05). CONCLUSION: The differnces between the CT and operative measurements observed in this study were due to differnt measuring points, differences in the measuring angles, and inaccurate locations of the landmarks on the CT scout films owing to their small sizes. These findings indicate that a more accurate method need to be introduced in using the CT films to measure the anatomical landmarks in the paranasl sinuses.

Cytokine mRNA Expression of Otitis Media with Effusion in Children / 대한이비인후과학회지

Otitis media with effusion(OME) is the most common cause of acquired hearing loss in children. Some children suffer from a chronic form of this disease known as chronic otitis media with effusion(COME), which is manifested by the retention of fluid and inflammatory products in the middle ear cleft and by the eustachian tube dysfunction. The etiology and pathogenesis of COME, however, have not been fully elucidated. Middle ear effusion(MEE) is a complex mixture of transudate, secretory products from glands of middle ear mucosa and products from inflammatory cells and infecting organisms. Recently, there has been a great interest in the pathogenetic roles of cytokines, a group of low molecular weight glycoproteins produced by macrophages, lymphocytes and other cells. Activities of cytokines include fever production, activation of osteoclasts, fibroblasts, phagocytes and cytotoxic cells, regulation of antibody formation and inhibition of growth of cartilage, bone and endothelial cells. In this study, we have utilized the reverse transcription polymerase chain reaction(RT-PCR) technique to determine accurately the existence of mRNAs for five cytokines in MEEs collected from 22 children with COME. Messenger RNAs for TNF-alpha, IL-1beta, IL-2 and IL-8 were detected in 68%, 86%, 59% and 95% of specimens, respectively, Interleukin-4 mRNA was absent in all the specimens. The persistent production of cytokines by the inflammatory cells in MEE of COME due to sustained presence of antigens or most-recent antigenic stimuli may play the central role in prolonged OME and responsible for the mucosal damage, bone erosion, fibrosis and resulting hearing loss seen in some cases of COME.

Anatomical Measurements of the Nose and Paranasal Sinuses Using Nasal Endoscope / 대한이비인후과학회지

Endoscopic sinus surgery as a surgical technique for chronic sinusitis has become very popular. So, surgeons should be familiar with the structures and variation of the paranasal sinus to avoid the risks of endoscopic sinus surgery. Many investigations were performed to measure the sinus structure with CT and cadaver dissection. But, there were not to be performed precise measurements in paranasal sinus during operation. The authors measured the distance between anterior nares to intranasal structures such as uncinate process, bulla ethmoidalis, basal lamella, maxillary ostium, posterior wall of ethmoid sinus, anterior wall of sphenoid sinus and posterior wall of sphenoid sinus in 86 patients during endoscopic sinus surgery which were performed by one surgeon. The authors analyzed between measured distance in paranasal sinus and circumference and anteroposterior diameter of head using t-test. The results were as followed. 1) The distance from anterior nares to uncinate process was 45.3+/-2.8mm, to basal lamella 57.9+/-4.6mm, to maxillary ostium 48.3+/-4.7mm, to anterior wall of sphenoid sinus 69.9+/-3.6mm, and to posterior wall of sphenoid sinus 83.7+/-4.3mm. 2) There were no significant difference between sex, circumference and anteroposterior diameter of head.

Study on Short Term Test-Retest Reliability of High Frequency Audiometry / 대한이비인후과학회지

Although high frequency threshold has been regarded as a early detector of cochlear damage, there has been no standardized system for calibration or measurement of high frequency threshold. Compared measurement of the high frequency(10-20KHz) with measurement of the low frequency(250-8000Hz), it is difficult to establish high frequency normative values because thresholds vary widely with age, calibration system and kinds of audiometer, etc.... But short term test-retest may not be influenced by calibration variance. So we tried to obtain intrasubjective test-retest threshold difference of high frequency threshold difference within 4 weeks intervals. 47 ears of normal low frequency hearing(250-8000Hz) young adults were tested with commercial high frequency audiometer(Beltone 2000) and Sennheiser HD 250 linear headphone. The results were as follows: 1) Test-retest difference within 10dB SPL was more than 89% in every frequency. 2) Test-retest difference within 15dB SPL was more than 96% in every frequency. Results of this study suggest that acceptable range of intrasubjective difference of high frequency threshold within 4 weeks intervals is 15dB SPL.

A case of huge cholesterol granuloma in fibrous dysplasia of temporal bone / 대한이비인후과학회지

No abstract available.

Olfactory detection and identification test for outpatient / 대한이비인후과학회지

No abstract available.