The Effect of the Postoperative Weight Reduction on the Quality of the Life in the Patients with Obstructive Sleep Apnea Syndrome and Obesity / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The incidence of obstructive sleep apnea syndrome (OSAS) among obese patients is about three times higher than that of non-obese patients. Obesity is the most significant risk factor of OSAS. But in the treatment of OSAS, we tended to neglect treating obesity till now. The aim of this study was to assess the effect of weight loss after surgery on the quality of the life in OSAS patients with obesity. SUBJECTS AND METHOD: Twenty OSAS patients with obesity (body mass index >25) completed the preoperative SF-36v2TM questionnaire. All patients were treated by LAUP or UPPP. Ten of them (experimental group) were induced to lose weight by 10 mg of sibutramine for 3 months whereas nothing was done in the others (control group). And then all patients completed the same questionnaire again. The changes of the SF-36v2TM scores have been assessed. RESULTS: In the experimental group, the mean BMI decreased from 30.2 to 28.4 (p<0.05), the mean physical component sum-mary of SF-36v2TM scores was increased from 50.2 to 54.6 (p<0.05) and mean mental component summary was also increased from 45.8 to 49.6 (p0.05). But in the control group, only mean mental component summary was statistically increased from 49.1 to 50.8. CONCLUSION: This study demonstrates that the trial of postoperative weight loss may improve the quality of life in OSAS patients with obesity. So we must consider the positive trial of weight loss as well as the surgeries in the treatment of OSAS patients with obesity.

Postoperative Results of Canal Wall Up Mastoidectomy Only Performing Anterior Tympanotomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Retrospective reflect of canal wall up (CWU) mastoidectomy with posterior tympanotomy revealed some problems such as ineffectiveness against the recurrence of cholesteatoma, reclosure of ventilation route and that a posterior tympanotomy might be harmful to inner ear. Objectives of this study is to evaluate the effect of mastoidectomy with anterior tympanotomy on postoperative hearing results and complications. SUBJECTS AND METHOD: From January 1998 through July 2001, 29 cases of CWU mastoidectomy with anterior tympanotomy were reviewed retrospectively. All of the cases were difficult to perform posterior tympanotomy due to anatomical variations and had lesions restricted to anterior epitympanum. The hearing results were assessed by postoperative 1-year pure tone average and postoperative 1-year air-bone gap (ABG), and we checked complications. RESULTS: Of the 29 cases, 21 cases (72.4%) had ABG <20 dB in the postoperative 1-year, with the postoperative 1-year ABG of 14.9+/-9.2 dB. The postoperative hearing gain was 10.1+/-10.6 dB. There were 3 cases of chorda tympani nerve cutting, 1 case of accidental malleoincudal joint dislocation and 1 case of recurrence. CONCLUSION: Anterior tympanotomy could be a good approach for ventilation in selected CWU mastoidectomy approach, and further long term follow-up is needed to study about recurrence.

The Effectiveness of Long-Term Immunotherapy with Every 3-Month Injection after 3-Year Immunotherapy in the Treatment of Perennial Allergic Rhinitis Using Quality of Life Questionnaires / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Long-term immunotherapy lasting for 3 to 5 years is known to be one of the effective treatment modalities for the perennial allergic rhinitis. However, it is questionable whether open-ended immunotherapy is beneficial to control the symptoms of perennial allergic rhinitis. This study was designed to confirm the effectiveness of open-ended immunotherapy with every 3-month injection after 3-year immunotherapy by comparing the results of immunotherapy between patients who received less than 3 years and those who received more than 3 years. MATERIALS AND METHOD: One hundred-one perennial allergic rhinitis patients who received immunotherapy more than 1 year and had no history of sinonasal operation were chosen. They were divided into two groups; the duration of immunotherapy was from 1 year to 3 years in one group and more than 3 years in the other group. They were surveyed with global study and the questionnaires regarding practical problems about nasal, eye, and generalized systemic symptoms as well as their medical treatment history. This questionnaire was administered twice in one sitting, with the first on recalling symptoms before immunotherapy treatment, and the second on an evaluation of current symptoms. RESULTS: Improvement in the allergic symptoms was preserved in group B as well as in Group A. With the treatment, the patients in both groups experienced decrease in the frequency of absence from work or school, hospital visits and the use of antibiotics. There were no significant differences in the results between two groups. CONCLUSION: The long-term maintenance of immunotherapy with 3-month injection after 3-year immunotherapy is effective for the prevention of recurrence of perennial allergic rhinitis.

Clinical Usefulness of VEMP(Vestibular Evoked Myogenic Potential) in the Evaluation of Dizzy Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Click-evoked myogenic potentials have been used as a clinical test of the vestibulospinal reflex (VSR) and a complementary test for determining the lesion site. But there have not been clear diagnostic criteria for the VEMP test, so its use has been limited. We compared the parameters of VEMP among the normal and vestibulopathy patients and clarified the diagnostic value of each parameter. MATERIALS AND METHODS: We compared the results of VEMP conducted in 14 healthy volunteers and 35 patients who had been diagnosed with unilateral vestibulopathy by the vestibular function test (VFT). As parameters of VEMP, latency, amplitude and interlatency were compared between the two groups. We got positive findings of VEMP according to each parameter. RESULTS: Twenty-four percent of the patients showed normal VEMP findings, but seventy-five percent of that patients showed abnormal findings. Absent VEMP formation, prolonged latency, especially p13, and decreased amplitude (increased VEMP asymmetry) were shown in significant proportions of the patients. CONCLUSION: VEMP is a clinically complementary diagnostic method of VFT for dizzy patients. Prolonged peak latency and increased VEMP asymmetry are diagnostically valuable in the evaluation of that test.

Clinical Efficiency of Adenoidectomy Using Microdebrider / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Remnant adenoid tissue after adenoidectomy or immoderate procedure result in various complications such as bleeding, damage to the mucosa of posterior nasopharyngeal wall or orifice of Eustachian tube. The purpose of this paper is to compare conventional adenoidectomy with microdebrider-assisted adenoidectomy based on postoperative outcome and intraoperative effectiveness. MATERIALS AND METHOD: We performed a prospective study comparing thirty cases of adenoidectomy using conventional approach with fifteen cases of transoral microdebrider adenoidectomy using an indirect laryngeal mirror. Skull lateral radiographs and a symptom scale were used to evaluate preoperative and postoperative states. RESULTS: There was no significant difference in the improvement of symptoms and postoperative outcome between the conventional group and the microdebrider adenoidectomy group. However, it was found that more adenoid tissue could be removed in the microdebrider group. Postoperative nasopharyngeal endoscopic views revealed that microdebrider removed adenoid tissue precisely and preserved the posterior nasopharyngeal wall better when compared to the conventional group. CONCLUSION: Compared with the conventional procedure, adenoidectomy using the transoral microdebrider with an indirect laryngeal mirror was similar in achieving symptom improvement and postoperative outcomes, but removed more adenoid tissue with higher precision. From this study, we suggest that using microdebrider with indirect laryngeal mirror is another valuable method of adenoidectomy in the aspect of precision.

Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) as an Evaluator of Perennial Allergic Rhinitis Patients-The First Report- / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The symptom score index (SSI) has not been able to express fully the states of the perennial allergic rhinitis patients. So, other tools were deemed necessary to not only evaluate the degree of severity but also to evaluate the efficacy of the newly developed drugs on perennial allergic rhinitis. The aim of this study was to evaluate the impact of perennial allergic rhinitis on the quality of life of patients and to verify the correlation between the nasal symptoms and other factors influencing the patients' complaints on allergic rhinitis. MATERIALS AND METHOD: One hundred and three allergic rhinitis patients who do not have nasal septal deviation, chronic rhinosinusitis and nasal polyps were subjected to study. The patients answered the quality of life questionnaire on the scale of one to five. We calculated the frequency, importance and correlation coefficient of each nasal symptom item and the other question items. We also carried out a x(2)-test for the test group and the control group. RESULTS: In addition to nasal symptoms, patients experienced impairment of the quality of life due to generalized symptoms of allergic rhinitis and practical problems. On the questionnare, generalized symptoms, practical problems, emotional problems, activity limitations and ocular symptoms were frequently checked complaint items, but sleep disorder was not. The relationship between the quality of life of patients with nasal symptoms was statistically significant, but sleep disorder was not. CONCLUSIONS: This questionnaire was effective as an evaluator of impairment of quality of life in patients with perennial allergic rhinitis.

Immuno-expression of Type IV Collagen in the Intervertebral Disc / 대한척추외과학회지

STUDY DESIGN: In vitro studies using human intervertebral disc for the localization of the type IV collagen. OBJECTIVE: 1) To study the distribution pattern and immunoexpression of type 4 collagen in the intervertebral disc, 2) To study the function of type IV collagen in the intervertebral disc. SUMMARY OF BACK GROUND: The correlations of degeneration changes and collagens in the dics have not been determined. The reports for type IV collagen were few. So far, the histologic analysis for the expression of type IV collagen in the intervertebral disc has not been done. There was no report to study the function of the type IV collagen in the intervertebral disc. METHODS: Fifty-four disc blocks obtained during anterior interbody fusion of the lumbar spine were used to observe the expression pattern of the type IV collagen with immunochemical stain. For the observation of the myxomatous degeneration in the intervertebral disc, the alcian blue stain with periodic acid-schilff was done. For the control group, 22 neonate intervertebral disc blocks were obtained at autopsy. RESULTS: The immunoreactions for type IV collagen were associated blood vessels in the anulus fibrosus in the disc. There was no statistical significant difference of the type IV collagen expression between the control and disease groups. Myxomatous degenerations were observed as the irregular form in the degenerative intervertebral disc. CONCLUSION: The immunoreactions for the type IV collagen were observed in the intervertebral discs and associated with the formation of the blood vessels, especially in anulus fibrosus.

Result of Allergic Skin Test, MAST and Nasal Provocation Test in Children with Atopic Dermatitis / 대한이비인후과학회지

BACKGROUND & OBJECTIVES: Allergic diseases are considered to be systemic diseases. Atopic diseases are the first manifestation among allergic diseases, with the suggested relation to allergic rhinitis and asthma, as reported in several studies. The objective of this study was to evaluate the responses to allergic tests in children who have atopic dermatitis or have allergic rhinitis and atopic dermatitis. Materials & Methods : Eighty subjects without atopic dermatitis (control group) and 80 patients with atopic dermatitis (atopy group) were subjected to study from Nov. 1997 to Nov. 1999. The atopic group included pediatric patients who were diagnosed as having atopic dermatitis, but excluded patients who received medical treatment of steroid or antihistamine before the test for 1 month. In all the control and atopic groups, the nasal cavity volume was first estimated by acoustic rhinometry, followed by the allergic skin test (AST) and MAST. A nasal provocation test was taken with a positive allergen for patients who showed positive response to AST and MAST; for patients who showed negative response to AST and MAST, the test was taken with the House dust mites. RESULTS: In the atopic dermatitis group, the rate of positive responses to AST and MAST were 65% and 72.5%, respectively; in the control group, the rates were 25% and 35%, respectively. The most common positive allergen was the House dust mite in AST and MAST. In the nasal provocation test, the more positive rate was observed in the atopic group. CONCLUSION: The atopic group showed more positive response than the control group to AST, MAST and the nasal provocation test. Also, the nasal mucosa of 37.5% of the atopic dermatitis patients were sensitized to a certain allergen.