Short Term Follow-up of Hearing Changes according to Insertion Site of Temporalis Muscle Fascia in Type I Tympanoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There are two types of methods in the underlay technique that are employed according to the graft insertion site. The purpose of this study is to evaluate the short term follow-up results of air-bone conduction threshold changes according to the insertion of temporalis muscle fascia to medial and lateral side of malleus in type I tympanoplsty with simple mastoidectomy. MATERIALS AND METHOD: 72 patients with perforated tympanic membrane over the half size in pars tensa were operated in type I tympanoplasty with simple mastoidectomy. Patients were divided into two groups according to the insertion of fascia of temporalis muscle to either i) lateral side of the malleus (group A, 32 cases) or ii) medial side of the malleus (group B, 40 cases). Each group was divided into three subgroups according to size of perforation in the tympanic membranes, ranging from moderate, large, to total. Difference in the air-borne conduction threshold changes between the first preoperative and postoperative year was analyzed for each group. RESULTS: The differences in the pre and postoperative air-bone conduction gap (ABG) between the group A and B were 14.4+/-7.1 dB, 10.4+/-6.2 dB, respectively. There was no statistical difference between the two groups (p>0.05). The pre and postoperative ABG differences for different sizes of perforation in the tympanic membrane in group A were 17.5+/-12.2 dB (moderate), 14.1+/-7.4 dB (large), 14.5+/-8.5 dB (total), and in group B were 9.5+/-4.8, dB (moderate), and 9.3+/-7.2 dB (large), and 12.0+/-7.1 dB (total). There was no statistical difference between the subgroups of the same group (p>0.05). The pre and postoperative bone conduction threshold of group A decreased at 250, 500, 1000, and 2000 Hz but increased at 3000, 4000 Hz. The threshold of group B decreased at all frequency. Postoperative reperforations were observed in just 2 cases of the group B. One case was observed at 5 postoperative months in the large perforation group, and the other case was observed at 15 months in the total perforation group, with the former case healing spontaneously at 6 months. CONCLUSION: The results suggest that the two methods of underlay technique could be selected properly by location of perforation, middle ear anatomy and its pathological state, and continuity of ossicles, as well as per operator's preference. When the perforation is located at the anterior, anterosuperior and anteroposterior portion of tympanic membrane, the tympanic membrane is thickened severely so the boundary becomes uncertain between the middlear mucosa and the tympanic membrane. The insertion of fascia to lateral side of malleus is therefore recommended.

Differences between pre- and post-operative bone conduction threshold changes according to the types of mastoidectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There have been many studies about elevated bone conduction (BC) thresholds in patients with chronic otitis media (COM) with or without cholesteatoma and the relationships between operative techniques and postoperative changes of BC thresholds. The purposes of this study are evaluation of the effect of chronic otitis media on BC thresholds, the relationships between various operative techniques and postoperative BC threshold changes. MATERIALS AND METHODS: Preoperative BC thresholds in 237 patients with ipsilateral COM were evaluated and pre- and postoperative differences of BC thresholds were compared by each frequency in all patients. The patients were divided into three groups according to the severity of diseases: (1) Simple: relatively healthy middle ear mucosa and thus only simple mastoidectomy (SM) was done (N=92), (2) Severe: mastoidectomy with posterior tympanotomy (ICWM) or open cavity mastoidectomy (OCM) were done because of severe edematous middle ear mucosa, granulation tissues, or poor ventilation (N=89), (3) cholesteatomas (Chole, N=56). RESULTS: Preoperative audiograms revealed a significant relationship between the elevation of BC threshold and the severity of diseases. Postoperative BC thresholds were improved in 49% of SM (13.8 +/- 8.5), 51% of ICWM (13.8 +/- 6.1), and 35% of OCM (14.4 +/- 8.4), maintained in 45% of SM, 37% of ICWM, and 43% of OCM, but worsened in 6% of SM (-8.7 +/- 1.4), 12% of ICWM (-10.9 +/- 5.2), and 22% of OCM (-13.8 +/- 6.0). CONCLUSION: The preoperative BC threshold were maintained or improved in the majority of patients postoperatively. In OCM, more patients were worsened in BC hearing postoperatively than the others.

Osteoma of the External Auditory Canal: A Case Report

An osteoma is a protruding mass composed of abnormally dense but otherwise normal bone and arises in the periosteum. It is usually found in the skull or facial bone, most often in the frontal or ethmoid sinuses, rarely occurring in the external auditory canal. The mass is usually hard and painless, and is connected to the osseous canal by its stalk or neck. Differential exestotic diagnosis is important. We report a case of osteoma of the external auditory canal.

A Case of Endoscopic Approach of Epidermoid Cyst Arising in the Inner Surface of Nasal Bone / 대한이비인후과학회지

The midline dermoid cysts are rare congenital lesions that occur either solitary or in association with various craniofacial disorders. The growth of these lesions can cause nasal and midfacial disfigurement, recurrent localized infection, and symptoms consistent with an intranasal lesion (e.g., obstruction). Complete excision is necessary, otherwise the epithelial-lined tract (s) can regenerate, often resulting in chronic drainage and intermittent infection. We present an unusual case of congenital midline nasal epidermoid cyst in an 19-year-old girl for whom no radiographic evidence of transcranial extension was found. Transnasal endoscopic access without craniotomy was used to remove the epidermoid cyst arising in the inner surface of nasal bone.

The Effects of All-trans-retinoic Acid on the Proliferation of Cultured Keratinocytes from External Ear and Cholesteatoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cholesteatoma is a disease of the temporal bone, affecting the squamous epithelium and invading into the middle ear cavity. Retinoic acid (RA) is known to inhibit or accelerate the proliferation of normal keratinocytes depending on its concentration. This study was aimed at investigating the effects of different concentrations of RA on the proliferation of cultured keratinocytes from the external ear and cholesteatoma and whether the effect is different according to the origin of tissue. MATERIALS AND METHODS: Patients undergoing tympanomastoid surgery for cholesteatoma were selected, and cholesteatoma matrix and skin were obtained from their middle ears and external ears, respectively. After culturing keratinocytes from the external ear and cholesteatoma, cells were cultured for 7 days in the medium 154 (Cascade, USA), and 10(-6)M RA or 10(-7)M RA was added twice every three days. The control group was cultured without the addition of RA. The absorbance was estimated at 490 using CellTiter 96(TM)AQ(ueous) Non-Radioactive Cell Proliferation Assay, nm and the survival fraction was calculated and compared with the control group. RESULTS: Proliferation of keratinocytes from the external ear and cholesteatoma was inhibited when the concentration of RA was 10-6 M and accelerated when the concentration of RA was 10(-7)M. The accelerated effect of retinoic acid on the proliferation of keratinocyte seems to be less prominent in the cholesteatoma tissue than in the skin of normal ear canal. CONCLUSION: Retinoic acid can inhibit or accelerate the proliferation of cholesteatoma keratinocytes dependining on its concentration.