Acquired Atresia of External Auditory Canal Associated With Synovial Chondromatosis of the Temporomandibular Joint / 대한이비인후과학회지

Synovial chondromatosis (SC) is a rare disease involving long bones, rarely affecting the temporomandibular joint (TMJ). It can manifest as preauricular swelling, pain, and joint dysfunction. This report represents the case of acquired atresia of external auditory canal in association with SC of TMJ. Active evaluation and treatment of TMJ pathology seem essential when addressing the acquired atresia of external auditory canal.

Management of Attic Cholesteatoma While Preserving Intact Ossicular Chain; “Modified Bondy Technique” vs. “Canal Wall Up Mastoidectomy with Tympanoplasty Type I & Scutumplasty” / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study is to evaluate the clinical outcomes of two surgical techniques-modified Bondy technique and canal wall up mastoidectomy with tympanoplasty type I and scutumplasty (CWUM/T1)-to remove attic cholesteatoma while preserving ossicular chain intact. SUBJECTS AND METHOD: A retrospective study was performed on 23 surgical cases for the attic cholesteatoma with postoperative audiometry data of more than six months after surgery. The patients' postoperative clinical features and audiometric results were compared between the two surgical groups. RESULTS: Out of 23 patients, CWUM/T1 was performed in 13 cases and modified Bondy technique was used in 10 cases. There were no significant differences for the preoperative and postoperative audiograms between the two groups. But air-bone gap increased significantly after CWUM/T1 while it decreased after modified Bondy technique. Three cases with postoperative problems were seen after CWUM/T1 (recurrent cholesteatoma, pars tensa adhesion, recurrent otitis media with effusion). Two cases with postoperative problems were found after modified Bondy technique (mild attic retraction, pars tensa retraction). CONCLUSION: Both surgical techniques seem to be adequate to treat attic cholesteatoma while preserving intact ossicular chain. Given good postoperative hearing results and stability of open cavity against recidivism, the modified Bondy technique seems to be a good choice for the attic cholesteatoma with intact ossicular chain when mastoid is not highly pneumatized.

Comparisons of hearing threshold changes in male workers with unilateral conductive hearing loss exposed to workplace noise: a retrospective cohort study for 8 years

BACKGROUND: The purpose of this study was to investigate hearing threshold changes of workers with unilateral conductive hearing loss who were exposed to workplace noise for 8-years. METHODS: Among 1819 workers at a shipyard in Ulsan, 78 subjects with an air-bone gap ≥10 dBHL in unilateral ears were selected. Factors that could affect hearing were acquired from questionnaires, physical examinations, and biochemistry examinations. Paired t-test was conducted to compare the hearing threshold changes over time between conductive hearing loss (CHL) ear and sensorineural hearing loss (SNHL) ear. RESULTS: The study included male subjects aged 48.7 ± 2.9, having worked for 29.8 ± 2.7 years. Hearing thresholds increased significantly in CHL ears and SNHL ears at all frequencies (0.5–6 kHz) during follow-up period (p < 0.05). The threshold change at 4 kHz was 3.2 dBHL higher in SNHL ears which was statistically significant (p < 0.05). When workers were exposed to noise levels of 85 dBA and above, threshold change at 4 kHz was 5.6 dBHL higher in SNHL ears which was statistically significant (p < 0.05). Among workers aged below 50, the threshold change values were lower in low-frequency (0.5–2 kHz) in SNHL ears, with a small range of changes, whereas in high-frequency (3–6 kHz), the range of changes was greater SNHL ears (p < 0.05). Among workers aged 50 and above, SNHL ears showed a wider range of changes in both high- and low-frequency areas (p < 0.05). CONCLUSIONS: At high-frequencies, particularly at 4 kHz, the range of hearing threshold changes was lower in ears with conductive hearing loss than in contralateral ears. This is suggested as a protective effect against noise exposure.

A Case of Schwannoma Located in the External Auditory Canal / 대한이비인후과학회지

Schwannoma is slowly-growing, benign tumor that originates from the schwann cell and is rarely found in the external auditory canal (EAC). In this article, we describe a 30-year-old female patient with 12x7x4 mm EAC schwannoma located between the helical crura and tragus of the left ear. The schwannoma was easily removed by local excision. We discuss the differential diagnosis, clinical and histologic features, and treatment of EAC schwannoma.

Two Cases of Intracranial Complications Associated with Chronic Silent Otitis Media in Immune-Competent Adults / 대한이비인후과학회지

Chronic otitis media is defined as a condition associated with a perforation of the tympanic membrane with a history or existence of otorrhea. Chronic silent otitis media refers to chronic pathologic condition behind an intact tympanic membrane, which may be clinically undetected or undetectable. Because this chronic pathology is undetected, there is a lack of clinical treatment, which increases the risk of complications and sequelae. Otogenic intracranial complications in intact tympanic membrane are usually reported in pediatric patients with acute otitis media and are rare in immune-competent adult patients. We report two cases of immune-competent patients who suffered from intracranial complications of chronic silent otitis media, one leading to a lateral sinus thrombophlebitis and the other leading to meningitis.

Effects of Workplace Noise and Hearing Protective Devices on Worker's Speech Intelligibility / 대한산업의학회지

OBJECTIVE: The objective of this study was to evaluate the degree of intelligible speech in workers wearing hearing protective devices and the differences in background noise type. METHODS: A total 82 shipyard company employees and normal hearing volunteers were recruited as subjects from a company in Ulsan: subjects were classified to the hearing-impaired group or to the control group according to hearing status. They were tested pure tone and speech audiometry in varying test environments including signal-to-noise ratio and background noise type in a headphone and in a free field environment. RESULTS: For both groups, the attenuation of hearing protective devices was greater at high frequencies. For the hearing-impaired group, speech discrimination scores differences between the unprotected and the protected ear were not significant between background noise type, when speech was presented at 65 dBA. However speech intelligibility in white noise background was lower than in the other background noise types when speech was presented at 75 dBA. CONCLUSIONS: Workers' speech intelligibility increased with an increasing signal-to-noise ratio. Speech intelligibility was also dependent on background noise type. Workers and their colleagues were trained to pronounce words more loudly and more clearly when they wearing hearing protective devices or other communication methods that do not use sound signal should be considered.

Comparison of the Effect of High-Dose Steroid with That of Super-High-Dose Steroid Therapy in Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Corticosteroids have been used for therapeutic management of sudden sensorineural hearing loss (SSNHL). Because the levels of steroid within inner ear after systemic administration is very low, high-dose steroid regimens have been used. The purpose of this study is to compare the effect of high-dose (HD) steroid therapy with that of super-highdose (SHD) steroid therapy in SSNHL. SUBJECTS AND METHOD: The study group consisted of 97 patients diagnosed as SSNHL. They were divided into two groups : those who were administered 60 mg prednisolone as the initial high dose (HD group) and those who were administered 1,200 mg hydrocortisone (about 300 mg prednisone) as the super high dose (SHD group). RESULTS: Hearing improvement was observed in 76.8% of HD group and in 67.9% of SHD group and there was no statistically significant difference in the rate of hearing improvement between HD group and SHD group. CONCLUSION: Super-high-dose steroid regimen is not superior to high-dose steroid regimen in the treatment of SSNHL.

The Impact of Noise Expose on the Hearing Threshold Extended High Frequency / 대한산업의학회지

OBJECTIVES: To determine how extended high frequency is affected by noise exposure and other factors that maybe have adverse effects. METHODS: Pure tone audiometry for usual frequencies (250-8000 Hz) and extended high frequencies (1000-16000 Hz) was conducted for 331 workers at a manufacturing company from 2004 to 2005. History of noise exposure, military service, tinnitus, alcohol drinking, smoking, ear diseases, and noisy hobbies were taken by interview. T-test, ANOVA, and multiple regression was conducted according to the frequency to evaluate the factors that could affect extended high frequency hearing. RESULTS: The noise-exposed group had significantly poorer hearing than the noise-unexposed in the frequency range 2000-16000 Hz. The hearing deteriorated with increasing age through all the frequencies. High frequency hearing of 14000 Hz was significantly worse in the noise-exposed group in their 30s. Noise exposure during military service had a bad effect on hearing, especially for the noise-unexposed group. Tinnitus was associated with poorer hearing in both noise-exposed and noise-unexposed groups. Workers with noisy hobbies exhibited better hearing in the noise-unexposed group, contrary to our expectation. Extended high-frequency hearing was affected by aging, ear protection, and noisy hobbies. In extended high frequency, 14000 Hz was especially related with noise exposure history. CONCLUSIONS: Extended high frequency, especially 14000 Hz, could be used as an indicator of noiseinduced hearing loss and should be considered as a screening test for workers in noisy environments.

Is Helicobacter Pylori the Pathogen of Chronic Tonsillitis? / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tonsillar tissue is a component of mucosa-associated lymphoid tissue (MALT), which has evolved to protect vulnerable mucosal surfaces. Helicobacter pylori, implicated as an etiological factor in duodenal ulcer and gastritis, induces the appearance of lymphoid aggregates in the stomach. Therefore, we investigate the possibility that tonsils can be extragastric reservoir and target tissue for H. pylori. SUBJECTS AND METHOD: Campylobacter-Like Organism (CLO) test and immunohistochemical (IHC) analysis for H. pylori was performed on 98 patients undergoing tonsillectomy. Chronic tonsillitis group (62 patients) and controlled group (36 patients) were enrolled in this study. Tissue samples were collected from excised palatine tonsils. Two millimeter diameter tissue piece that had been obtained from palatine tonsil specimens were placed in the CLO test kit. Remnant tonsils were sent to the Department of Pathology for IHC analysis. RESULTS: Using the CLO test, H. pylori was detected in 60 (61.2%) of the 98 patients, 39 (62.9%) of 62 in chronic tonsillitis group and 21 (58.3%) of 36 in control group. Using the IHC analysis, it was detected in 54 (55.1%) of the 98 patients, 35 (56.5%) of 62 in chronic tonsillitis group and 19 (52.8%) of 36 in control group. There are no significant differences between chronic tonsillitis group and control group with regard to both CLO & IHC analysis. CONCLUSION: This result suggests that palatine tonsil represents an extragastric reservoir for H. pylori infection, but not a target tissue.

Is the Patient-Controlled Analgesia(PCA) Helpful for the Recovery from the Tonsillectomy? / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study investigates the effect of patient controlled analgesia (PCA) on post-tonsillectomy pain for the first two weeks of operation, and its effects on the postoperative bleeding and the pain duration. SUBJECTS AND METHOD: In a prospective group study, 43 patients with tonsillectomy were studied. PCA was applied for 48 hours after surgery. Pain scores, postoperative bleeding, and pain duration were compared. RESULTS: PCA reduced postoperative pain during the time it was appled but pain was worse after disconnection. There were no differences between the groups regarding postoperative bleeding and recovery time. CONCLUSION: PCA could effectively control the post-tonsillectomy pain only during its application period. It was not helpful for long term pain control, pain duration, or post-tonsillectomy bleeding. Other long lasting and effective pain control method should be administered to reduce post-tonsillectomy pain during the recovery period.

Kuttner Tumor(Chronic Sclerosing Sialadenitis of Submandibular Gland) / 대한이비인후과학회지

Kuttner tumor or chronic sclerosing sialadenitis is a benign inflammatory condition of the salivary gland that mimics a malignant neoplasm clinically because of its presentation as a hard mass. The cause of this inflammatory is still unknown. The effects of microliths, infectious agents, secretory dysfunctions, duct abnormalities, and immune processes have been considered. Histologically, it is characterized by progressive periductal sclerosis, acinar atrophy, and dense infiltration of lymphocytes. Kuttner tumor is best diagnosed by open or excisional biopsy. We report one case of Kuttner tumor of right submandibular gland in a 42 year old man.

Recurrent Typical Carcinoid Tumor in the Supraglottis / 대한이비인후과학회지

Neuroendocrine neoplasms of larynx are a rare group of tumors that include typical carcinoid, atypical carcinoid, small cell neuroendocrine carcinoma and paraganglioma. Among them, typical carcinoid is the least common type and the treatment and prognosis is different from the other tumors. We report a case of recurrent typical carcioid of supraglottis with interval of 5 years, which were excised locally at each time. As far as we know, this is the 15th case of a typical carcinoid of larynx.

Two Cases of Enlarged Vestibular Aqueduct Syndrome / 대한이비인후과학회지

A large vestibular aqueduct, an isolated anomaly of temporal bone, is relatively rare and its association with sensorinerual hearing loss in childhood is known as the enlarged vestibular aqueduct syndrome. Using MRI, we found enlarged endolymphatic ducts and sacs in four ears of our two patients. Signal intensity of enlarged endolymphatic sac that is detected higher than that of CSF in Fluid Attenuated Inversion Recovery (FLAIR) image may indicate poor prognisis with respect to bone conduction threshold in pure tone audiogram.

A Case of Orbital Apex Syndrome Caused by Paranasal Sinusitis / 대한이비인후과학회지

Acute visual loss may occur in association with sinusitis either as a complication of orbital cellulitis or, less frequently, as a part of the orbital apex syndrome. Originally, an orbital apex syndrome is associated with an affection of the vessels and nerves passing through the superior orbital fissure and the optic foramen. A classical feature of orbital apex syndrome is presented with visual loss and ophthalmoplegia, but with minimal or no signs of orbital inflammation such as proptosis, chemosis, or lid edema. We present a case of male patient with alternating bilateral visual loss with ophthalmoplegia secondary to paranasal sinusitis.

A Case of Nevus Lipomatosus Cutaneous Superficialis

Nevus lipomatosus cutaneous superficialis is a very rare disorder characterized by nevoid fatty growth in the dermis. It usually arises in the pelvic girdle, so is unfamiliar to most otolaryngologists. A case of a 72-year-old male with nevus lipomatosus cutaneous superficialis in the nasal cavity is presented with a brief review of the disease.

A Case of Isolated neurofibroma arising from the Vocal Cord / 대한이비인후과학회지

Neurofibroma of the larynx is a rare disease. Endolaryngeal neurofibromas may take place as an isolated lesion or a part of multiple neurofibromatosis (von Recklinghausen's disease). A case of endolaryngeal neurofibroma was the first reported by Suchanek in 1925. Following the first report, there have been sporadic reports of endolaryngeal neurofibroma When the lesion is in the larynx, the major site is the aryepiglottic fold or the arytenoid, because the branch of the superior laryngeal nerve is involved. Rarely, a vocal cord is also concerned. Surgical excision is the treatment of choice. We report a case of isolated neurofibroma arising from the right true vocal cord.

Histologic Study on the Development of Olfactory Mucosa in Rats

BACKGROUND AND OBJECTIVES: There is evidence which suggests that mammals have functional olfactory systems at birth or shortly before birth. This study was performed to investigate perinatal development of the olfactory mucosa. MATERIALS AND METHODS: Sprague-Dawley rats at the 19th gestational day, and of the 1st, 3rd, 7th, 14th, 21st, and 28th postnatal day were sacrificed. The light microscopic investigation of the olfactory mucosa was conducted with hematoxylineosin stain, immunohistochemical stain for proliferating cell nuclear antigen (PCNA) and protein gene product (PGP) 9.5. RESULTS: Number of the cell layers, epithelial thickness, and density of the olfactory receptor cell peaked at the postnatal 14th day. The cells of the basal layer changed from globose cells to basal cell proper with age. The number of the basal cells to the receptor cells decreased with age. PCNA was positive both in the supporting and basal layers. PCNA positivity decreased with age in the supporting layer but stayed stationary in the basal layer. PGP 9.5 was strongly positive in the olfactory receptor cells, dendrites, and the nerve bundles but negative in the supporting and basal layers. CONCLUSION: The olfactory epithelium proliferated maximally at postnatal 14 day, and afterwards the olfactory mucosa tended to show their characteristic maturation with slowed neurogenesis.

Effects of Endoscopic Sinus Surgery on Nasality / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: When the impairment of nasal airway patency in patients with chronic sinusitis such as mucosal edema or nasal polyps is resolved after functional endoscopic sinus surgery (FESS), it is expected that patients no longer complain of hyponasal voice. However, patients who have undergone FESS sometimes complain of more hyponasal voice, or thick voice. The purpose of this study was to examine the effect of FESS on voice in terms of nasality. MATERIALS AND METHODS: Thirty-three patients who underwent FESS and thirty normal adults who had no sinus or nasal pathology were selected for this study. We performed nasalance test for patients group before and 3 months after the operation and for the control group without any medication. RESULTS: Patients' preoperative mean nasalance were not low compared with that of control group in all sentences. It was different from perceptual hyponasality they had complained. Postoperative mean nasalance in patients showed statistically significant increase. Higher change ratio of nasalance was noted in Mamma passage than the other passages. CONCLUSION: There was significant increase in nasalance scores after FESS. Thus, we must consider the possibility of voice changes postoperatively in professional voice users.

A Suspected Case of Metastatic Tumors Involving Both Internal Auditory Canals / 대한이비인후과학회지

Malignant leptomeningeal metastases involving both internal auditory canals (IACs) are rare and can mimic neurofibromatosis type 2 (NF2). Rapid progression of symptoms and involvement of facial nerve are characteristic clinical courses in contrast to the slow progression of symptoms in NF2. We report a rare case suspected to be metastatic tumor involving bilateral IACs, and presenting sudden bilateral hearing loss in a patient who was previously treated for adenocarcinoma of lung.

Importance of Psychological Factors and Organic Factors in Globus Pharyngeus / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Recently, researchers have come to believe that gastroesophageal reflux (GER) and esophageal motility disorders are the most important etiologic factors causing globus pharyngeus. On the other hand, psychological factors such as somatization or depression are regarded as relatively less important etiologic factors. In an attempt to verify this current belief, the authors performed a prospective study in patients who complained of globus sensation in the throat. MATERIALS AND METHODS: Among 62 adult patients with globus symptoms, 33 patients underwent 24-hour esophageal ambulatory pH-monitoring: 46 patients underwent esophageal manometry: 26 patients underwent Minnesota multiphasic personality inventory (MMPI): and 25 patients underwent Becks depression index (BDI) test. RESULTS: GER was diagnosed in 21.2% of the tested patients and non-specific esophageal motility disorder was found in 4.3%. MMPI showed abnormalities in 57.7% of the tested patients, and BDI showed a high index of depression in 96% of the tested patients. CONCLUSIONS: In contrast to the current belief, GER and esophageal motility disorder should be regarded as just one of the possible etiologic factors, and psychological factors should not be ignored in the evaluation of a patient with globus pharyngeus.