The Relationship Between Tinnitus Frequency and Speech Discrimination in Patients With Hearing Loss / 대한이비인후과학회지

Background and Objectives@#Patients with hearing loss and tinnitus experience difficulty in engaging in daily conversations. However, only few studies have examined how tinnitus affects individual speech discrimination to comprehend speech. This study aimed to analyze the correlation between tinnitus frequency and speech discrimination in patients with hearing loss and tinnitus.Subjects and Method A total of 275 ears with hearing impairment were retrospectively analyzed via audiometry and tinnitogram. The ears were divided into three groups depending on the frequency of their tinnitus. Average pure tone audiometry (PTA), hearing threshold of tinnitus frequency, speech discrimination test (SDT), degree of discrepancy between tinnitus frequency and worst PTA frequency were collected and compared among the three groups. @*Results@#No significant difference was observed in PTA in the three patient groups. Hearing threshold of tinnitus frequency was the highest at 78.27 dB in the high-frequency group and the lowest at 45.14 dB in the low-frequency group. SDT was significantly lower (53.69%) in the low-frequency group. The correlation between tinnitus loudness and SDT was the strongest in the low-frequency group. The degree of discrepancy between tinnitus frequency and worst PTA frequency was also significantly observed in the low-frequency group. @*Conclusion@#Patients who are severely affected by tinnitus are found to have significant discrepancy between tinnitus frequency and worst PTA frequency, indicating decreased SDT.

Difference in Thresholds Between Auditory Brainstem Response Test and Pure Tone Audiometry by Frequency / 대한이비인후과학회지

Background and Objectives@#There is no clear standard for the difference in the thresholds of auditory brainstem response (ABR) and pure tone audiometry (PTA) when using ABR to evaluate the reliability of PTA. Therefore, we assessed the difference in the thresholds of ABR and PTA for each frequency. Consequently, we present here the actual difference values between the two tests that can be used as a reference in the clinic.Subjects and Method We retrospectively assessed the audiometry results of 129 ears. Ears in which the hearing thresholds of each frequency continuously declined were classified as the downward group. We compared the average of differences between the two tests by frequency. The differences were compared for each hearing level from 50 dB or higher. @*Results@#For all ears, the appropriate range of difference value was ±5 dB at 2 kHz. At 1 kHz, the ABR threshold was 10 dB higher than PTA, and it was 10 dB less than PTA at 4 kHz. In the downward group, the difference value increased by 10 dB at 1 kHz and 4 kHz. In the subgroups at each hearing level, the difference value showed similar results (p<0.05). @*Conclusion@#The difference in the threshold, regardless of the severity or tendency of hearing loss, was the smallest at 2 kHz and the range was ±5 dB. ABR was 10 dB higher at 1 kHz and and 10 dB lower at 4 kHz than PTA. In the downward group, the difference at 1 kHz and 4 kHz increased by 10 dB each.

Test-Retest Differences of the Speech Discrimination Score in Patients with Hearing Loss / 대한이비인후과학회지

Background and Objectives@#The diagnosis of hearing impairment is based on repeated audiometry, including pure tone audiometry (PTA), speech reception threshold test (SRT), and speech discrimination test (SDT). SDT results particularly show a wide discrepancy upon repeated testing, while malingering is suspected when having more than 12% difference between 3 individual SDT results. Therefore, in this study, we compared the proportion of malingering found in repeated SDT with that found in other audiometric tests and analyzed the characteristics of malingering group in order to reevaluate the current criteria of defining malingering.Subjects and Method We retrospectively assessed the audiometry results of 113 patients (226 ears) with hearing impairment. Each ear was divided into a malingering group and a true hearing loss group. The proportion of ears corresponding to each malingering criterion was compared using a chi-square test. An independent sample t-test was performed to identify the differences between the characteristics between the two groups. @*Results@#The number of ears that met the malingering criteria were 19 (8.41%) in PTA, 15 (6.64%) in SRT, and 75 (33.19%) in SDT. There was a significant difference in the proportion of malingering between the 3 hearing test modalities (p<0.001). There was no significant difference in auditory brainstem response, mean age and sex distribution between the malingering group and the true hearing loss group. @*Conclusion@#When conducting repeated SDT, there is a risk of misdiagnosing an actual hearing loss patient as a malingering patient under the current malingering criteria. Therefore, the current criteria on SDT requires reevaluation.

Comparison between Group I in Which Non-Supine Apnea-Hypopnea Index> or =5 and Group II in Which Non-Supine Apnea-Hypopnea Index<5 in Patients with Positional Sleep Apnea / 수면정신생리

OBJECTIVES: The aim of this study was to evaluate the differences in patients with positional dependent sleep apnea according to their non-supine apnea-hypopnea index (AHI, > or =5 vs. or =5 ; group II was non-supine AHI having less than 5. Statistical analysis was performed to find the difference between two groups. RESULTS: In 92 patients, the number of group I patients was 11 (12%) and the number of group II patients was 81 (88%). In the severe AHI group, percentage of group I was dominated (70%) and showing a significant difference compared with the mild and moderate AHI groups (p or =5 than non-supine AHI<5.

A Case of Central Serous Chorioretinopathy Associated with Systemic Corticosteroid Treatment of Bell's Palsy / 대한이비인후과학회지

Central serous chorioretinopathy (CSCR) is potential ophthalmologic sequelae of steroid use characterized by an idiopathic serous detachment of neurosensory retina within the macula. Its etiology and pathophysiology are still unknown, but what has been implicated to cause CSCR is the the use of corticosteroid via multiple administration routes including oral, intravenous, inhaled, intranasal, epidural and intraarticular as well as topical forms. We report, with a review of the literature, an additional case of CSCR, which developed during systemic corticosteroid treatment in a Bell's palsy patient.

A Study on the Effectiveness of Treatment of Acoustic Trauma Caused by Gunshot Noise / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The effectiveness of many treatment regimens on acoustic trauma has been debated, but there is no established treatment yet. The purpose of this study was to evaluate the efficacy of steroid treatment in acoustic trauma caused by rifles and to find a critical time limit for the treatment to be effective. SUBJECTS AND METHOD: A retrospective review was conducted for 86 conscripted policemen (97 ears) who suffered acoustic trauma after rifle exercise. Pure tone audiograms were compared before and after treatment at 0.5, 1 and 2 kHz (speech-frequency pure tone average, speech-PTA) and at 4, 6 and 8 kHz (high tone pure tone average, high-PTA). Treatment consisted of drugs (steroid, ascorbic acid, gingko biloba, dextran) and carbogen therapy. The patients who came to the hospital after the first 14 days following injury were grouped as control. Hearing outcomes of patients treated within 3 days and within 7 days were compared to the control. Pre-and post-treatment hearing was compared according to the elapsed time before treatment. RESULTS: Hearing outcomes of patients who received treatment within 3 days of acoustic trauma was better than the control group. Speech-frequency did not show any difference. Treatment within 7 days showed no statistical difference compared to the control. Hearing gain was better when treated within 7 days, especially if it was within 3 days. Speech-frequency showed significant spontaneous recovery within 3 days. CONCLUSION: Our data showed a possible effectiveness of treatment of acoustic trauma on the recovery of high frequency hearing when started within 3 days. Speech-frequency seems to recover spontaneously within 3 days.

Correction of Hump Nose Using Radix Augmentation with Silicone / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Hump resection by osteotome or rasp is a commonly used surgical technique in hump correction. However, during this procedure, the structure of the osseous-cartilaginous framework is altered and may lead to an open roof deformity or dorsal irregularity. So we preserved the hump as much as possible, and then augmented the radix with silicone. We compared this result to that of the hump resection group. SUBJECTS AND METHOD: We retrospectively studied 21 patients who underwent rhinoplasty with hump correction. We classified the patients into two groups by operation technique; hump preservation and hump resection. The result of surgery was evaluated by comparing nasal measurements on pre and postoperative photos. Patient's satisfaction about cosmetic results were investigated using the visual analogue scale (VAS). All results were statistically tested. RESULTS: The hump preservation group (N=13) had 12 cases (92.3%) of isolated hump type and one pseudo hump type (7.7%), whereas the hump resection group (N=8) had 5 cases (62.5%) of generalized hump type and 3 isolated hump type (37.5%). The preoperative nasofrontal angle in hump preservation (129.4degrees+/-10.6) was significantly lower than that in the hump resection group (139.3degrees+/-8.2). The nasion/nasal tip depth ratio in the hump preservation group (0.22+/-0.1) was also lower than that in the hump resection group (0.29+/-0.1) preoperatively; but there was no significant difference between the two groups. VAS was improved significantly in both groups after surgery. CONCLUSION: Hump preservation and radix augmentation can be an effective and less complicated surgery for patients who have an acute nasofrontal angle with an isolated hump.

Radiologic Analysis of Nasal Septal Fracture in Nasal Bone Fracture Patients through Computerized Tomography / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Diagnosis of nasal bone fracture is important because of not only deformity of the external nose but also because of other additional injuries around the nose. The purpose of this study is to explore the incidence, type, location and direction of nasal septal fracture in nasal bone fracture patients who were diagnosed by nasal bone CT. SUBJECTS AND METHOD: We analysed the medical records and films of 135 nasal bone fracture patients who were diagnosed by computerized tomography from January 2005 to September 2005. The nasal bone fracture was classified by six types on nasal bone CT: unilateral, bilateral, open book, impacted, greenstick, comminuted. The external deviation of nasal bone (20 degree below or up) and correlation between septal fracture and nasal bone fracture were analysed by chi-square test (p<0.05). RESULTS: The incidence of each type of nasal bone fracture is unilateral (41%), bilateral (18%), open book (8%), impacted (6%), green stick (17%), and comminuted (10%). The incidence of combined septal fracture was high in comminuted and impacted rather than in unilateral and bilateral (p<0.05). And there was no correlation between the directions of the trauma force and nasal septal deviation. CONCLUSION: The incidence of concurrent nasal septal fracture when nasal bone fracture occur is relatively high, so we must consider nasal septum more carefully on nasal trauma.

A Case of Postauricular Dermoid Cyst / 대한이비인후과학회지

Dermoid cysts are congenital anomalies that arise from trapped pouches of the ectoderm near the normal fold or from the surface ectoderm that has failed to separate from the neural tube. Dermoid cysts of head and neck area are relatively rare, whereas those located in the postauricular area are extremely rare. In Korea, only 3 cases of postauricular dermoid cysts have been reported. In this article, we report a case of postauricular dermoid cyst in a 21 year-old man, along with a review of articles.

Development of Mastoid Air Cell System in Korean Normal Population: Three-Dimensional Reconstruction Based on Images from Computed Tomography / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although there have been some reports that measured the size of the mastoid pneumatization, only a few studies have reported the age-related variations in the mastoid air cell system using three-dimensional (3D) reconstruction techniques of computed tomography (CT) images. This study presents that 3D reconstruction techniques of CT images can be used to measure the volume of mastoid pneumatization. In adddition, normal development of the mastoid air cell system in Koreans was evaluated. SUBJECTS AND METHOD: Retrospective study. A 3D reconstruction based on the image data obtained from CT was performed in the 205 ears of 105 patients without otologic diseases in order to measure the volume of mastoid pneumatization by a surface-rendering algorithm on a personal computer. RESULTS: The mastoid pneumatization continued to grow until the third decade. Thereafter, it declined slowly, and then rapidly after the seventh decade. The mean volume of mastoid pneumatization was 7095.2 mm3 in Korean adults. No statistically significant difference was found between males and females or between right and left sides. There was a significant difference between the larger and smaller sides of individuals. CONCLUSION: The volume measurement technique based on the 3D reconstruction technique reported here is widely available, highly accurate, and easy to perform. The results of this study may be helpful in evaluating the mastoid air cell system and for managing mastoid diseases.

Three-Dimensional Reconstruction Based on Images from Spiral High-Resolution Computed Tomography of Temporal Bone: Anatomy and Clinical Application / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The intricate anatomy of the temporal bone has always been difficult to visualize. In this regard, the advantages of computer-assisted reconstruction of temporal bone based on image data from computed tomography (CT) are widely recognized. The goal of this study was to investigate the usefulness of three-dimensional (3D) reconstruction of computed tomography in determining the anatomy and topographic relationship of various important structures. SUBJECTS AND METHOD: For 40 ears of 20 patients with various otological diseases, 3D reconstruction based on image data from spiral high-resolution CT was performed by segmentation, volume-rendering and surface-rendering algorithm on a personal computer. The scanning was carried out in axial plane with technical factors of 140 kV, 100 mAs, 1 mm thickness, and 1 second scanning time. A software (Vworks(TM) 4.0, CyberMed Inc, Korea) was used for image processing. RESULTS: We were able to demonstrate the 3D display of the middle and inner ear structures. The computer-assisted measurement of reconstructed structures demonstrated the anatomic details comprehensively, which improved the surgeon's understanding of their spatial relationship, and provided many details that could not be easily measured in vivo. CONCLUSION: The 3D reconstruction of temporal bone CT can be useful in demonstrating and thus understanding the anatomical structures of temporal bone. Also, its clinical applications are inestimable. But it is necessary to confirm the correlation between 3D reconstructed images and histologic sections through the validation study.

The Clinical Significance of Three-Dimensional Reconstruction of Paranasal Sinus Computed Tomography in Assessing the Aeration of Unilateral Maxillary Sinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purposes of this study were to evaluate the aeration of maxillary sinus, using 3-dimensional reconstruction of computed tomography (3DR-CT), to compare the estimated air volume of the normal maxillary sinus with that of the inflamed one, and to evaluate the relationship between the aeration of maxillary sinus and the degree of decreased area of natural ostium. SUBJECTS AND METHOD: In 10 patients having unilateral maxillary sinusitis refractory to proper medical therapy, 3-dimensional reconstruction images were obtained based on high-resolution CT by surface-rendering technique on a personal computer. A software (Vworks(TM) 4.0, CyberMed Inc, Korea) was used for 3-dimensional reconstruction. "Maxillary ostium on CT" was defined to measure the maxillary natural ostium on 3-dimensional reconstruction images. RESULTS: In unilateral maxillary sinusitis, an air volume of the affected sinus was 4.71+/-3.12 mL, and that of the contralateral normal one was 13.29+/-9.76 mL. The area of the affected "maxillary ostium on CT" was 11.10+/-14.40 mm2, and that of the contralateral normal sinus was 24.20+/-18.64 mm2. The air volume and area of "maxillary ostium on CT" of the affected maxillary sinus were reduced significantly, compared with those of the contralateral normal one (p<0.05). But, there was no significant correlation between the aeration of maxillary sinus and the degree of decreased area of "maxillary ostium on CT" (p=0.285). CONCLUSION: 3DR-CT is the new technique, which enables us to measure the volume of maxillary sinus as well as the area of maxillary ostium. Also, it is helpful in assessing the aeration of maxillary sinus.

Cytogenetic Analysis in 543 cases of amniocentesis / 대한산부인과학회잡지

OBJECTIVE: To analyze 543 cases of amniocentesis with indications, cytogenetic results. METHOD: This study includes 543 cases cytogenetic study results which amniocentesis to detect fetal chromosomal abnormality in the Cytogenetic Laboratory at Eun Hospital in Kwang-Ju from August 1996 to December 2000, as gestational ages, indications of amniocentesis, maternal age distributions, chromosome aberrations with cytogenetic results. The cytogenetic results of chromosome aberration was identified by parents inheritance and de novo karyotypes as parents periperal blood cytogenetic study. RESULTS: Amniocentesis performed mostly from 15 weeks to 20 weeks of gestaional ages. Requested indication of amniocentesis presents abnormal maternal serum screening (37%), infertility (23%) and maternal old age (> or =35) (17%). Chromosome aberration according to amniocentesis indication was suspected fetal anomaly by ultrasonogram (8.6%), previous family history (5.7%). Chormosome aberration following maternal ages, more 40 years old women were found highly 7.9%. The frequency of chromosome aberration was 5.5% but de novo chromosome aberration was 2.2%. Numerical aberration was overall new karyotypes (1.3%). Structural aberration was inheritance karyotypes (3.3%) and de novo karyotypes (0.9%). CONCLUSION: Amniocentesis is a effective diagnostic tools in fetal chromosome aberration. Indication of fetal chromosomal anormality by ultrasonography and advanced maternal ages is an important diagnostic method with chromosome aberrations. Prenatal fetal chromosome aberrations included inheritance and de novo karyotypes. Especially, identification of de novo chromosome aberrations may predict fetal anomaly and counsel the fetus for pregnant parents.

A Case of Tuberculous Petrositis / 대한이비인후과학회지

Tuberculous petrositis is a very rare disease. It is thought to be developed by a spread of tuberculous infection from the middle ear or pneumatized air cells of mastoid. We report a patient with tuberculous petrositis who complained persistent headache after previous tympanomastoid surgery. The classic symptoms of petrositis (Gradenigo's syndrome) were absent, but the diagnosis of petrositis was made with CT, MRI and Ga-67 citrate scan. Revision surgery including infracochlear drainage of the petrous apex was performed, and the pathologic report revealed a tuberculous infection.

Electron microscopy of the oocyte-cumulus complex and immuncytochemistry on the distribution of fibronectin, tenascin, and laminin / 대한산부인과학회잡지

OBJECTIVE: Immunofluorescence microscopy including confocal laser scanning microscopy and electron microscopy were used to study the production of fibronectin, tenascin, and laminin in the cumulus-corona (CC) cells surrounding mature, unfertilized oocytes after ovulation in view of their presumptive importance in the coordination of the processes leading to fertilization and early embryo cleavage, including the final maturation of the ovum, the sperm-egg interaction, and the complex biochemical mechanism between the ovum and the oviduct. METHODS: Mature oocyte-cumulus complex (OCC) was cultured for 24 and 48 hour and fixed in 3.7% formaldehyde. Specimens were incubated with a mixture of primary monoclonal antibodies recognizing different epitopes of fibronectin, tenascin, and laminin, and then with a mixture of secondary antibodies containing FITC, TRITC, and Cy-5 conjugated antibodies. Observation was made by confocal laser scanning microscope equipped with epifluorescece optics. Transmission electron microscopy were used to observe the OCC at 24 and 48 hours after cultrue. RESULTS: The immunocytochemical date demonstrated that CC masses are capable of producing fibronectin and tenascin but their production is heterogeneous in the CC population. Immunoreactivity to fibronectin and tenascin was shown mostly by inner corona cells, and the intensity of immunofluorescence decreased from the central corona cells to the peripheral cumulus cells. Colocalization of fibronectin and tenascin was evident in most CC cells. Moreover, fibronectin and tenascin immunoreactive material was observed in the intracytoplasmic areas, at the plasma membrane level as well as in the extracellular matrix. Whereas, laminin immunofluorescence was found around plasma membrane and extracellular area, but a intracytoplasmic reaction was rarely observed. The distribution of laminin immunofluorescence was similar to that of fibronectin and tenascin, but in some cumulus cells, colocalization between them was not found. Ultrastructurally, cumulus cells projected numerous long, thin microvilli into the intercellular area and some micovilli penetrated into zona pellucida. The inner layer of the cumulus mass was loose arrangement of relatively uniform, small cells with widened intercellular spaces, whereas in the outer layer, cumulus cells are rather larger in size and compact arrangement by narrow, irregular spaces. A small and large linear gap junctions were easily found at cell contacts. The cytoplasm of most cells had abundant organelles typical of steroidogenesis: numerous mitochondrias, a well-developed smooth endoplasmic reticulum, electron dense lipid droplets, and bundles of microtubules and microfilaments. Rudimentary disrupted basal lamina along the cytoplasmic border was rarely seen in a few inner conora cells. CONCLUSION: Even though the functional role of these extracellular matrix proteins remains still unclear, it is reasonable to suggest that they are necessary in various steps of the reproductive process. Cumulus cells appears to be a heterogeneous and dynamic system for suitable microenviroment of fertilization. And functional differences between corona and cumulus cells during the oocyte denudation may be accounted for particular distribution of these adhesive proteins and steroidogenesis-related organelles.

Effects of Peritonsillar Infiltration with Bupivacaine and Oral Dextromethorphan on Post-Tonsillectomy Pain / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Peripheral tissue or nerve injury often leads to post-injury pain hypersensitivity caused by peripheral and central sensitization. Central sensitization which plays a significant role is triggered by nociceptive afferent inputs and mainly results from N-methyl-D-aspartic acid (NMDA) receptor activation. If the afferent impulses are prevented from gaining access to the CNS or if NMDA receptor is blocked by antagonist, central sensitization will not develop and then less pain will result. Previous studies demonstrated that preoperative infiltration of local anesthetics or oral NMDA receptor antagonist could alleviate postoperative pain. We investigated the effects of peritonsillar infiltration with bupivacaine and oral dextromethorphan on post-tonsillectomy pain. MATERIALS AND METHODS: Forty consecutive patients were randomly allocated to one of four groups. Group I was bupivacaine-treated group, and group II was dextromethorphan-treated group. Group III was both bupivacaine and dextromethorphan-treated group, and group IV was control group. Pain scores were assessed using self-rating numeric rating scale ( NRS) at rest and on swallowing during the postoperative day 0, 1, 2, and 7. Doses of supplementary diclofenac administered postoperatively were also recorded. RESULTS: Group I, II, and III showed significantly lower NRS pain scores compared with control group at rest and on swallowing throughout the postoperative 7 days. Diclofenac doses were not statistically different among the four groups. CONCLUSION: Preoperative peritonsillar infiltration with bupivacaine and/or medication with dextromethorphan contributed to decrease the intensity of postoperative pain after tonsillectomy.

A Study on Preoperative Diagnosis in Malignant Ovarian Tumor / 대한부인종양콜포스코피학회잡지

We studied the best parameter to differentiate preoperatively between malignant ovarian tumors and benign ovarian tumors. From January 1988 to December 1992, 244 patients of ovarian tumor were treated with surgery at Chonnarn University Hospital. Patients diagnosed as malignancy by histopathology were 26.2%(64 patients), As the diagnostic pararnetar, we used age, ultrasonography, tumor markers, CT or MRI. The results were obtained as follows: 1. The predictive value of ultrasonographic examination for ovarian cancer was 73.1%. 2. The predictive value of seren CA-125 level for ovarian cancer was 69.1%. 3. The predictive value of combination af ultrasonographic examination and serum CA 125 level for ovarian cancer was 90%. 4. The predictive value of combination of the age older than 40 years, ultrasonographic examination and serum CA-125 level for warian canrer was 92.3%. 5. The predictive value of comhination of three tumor markers(CA-125, CEA and CA 72-4), ultrasonographic examination, CT and MRI for ovarian cancer was 94.6%. Finally, we could preaperatively most exactly differentiate between malignant ovarian tumors and benign ovarian tumors by use of age, three tumor markers(CA-125, CEA and CA 72-4) and ultrsonography, CT or MRI.