Retraction: Molecular Genetic Analysis of Connexin 26 in Korean Congenital Hearing Loss / 대한이비인후과학회지

No abstract available.

A Case of Hereditary Hemorrhagic Telangiectasia Managed with Intranasal Topical Estrogen / 대한이비인후과학회지

Hereditary hemorrhagic telangiectasia is an autosomal dominant disorder affecting blood vessels of the skin, mucous membrane and viscera. It is characterized by a clinical triad of multiple telangiectasia, recurrent hemorrhages and familial occurrence. In 80% of patients, epistaxia is the first presenting symptom. It can have a massive impact on the quality of life of those affected. Otolaryngologists should be familiar with this disease because of its potential systemic complication. Recently, we have experienced a 69 year old female complaining of melena and recurrent epistaxis for 20 years. Epistaxis was successfully managed with topical estrogen ointment.

Bacteriological Findings and Antimicrobial Susceptibility in Chronic Sinusitis with Nasal Polyp

BACKGROUND AND OBJECTIVES: Microbiologic data in chronic sinusitis with nasal polyps, which is the foundation of proper antibiotic treatment, is insufficient due to problems with sampling and culture technique. Therefore, the objective of this study is to identify the causative agents in chronic sinusitis with nasal polyps based on culture results in adults and children and the relationship between the results of the middle meatus and maxillary sinus. Materials and Method: Samples were obtained with middle meatus swabs and endoscopically guided maxillary sinus aspirations and then transferred to a microbiology laboratory using different media for aerobic and anaerobic cultures. RESULTS: Eighty one samples were studied. Sixty six from the middle meatus and sixty four from the maxillary sinus bacterial isolates were recovered. The most frequently isolated aerobic organisms were the Staphylococcus, Haemophilus influenza and Streptococcus while those of the anaerobic organisms in adults were the Prevotella and Peptostreptococcus. No anaerobic microorganisms were isolated in the children. Concordance rates of aerobic bacteria were 75.4% among adults and 90.0% among children. That of anaerobic bacteria was 83.6% among adults and 100% among children between the middle meatal swab and the maxillary sinus aspiration. CONCLUSION: Authors recommend amoxacillin/clavulanate, cephalosporins and macrolide as the first-line medical treatment. In cases where there are no improvement of symptoms, cultures should be taken from the middle meatus, followed by appropriate selection of second-line antibiotics according to the sensitivity test results.

Clinical Analysis of Orbital Complications of Acute Sinusitis according to Age

BACKGROUND AND OBJECTIVES: Acute sinusitis is a mild, self-limiting disease. In children, however, sinusitis may lead to other severe, even life-threatening, conditions. Therefore, appropriate diagnosis and management are needed. Orbital complications from sinusitis are caused by expansion through natural suture lines, foramen, dehiscence of lamina bone and bony erosion due to acute infection and necrosis. The purpose of this study was to analyze the common types of orbital complications and to compare the symptoms, prognoses and treatments of children and of adults, respectively. Materials and Method: Twenty-one children under15 years of age and thirteen adults over 15 were enrolled in the study. Symptoms, durations of treatment, treatment modalities, prognoses, and CT findings were analyzed. RESULTS: Preseptal cellulitis was found in 6 children (28.6%) and 8 adults (61.5%) ; subperiosteal abscess in 9 children (42.9%) and 3 adults (23.1%) ; and orbital cellulitis in 6 children (28.6%) and 2 adults (15.4%). Eye lid swelling was found in all subjects, while diplopia and limitation of eye movement was found in 4 children (19%) and 2 adults (15.4%). Medical treatment was the first line of therapy for both children (76.2%) and adults (61.5%), with the remaining children (23.8%) and adults (38.5%) receiving surgical treatment. CONCLUSION: While generally more severe, orbital complications in children can be treated more conservatively than those arising in adults.

Treatment Effects of Glutamate Antagonist for Tinnitus / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tinnitus is one of the most widespread disorders of the auditory system, affecting approximately 17% of the general population, with the frequency increasing to about 33% in the elderly. However, little is known about the underlying physiological mechanism that causes tinnitus and there is no definite treatment. Recently, several studies have showed that subjective tinnitus is mostly generated at the synapse between inner hair cells and their afferent nerves and in addition, some have showed that glutamate is likely to act as the neurotransmitter. The aim of this study has been to evaluate the effective use of caroverine hydrochloride and memantine hydrochloride for tinnitus treatment and to determine their appropriate indication of glutamate antagonist therapy. MATERIALS AND METHOD: From May 1998 through June 2000, 188 patients with subjective tinnitus were treated with caroverine hydrochloride (Spamon(R)). Of the patients, 153 were followed, and 20 of these patients who did not respond to caroverine hydrochloride were treated additionally with memantine hydrochloride (Akatinol(R)). Audiological evaluations were performed in all of the patients. Pre and post-treatment status was analyzed by handicap inventories. RESULTS: Subjective tinnitus was improved in 55 (35.9%) of 153 patients who were treated with caroverine hydrochloride and 11 (55.0%) of 20 patients with memantine hydrochloride. The response group had tendency of shorter duration history of tinnitus than the non-response group. There was no difference between the response group and the non-response group in age, sex, site, and tinnitus characteristics. CONCLUSION: We suggest that glutamate antagonists such as caroverine hydrochloride and memantine hydrochloride can be used as an alternative modality for treatment of subjective tinnitus.

Two Cases of Misdiagnosed Congenital Stapes Fixation / 대한이비인후과학회지

Congenital stapes fixation showing normal finding of external auditory canal and tympanic membrane causes non-progressive conductive hearing loss in the range of 40 to 60 dB since childhood. It is a rare disease, but most commonly found among the isolated ossicular anomalies. Patients with this disease are very suitable candidates for stapes surgery, and successful hearing improvement can be expected by an appropriate surgical procedure. We report 2 cases of congenital stapes fixation which had been operated improperly. One case showed interposed homologous ossicle between the stapes head and the incus, and the other case showed transposed incus between the malleus handle and the stapes head along with the anterior crus fracture. They showed hearing improvements of more than 30 dB after stapedotomy with placement of the Fisch type stapes prosthesis. We are reporting two cases of misdiagnosed congenital stapes fixation with a discussion.

Analysis of Lymph Nodes Number according to Various Modifications of Neck Dissection / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The type of neck dissection performed for head and neck cancers depends on the experience of the surgeon and the status of the neck metastasis. The purpose of this study was to quantify the extent of lymphadenectomy achieved according to the various modifications of neck dissection based on microscopic pathologic analysis and to analyze the difference in the number of lymph nodes between the types of neck dissection. MATERIALS AND METHODS: Charts and pathologic finding of patients who underwent neck dissection from June 1994 to October 1999 were reviewed. Patients who received selective neck dissection or preoperative radiotherapy to the neck were excluded. The samples were 65 necks and were divided into four groups based on Medina's classification: radical neck dissection (group 1), Type I modified radical neck dissection (group 2), Type II modified radical neck dissection (group 3), and Type III modified neck dissection (group 4). The number of lymph nodes was counted by a pathologic microscopic examination for each region of specimens. The intergroup difference was analyzed by a one-way between-group analysis of variance (ANOVA). RESULTS: The mean number of dissected lymph nodes per specimen was 43.6 in group 1, 38.8 in both groups of 2 and 3, and 30.3 in group 4. Group 4 was significantly different from group 1 (p<0.05). Especially, the number of dissected lymph nodes from level II, III, IV of group 4 was significantly different from those of group 1 (p<0.05). There was no significant difference between other groups. CONCLUSIONS: The number of dissected lymph nodes decreases as the number of preserved non-lymphatic tissue structures increases. Level II, III, IV are less completely operated regions in functional neck dissection.

Molecular Genetic Analysis of Connexin 26 in Korean Congenital Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Congenital deafness is a relatively common disorder and its' incidence is as high as 1 per every 1, 000 newborn infants. In developed countries, genetic hearing loss accounts for 50% of all hearing losses. A least 20 autosomal recessive loci had been identified, and in 1997, Connexin 26, one of the gap-junction proteins, was found to be the main mutant gene of non-syndromic congenital sensorineural hearing loss. The objective of this study is the investigation of the clinical features and characteristics of connexin 26 mutation in congenital deaf patients in Korea. MATERIALS AND METHODS: Fifty-one patients who have visited the out-patient department of Ajou University Hospital and 125 patients attending two special schools for deafness were physically examined. Family history of each patient was also examined. One hundred normal hearing infants who were audiologically approved were selected as a control group. With their blood samples, we performed DNA extraction and sequenced PCR products. RESULTS: Among 176 patients, 53 patients had family history of hearing impairment, and 16 patients actually showed syndromic features. We sequenced Connexin 26 in 121 patients who have congenital non-syndromic sensorineural hearing loss. Two heterozygotes of 35delG, three heterozygotes, four homozygotes of 235delC, 35 heterozygotes, and four homozygotes of E114G were observed. CONCLUSION: Family history of deafness was relatively common among the patients and therefore it was an important factor in deciding that hearing loss was due to genetic origin. Syndromic hearing loss occupies a relatively minor portion of congenital deafness. With regard to Connexin 26 mutation, 35delG is reported as the major gene mutation in the western countries, but in our study, only 2 patients had this type of mutation. Therefore, 235 delC. and E114G can be considered as race specific gene mutations, even though further studies are need.

Distribution of Lysozyme- and Lactoferrin-Secreting Cells in Eustachian Tube of Normal BALB/c Mouse / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mucosal surfaces in the middle ear and eustachian tube are protected by several complex defense mechanisms, namely mucociliary clearance, immunoglobulins, cellular components, and antibacterial secretory enzymes. The secretory enzymes such as lysozyme and lactoferrin are found in various mucosal tissues and most of body secretions which cover the human mucosal surfaces. Because of their bactericidal activity, it has been suggested that these enzymes contribute to the defense against local mucosal infections. It has been known that lysozyme- and lactoferrin-secreting cells in tubotympanum were various in species such as human, chinchilla, guinea pig and Mongolian gerbil. The purpose of this study is to identify and localize the lysozyme- and lactoferrin-secreting cells in the eustachian tube of normal mice using histochemical and immunohistochemical techniques. MATERIALS AND METHODS: Normal mice (BALB/c, 60-120 days old, 10 heads) were used for staining of tubotympanum with hematoxylin-eosin stain, Alcian blue-periodic acid-Schiff (AB-PAS) stain and immunohistochemical stain (antihuman lysozyme, and antihuman lactoferrin antibodies). RESULTS: 1) Secretory cells in the epithelium and subepithelial glands are observed more in the pharyngeal portion than in the tympanic portion of eustachian tube. Subepithelial glands are also noted more in lower part than in upper part of eustachian tube. 2) Lysozyme was observed in the secreting cells of mucosal epithelium and the serous cells of subepithelial glands. 3) Lactoferrin was observed in the serous cells of subepithelial glands, but not in the epithelium. CONCLUSION: In the eustachian tube of BALB/c mouse, lysozyme and lactoferrin were detected in the serous cells in subepithelial glands and only lysozyme is observed in the secretory cells in the eustachian tube epithelium.