Clinical Application and Update of Video Head Impulse Test / 대한평형의학회지

Recently with the introduction of video head impulse test (vHIT), it can be easily performed quantitative and objective measurement of vestibulo-ocular reflex (VOR). vHIT has been used as a clinical vestibular function test that can individually evaluate the function of each semicircular canal. Loss of VOR gain and corrective catch-up saccades that occur during the vHIT usually indicate peripheral vestibular hypofunction, whereas in acute vestibular syndrome, normal vHIT should prompt a search for a central lesion. In this study, we will examine the principle of vHIT and its interpretation, and explain its clinical application in peripheral and central vestibulopathy. In addition, we will compare the caloric test and the differences, and review the most recently introduced suppression head impulse paradigm test.

Comparison of Video Head Impulse Test with Posterior Semicircular Canal Plane and Cervical Vestibular Evoked Myogenic Potential / 대한평형의학회지

OBJECTIVE: Cervical vestibular evoked myogenic potential (cVEMP) is thought to be assessing the function of the saccule and inferior vestibular nerve. Therefore, cVEMP indirectly reflects the function of the posterior semicircular canal. Recently, the video head impulse test (vHIT) is considered as useful clinical tool to detect each semicircular canal dysfunction. Goal of this study was to evaluate and compare the results of cVEMP with posterior canal plane of vHIT (p-vHIT). METHODS: Retrospectively, we compared the results of cVEMP with p-vHIT in 43 patients who visited with dizziness. We analyzed the inter-test agreement of cVEMP with p-vHIT. RESULTS: Positive asymmetry of cVEMP was present in 37.2% (16/43), and no responses of both ears were identified in 16.3% (7/43). In p-vHIT analysis, unilateral positive was 27.9% (12/43), bilateral positive was 11.6% (5/43) and negative in both sides was 60.5% (26/43). The inter-test agreement between cVEMP and p-vHIT was 75.8% (25/33) as we considered even in lesion side. And, Fleiss's kappa value showed a fair to good agreement (kappa value=0.559). In bilateral no response group (7 patients) in cVEMP, variable additional information could be obtained using p-vHIT. CONCLUSION: cVEMP and p-vHIT showed relatively lower inter-test agreement than expected. But, p-vHIT could be easily performed, and give additional information for differential diagnosis.

Two Cases of Cerebellar Hemangioblastoma with Isolated Vertigo / 대한평형의학회지

Hemangioblastoma is solid or cystic benign vascular tumor that may arise anywhere in the body. It is rarely presented tumor accounting for only 1% to 2.5% of all intracranial neoplasms. Usually, hemangioblastoma is located in the cerebellum and posterior cranial fossa and it occurs in a variety of symptoms depending on where the tumor is located. The initial symptoms in 80% to 90% of hemangioblastoma patients are headache and vomiting due to elevated intracranial pressure, and also dizziness and balance problems are initially presented in about half of the patients. We experienced 2 cases of hemangioblastoma who presented with isolated vertigo. All of them initially showed unidirectional spontaneous nystagmus during head impulse test. Finally, hemangioblastoma of the cerebellum has been diagnosed on magnetic resonance imaging scan. In one case, the tumor was successfully removed by retrosigmoid approach and the other case was treated conservatively due to pregnancy.

Usefulness of Voice Therapy on Vocal Nodules in Professional Voice Users Treated with Steroid Injection / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A local steroid injected directly into the vocal nodules has recently come to the forefront as another treatment option, which is reported as useful and effective. However, vocal nodules are caused mainly by excessive voice use, and therefore, even if a marked improvement was shown after injection, recurrence can occur unless the voice abuse habit is changed. We hypothesized that voice therapy after steroid injection would reduce recurrence of vocal nodules in professional voice users. SUBJECTS AND METHOD: This prospective study included thirty female professional voice users with vocal nodules treated with vocal cord steroid injection on between May 2010 and March 2011. The experimental group (n=15) received the voice therapy after vocal cord steroid injection, and the control group (n=15) received only vocal cord steroid injection. Videostroboscopy, acoustic voice analysis, and Voice Handicap Index (VHI) were evaluated prior to the steroid injection and 4 and 8 weeks after steroid injection. RESULTS: Jitter, shimmer, noise-to-harmonics ratio, and mean VHI improved significantly after steroid injection in both group (p<0.05). There was no significant complication and voice discomfort after steroid injection in both groups. And, there were no significant differences in all parameters between the two groups. However, the experimental group (13.3%) showed less recurrence rate of vocal nodules than the control group (53.3%) after 8 weeks. CONCLUSION: Vocal cord steroid injection was useful treatment option of vocal nodules in professional voice users. And voice therapy after steroid injection would be effective in preventing a recurrence of vocal nodules than only steroid injection.

A Case of Recurred Follicular Lymphoma in Sublingual Gland after Complete Remission / 대한이비인후과학회지

Non-Hodgkin's lymphoma (NHL) is a group of neoplasm affecting the lymphoid system. Follicular lymphoma is typically a slow-growing, indolent form of NHL that accounts for 1/3 of all NHL. It is one of the B-cell lymphomas, generally characterized by multiple relapses after responses to a variety of therapies. When lymphoma relapses, it may occur in the same or a different part of the body from where it occurred originally. Recurrence in the primary site is most common but recurrence in other parts is rarely observed. We experienced a rare case of 70-year-old woman who complained of swelling in the left mouth floor and was diagonosed with a recurrent NHL. It recurred in the sublingual gland after a complete remission of the follicular lymphoma.

A Case of Multiple Sclerosis with Isolated Vertigo / 대한이비인후과학회지

Multiple sclerosis (MS) is a chronic disease characterized by multiple areas of demyelination, inflammation, and glial scarring in the central nervous system. MS is the most common chronic and usually progressive neurologic disease whose clinical course varies from a benign and symptom-free disease to a rapidly progressive and disabling disorder. MS can be presented with various symptoms, but isolated vertigo, represented in only 5%, is very rare. Nevertheless, in such a case, differential diagnosis of peripheral vestibular disease is very important for neuro-otologist. We recently experienced a 39 year-old female patient of multiple sclerosis with isolated vertigo mimicking vestibular neuritis. We report our case with a review of literature.

Availability of Preoperative Systemic Steroids on Endoscopic Sinus Surgery for Chronic Rhinosinusitis with Nasal Polyposis

PURPOSE: To analyze the outcome of endoscopic sinus surgery (ESS) after preoperative systemic steroid (PSS) treatment for chronic rhinosinusitis (CRS) with nasal polyposis (NP) and to investigate and compare clinicopathological factors associated with the outcome. MATERIALS AND METHODS: We performed a retrospective chart review of 468 patients with CRS with NP who underwent primary ESS between January 2005 and October 2011. 124 patients who met the inclusion criteria were included. Beginning from 2008, our clinic administered steroid preoperatively in patients of CRS with NP, thus there were 84 patients with preoperative systemic steroid (PSS group) and another 40 patients without such regimen (no PSS group). To evaluate the outcome after ESS, poor outcome and complication were analyzed according to the following parameters: age, sex, follow-up duration, eosinophilic infiltration, atopy, asthma, Lund-Mackay score, and polyp grade. RESULTS: There was no significant difference in poor outcome rates between the PSS and no PSS group (35.0% vs. 47.6%, p=0.185). There was no significant difference in complication rates between the PSS and no PSS group (10% vs. 6%, p=0.468). As with the multivariate analysis of the clincopathological factors to the poor outcome rate, presence of asthma and eosinophilic infiltration were significantly related (odds ratio as 6.555 and 4.505, respectively), whereas PSS was confirmed as less likely related (odds ratio 0.611). CONCLUSION: Low dose PSS administration does not seem to have an effect on the outcome after ESS in patients who have CRS with NP. Eosinophilic infiltration and presence of asthma are important predictors of surgical outcome.

A Case of Bronchogenic Cyst in the Retropharyngeal Space / 대한이비인후과학회지

The bronchogenic cyst is an uncommon benign congenital anomaly of the primitive ventral foregut. They usually occur in the mediastinum and intrapulmonary regions. Localization in the cervical area is unusual and the majority of cases reported have been found in the pediatric population. Radiologically, it can not be differentiated from other cystic lesions. Therefore, it is pa-thologically confirmed only when there are bronchial tissues such as pseudostratified ciliated columnar epithelium, smooth muscle, mucous gland or cartilage. Since this cyst has potential for complication, a complete excision is mandatory. We recently experienced a case of retropharyngeal bronchogenic cyst presenting as a lump sensation in 32-year-old male. In this article, we reviewed the etiology, the diagnosis, and the treatment of this case with a review of the literatures.

A Case of Posterior Ischemic Optic Neuropathy after Endoscopic Sinus Surgery / 대한이비인후과학회지

Recently, endoscopic sinus surgery (ESS) has been acknowledged as a standard surgical procedure for the treatment of chronic rhinosinusitis. Orbital complications of varying degrees that may occur during ESS have been widely reported. Blindness, one of the major complications that can occur during or immediately after ESS, is mainly attributed to orbital hematoma or direct injury to the optic nerve. In contrast to such direct mechanical trauma caused during ESS, we report a case of acute loss of vision that followed ESS without a definite cause. A postulated mechanism for idiopathic optic neuropathy is that it is ischema resulted from vasospasm in the branches of ophthalmic artery due to topical use of vasoconstrictive agents. Otorhinolaryngologists should be aware that this condition may occur following an uncomplicated ESS procedure. When loss of sight is diagnosed postoperatively, patients should be given prompt ophthalmological consultation and possible causes should be considered.

Choice of Bearing Surfaces and Technical Tips to Reduce Complications

Various materials of artificial bearing surfaces are developed and applied to reduce wear and osteolysis and to improve the survival rate of total hip arthroplasty. The survival rate of artificial joint is affected by mechanical properties and biological response. The wear rate of alternative bearing surfaces as ceramic-on-ceramic, metal-onmetal, highly cross-linked polyethylene decreased significantly compared with conventional polyethylene, but longterm results are still under follow-up and several problems have been unsettled. Particularly acetabular component should be in appropriate position to reduce complications. Each bearing surface should be selected considering age, activity, obesity, underlying disease, and socio-economic state of patients because it has its own pros and cons.

Diagnosis for Osteoporosis

Osteoporosis is one of most common metabolic bone disease that the incidence and related fractures are increasing. Early diagnosis, prevention and treatment are becoming a big issue recently. Diagnosis of osteoporosis previously was from indirect assessment of bone mass by X-ray film of proximal femur, spine or calcaneus lateral, or from histologic grading of iliac bone biopsy. But recently development of dual energy X-ray absorptiometry (DXA) enabled noninvasive and precise assessment of bone mass, and measurement of biochemical bone markers from blood and urine are used as dynamic index of bone metabolism. These diagnostic methods can be used for assessment of fracture risk, and response of medication in osteoporotic patients.

Accuracy of Limb Alignment in Total Knee Arthroplasty using Image-Free Navigation System: Comparison with Conventional Total Knee Arthroplasty

PURPOSE: We analyzed the comparative results of limb alignment after total knee arthroplasty using conventional method and image-free navigation system. MATERIALS AND METHODS: Total knee arthroplasties were performed in sixty-four patients(74 knees) with conventional method(37 cases)(Group A) and Orthopilot 4.0 image-free navigation system(37 cases)(Group B). We measured the femoro-tibial angle, femoral and tibial component angle in coronal and sagittal plane using the weight bearing whole leg radiograph taken 1-month postoperatively. RESULTS: Mechanical femoro-tibial angle was 1.4 degrees of varus in conventional group (Group A) and 0.8 degrees of varus in the navigation group (Group B) on average. Femoral and tibial component angle in the coronal plane was mean 1.8 degrees of varus and 0.7 degrees of varus in group A, 0.3 degrees of valgus and 0.5 degrees of varus in group B on average. Average femoral and tibial component angle in sagittal plane was 0.3 degrees of flexion and 0.8 degrees of anterior tilt in group A, 0.7 degrees of flexion and 1.7 degrees of anterior tilt in group B. There were no statistically significant differences between two groups in the femoro-tibial angle, femoral and tibial component angle in coronal and sagittal plane. But the ranges of deviation from desired angle were smaller in Group B than Group A. Statistically significant different results of the limb alignment (femoro-tibial angle and femoral component angle in coronal plane) were observed in 5 cases with severely bowed femoral shaft in group B (average femoro-tibial angle 0.9 degrees and femoral component angle in coronal plane 0.9 degrees varus) than group A (average femoro-tibial angle 3.5 degrees and femoral component angle in coronal plane 3.9 degrees varus). CONCLUSION: Accuracy of limb alignment in total knee arthroplasty using navigation system was not statistically significant difference than using the conventional method, but had better results in the deviation of mechanical femoro-tibial angle and femoral component angle in coronal plane than the conventional method, especially in severely bowed femoral shaft.

Operative Treatment of Type III Coronoid Process Fractures

PURPOSE: To review the clinical results of eight cases of typeIII coronoid process fractures which were treated operatively. MATERIALS AND METHODS: Eight patients with coronoid type III fracture were reviewed retrospectively. All were men with an average age of 33. There were three isolated fractures, two elbow dislocations, two radial head and neck fractures, and one medial collateral ligament rupture. Open reduction and internal fixation through anterior approach with canulated screws was used. The patients were followed up for a mean of 31 months (24 to 60). RESULTS: Average active elbow joint motion at the most recent follow up was 105degrees. The average Mayo Elbow Performance Score was 76.9 (50 to 95). There was one excellent result, four good, two fair, and one poor. CONCLUSION: Early open reduction and stable internal fixation provided a reliable method for the treatment of type III coronoid process fractures. Any associated ligament injuries to the elbow and fracture comminution were considered as important prognostic factors.

Grade III Tibia Open Fractures Treated with Unreamed Tibial Nailing

PURPOSE: This is a retrospective study to analyze the results of unreamed intramedullary nailing in grade III tibial open fracture. MATERIALS AND METHODS: Twenty-nine Gustilo-Anderson grade III tibial open fractures fixed with unreamed tibial nail were followed more than one year. Primary union rate, union time, infection, conversion to external fixation, ankle and knee function according to different grade of open, fracture level, AO classification, and muscle flap were evaluated. RESULTS: Primary union was achieved at sixteen fractures. There were three delayed union that achieved union twenty week after primary operation. And eight undergone secondary bone grafts which were done after inflammation sign subcided. Complications about infection were in five cases. Two cases were unable to maintain internal fixation due to deep infection, and three of superficial infection were treated with repeated debridement and antibiotics use. CONCLUSION: In grade III tibial open fracture, unreamed nailing with early soft tissue reconstruction and early prophylactic bone graft can be a good treatment.

Rupture of silicone gel prosthesis after augmentation mammoplasty

No abstract available.

A case of pseudoxanthoma elasticum: case report

No abstract available.