The History of Research in Vestibular Organ and Benign Paroxysmal Positional Vertigo / 대한이비인후과학회지

Since B.C., vertigo had been described as a condition closely related to migraines or epilepsy. This perception remained during the 14th-16th century and vertigo was considered to be a symptom of brain disease. Until the 18th century, the perception remained that the vestibular organ would be in charge of hearing. However, during the 19th century, it was understood that the sense of equilibrium and vertigo might have been related to vestibular organs. Barany first mentioned positional vertigo and otolithic disease in 1921, and Dix and Hallpike defined their clinical characteristics in 1952. After studies from numerous otologists and neurologists, including Schuknecht and Epley, which identified benign paroxysmal positional vertigo (BPPV) has emerged as one of today’s most common diseases. The development of various test methods enabled more detailed diagnosis of BPPV. The treatment performance also improved significantly as various canalith repositioning procedures were introduced.

Retraction: Expression of PLC-1 in Human Middle Ear Cholesteatoma / 대한이비인후과학회지

No abstract available.

Retraction: Signal Transduction System of Experimentally Induced Cholesteatoma in the Mongolian Gerbil / 대한이비인후과학회지

No abstract available.

Retraction: Mitotic Activity of Tympanic Membrane and External Auditory Canal Skin in Normal Mongolian Gerbil / 대한이비인후과학회지

No abstract available.

Retraction: Study for ReVersibility of Experimental Cholesteatoma Using Mongolian Gerbil / 대한이비인후과학회지

No abstract available.

Retraction: Compressive Technique for Treatment of Auricular Hematoma Using Dental Impression Material / 대한이비인후과학회지

No abstract available.

Retraction: Mechanism of Apoptotic Cell Death in Cholesteatoma Epithelium / 대한이비인후과학회지

No abstract available.

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

No abstract available.

Clinical Evaluation of Small Vestibular Schwannoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is not easy to detect the small-sized vestibular schwannomas because they sometimes show atypical clinical presentation such as sudden deafness and detection by chance. However, it is very important to diagnose a vestibular schwannoma in the earlier stage to preserve facial nerve function and hearing. This study aimed to analyze clinical characteristics of small vestibular schwannomas and to make decision analysis of their diagnostic work-up. MATERIALS AND METHOD: we reviewed retrospectively 42 patients who were diagnosed with vestibular schwannoma of size less than 1.5cm at the Departments of Otolaryngology, Ajou University Hospital and Yonsei University Hospital from June, 1994 to May, 2002. This study analyzed chief complaints, size of tumor, audiological studies, caloric test, imaging study, and treatment modality. RESULT: Sixteen of 42 patients (38.1%) were in group IC , 20 patients (47.6%) for group 0 and 6 patients (14.3%) for group 1. One third of cases presented initial symptoms such as sudden hearing loss, the other third presented tinnitus, and 4 cases were detected by chance. Fourteen cases showed near normal hearing and auditory brainstem response (ABR) showed 76.2% sensitivity, which was relatively lower than we expected. CONCLUSION: Because acoustic neuroma was suspected in patients with unilateral hearing loss, tinnitus, and dizziness were very important considerations. We made the decision analysis in the diagnosis of small vestibular schwannoma. It consisted of earlier intervention of fast spin echo magnetic resonance imaging (MRI) based on a cost-effective approach.

Evaluation of NeonatalImmature Reticulocyte Fraction in Small-for-gestational Age Infant in Umbilical Cord Blood / 대한산부인과학회잡지

OBJECTIVE: To evaluate the immature reticulocyte fraction (IRF) by automated calculator that have played a role of predicting marker for hematopoiesis induced by perinatal asphyxia. METHODS: Hospital charts of 40 neonates with diagnosis of small for gestational age (SGA: birth weight <10 percentile) and 47 babies of appropriate for gestational age (AGA) who were delivered vaginally between May 8, 2000 and March 2, 2002 at department of Obstetric and Gynecology, Sanggye Paik Hospital, Inje university. About 5 cc in cord blood was collected immediately after delivery, the calculation of nucleated RBC (N-RBC)/100WBC by macroscopic exam and the evaluation of reticulocyte maturation by automated reticulocyte calculator (Sysmex SE 9000, TOA Medical Electronics Co., Ltd, Kobe, Japan) were performed, and made a comparative study of apgar score. RESULTS: The comparison between AGA and SGA infants, the mean values of cord blood sampling parameter N-RBC (3.53 +/- 4.89 vs 7.92 +/- 10.06, P=0.016), middle fluorescence ratio reticulocyte (MFR) (0.21 +/- 0.02 vs 0.23 +/- 0.03, P<0.001), high fluorescence ratio reticulocyte (HFR) (0.08 +/- 0.03 vs 0.12 +/- 0.03, P<0.001), IRF (0.28 +/- 0.03 vs 0.35 +/- 0.05, P<0.001) were obtained. All of the parameters were significantly different between SGA infants and normal infants and IRF was more valuable marker than N-RBC in evaluation of hematopoietic activity in SGA infants (multiple logistic regression analysis: P value 0.282 vs <0.001). CONCLUSION: Immature reticulocyte fraction by automated calculator is more accurate and confident marker better than N-RBC/100WBC by manual countingin evaluation of the fetal hypoxic induced hematopoiesis.

Clinical and Pathologic Study of Abnormal Uterine Bleeding in Premenopausal Women-To Evaluate the Prognostic Variables of Endometrial Hyperplasia / 대한산부인과학회잡지

OBJECTIVE: We performed this study to understand correlation between clinical aspects and pathological findings of abnormal uterine bleeding (AUB) and to evaluate the prognostic variables of endometrial hyperplasia. METHODS: We reviewed 500 premenopausal women with abnormal uterine bleeding who underwent endometrial biopsy from January 1996 to February 2003, retrospectively. Pregnant women, or women who had hematologic disease, or who used iatrogenic hormones were excluded. The age of women with AUB was mostly in the 5th decade (41.3 +/- 6.8). Body mass index (BMI) in most of women (69.6%) was between 18.6 and 24.9 (22.7 +/- 3.5). RESULTS: Among AUB menorrhagea (51.0%) was the most common bleeding pattern, and the next one was intermenstrual bleeding (38.0%). Histologic findings of endometrium were proliferative phase (34.0%), hyperplasia (26.4%), and seceretory phase (22.6%), in order of frequency. 79.0% (104 cases) of endometrial hyperplasia were simple hyperplasia, 16.0% (21 case) were complex hyperplasia, and 5.0% (7 case) were atypical hyperplasia. The associated diseases were myoma uteri, hypertension, and diabetes mellitus, in order of frequency. The endometrial hyperplasia was diagnosed in 46.4% of patients whose BMI was between 27.0-29.9, in 40% of patients between 30.0-34.9 and in 100% of patients whose BMI was 35.0 or more. The endometrial hyperplasia was diagnosed in 40.6% of patients with an endometrial thickness measured 15.1 mm to 20.0 mm, in 57.1% of patients with 20.1 mm to 25.0 mm, and in 100% of patients with 25.1 mm or higher. CONCLUSION: In premenopausal woman with AUB, the endometrial hyperplasia was highly associated with women whose BMI was 27.0 or higher, or with endometrial thickness measured more than 15.0 mm. Therefore endometrial biopsy should be taken in women with AUB whose BMI is high, or endometrial thickness is thick to exclude the endometrial hyperplasia.

Study for Reversibility of Experimental Cholesteatoma Using Mongolian Gerbil / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Epidermal characteristics of cholesteatoma such as invasion, migration, uncoordinated proliferation, and altered differentiation may arise as a result of defectiVe wound healing process, induction of preneoplastic transformation or genetic alteration. To date, a number of genes haVe been shown to be differentially regulated in cholesteatoma, which might be responsible for these clinical characteristics. HoweVer, it is still unclear whether these phenomena is only oVert when cholesteatoma is under specific conditions such as inflammation or infection. If these genetic alterations in the deVelopment of cholesteatoma are transient, the pathology of cholesteatoma may be reVersible. We hypothesized that once cholesteatoma is in the normal environment, the cellular or molecular pathology of cholesteatoma can return to normal epidermal characteristics. The aim of this study was to determine whether common molecular characteristics are reVersible or not after removal of inductive factors in aural cholesteatoma induced gerbils. MATERIALS AND METHODS: We induced canal ligation cholesteatoma using Mongolian gerbils. The treated group was untied and managed for 2 weeks. We examined differences between treated cholesteatoma and untreated cholesteatoma by using a TUNEL staining and immunohistochemical technique with proliferation markers (PCNA, cytokeratin 13/16). RESULTS: With PCNA and CK 13/16, untreated group showed positive staining in the suprabasal cells as well as in the basal cells, but the treated group showed weakly positive staining only in the basal cell layer. With TUNEL staining, positive cells increased more in the untreated group than in the treated group. CONCLUSION: These results encourage our belief that some cholesteatomas, especially cholesteatoma in early stages, might be managed with only minimal treatments such as control of inflammation and maintenance of adequate Ventilation.

Study on Umbilical Cord Plasma Leptin in Preeclamptic and Normal Pregnant Women / 대한산부인과학회잡지

OBJECTIVE: Leptin, the protein encoded by the Ob gene in the adipose cell, is produced by the placenta during pregnancy and materanal serum leptin is increased in preeclampsia. The objective of this study was to compare umbilical cord plasma leptin level between infants of mothers who experienced preeclampsia and infants of control subjects and to understand the physiology of leptin. METHODS: Leptin concentrations were measured in cord blood at birth using a specific radioimmunoassay employing human recombinant leptin (Human leptin RIA kit; Linco Research, Inc. U.S.A.). We compared cord plasma leptin between preeclamptic (n=17 women) and normal pregnancies (n=21 women). RESULTS: Gestational age is the only one significant variable among the demographic variables (P=0.011). There was no statistically significant difference in cord plasma leptin level between infants of mothers who experienced preeclampsia and infants of control subjects, but preeclampsia group had slightly lower leptin levels than control subjects (Control subjects: 4.8 [3.7-7.9] ng/ml, Preeclamptic women: 2.7 [2.3-6.8] ng/ml, P=0.142). There was also no difference in the leptin value adjusted for different gestational age, or ratio between cord plasma leptin level and gestational age (Control subjects: 0.017 [0.013-0.018], Preeclamptic women: 0.010 [0.008-0.025], P=0.131). CONCLUSION: We found no difference between umbilical cord plasma leptin in infants of mothers who had preeclampsia and umbilical cord plasma leptin in infants of control subjects, but insignificantly lower levels of umbilical cord plasma leptin in infants of mothers who had preeclampsia. It suggest that maternal serum concentration do not correlate with cord leptin concentration and dysregulation of leptin metabolism and/or function in the placenta may be implicated in the pathogenesis of preeclampsia.

Results and Cost-Effectiveness of Newborn Hearing Screening Program in Ajou University Hospital / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is estimated that more than 2 in every 1,000 neonates suffers from hearing loss. Early detection with appropriate rehabilitation of congenital hearing loss can reduce the adverse developmental consequences such as language delays, and behavior and attention deficits. The purpose of this study is to evaluate our newborn hearing screening program using the combined transient evoked otoacoustic emission (TEOAE) and auditory brainstem response (ABR), and to estimate the cost-effectiveness of our program. MATERIALS AND METHOD: 6,634 infants (5,918 well babies and 716 NICU babies) underwent the newborn hearing screening program at Ajou University Hospital for 4 years. Initially well babies were screened with TEOAEs, and those failing the TEOAEs were tested with the rescreening program. Neonates failing the TEOAE rescreening and the NICU babies were examined with ABR. The cost included personnel, fringe benefits, supplies, equipment and overhead. RESULTS: 660 (11%) out of 5,918 well babies failed the initial TEOAE screening and 27 (0.46%) babies failed the TEOAE rescreening. Eleven babies (0.16%), 3 of the well babies and 8 of the NICU babies, were confirmed to have hearing loss of more than 60 dB. We detected four deaf babies out of these eleven. From the four deaf babies, we confirmed a connexin 26-related deafness and an enlarged vestibular aqueduct syndrome. It cost $6 to screen one infant and $3,700 to detect one infant with hearing loss. CONCLUSION: We could detect 11 babies (0.16%) with hearing loss out of 6,634 neonates during the 4 years. Considering the benefits of early identification and rehabilitation of congenital hearing loss, the cost for the newborn hearing screen program is affordable. The newborn hearing screen should be extended as a national health program.

Compressive Technique for Treatment of Auricular Hematoma Using Dental Impression Material / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Several methods for treatment of auricular hematoma have been introduced to prevent the recurrence and cauliflower deformity of ear. However, these methods are not convenient to both patients and doctors, because they are time-consuming and complex and must be performed under sterile conditions. The aim of this article is to introduce a new technique for effective treatment of auricular hematoma using a dental impression material and to evaluate the effectiveness of this compressive technique compared with the results of other methods. MATERIALS AND METHOD: The subjects were 45 patients who were diagnosed with auricular hematoma at the Ajou University Hospital from June, 1994 to July, 2001. We analyzed the results, complications, number of visits, treatment duration according to treatment methods on the basis of outpatient charts, retrospectively. For the treatment of auricular hematoma, we aspirated hematoma with a large bore needle and then placed mixed base and catalyst of Exaflex? (GC America Inc., Illinois) type O on the anterior and posterior surfaces of the auricle in the shape of an inverted U. The patients were checked on the 3rd day following the procedure and the impression material was removed on the 7th day. RESULTS: Using the dental impression material, we treated 9 patients with excellent cosmetic results and one patient with minimal deformity. Eight patients were treated with collodion-cotton cast and 16 of 19 patients were successfully treated with cotton dental rolls. All patients treated with the dental impression material required an average of 3.1 visits to the hospital and 8.6 days for treatment compared to 6.9 hospital visits and 13.8 treatment days in cases using cotton dental rolls. CONCLUSION: We believe that this technique using the dental impression material is appropriate for treatment of auricular hematoma. It showed excellent cosmetic results and is simple and convenient for both patients and doctors.

Detection of Bacteria in the Middle Ear Effusion and Adenoid Tissue of Chronic Otitis Media Patient Using PCR Method / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Otitis media with effusion (OME) is one of the most common reasons for children to seek doctors. Although it is closely related to bacterial infection, the pathogenesis remains unclear. The most common bacteria associated with OME include Haemophilus influenzae (H. influenzae), Streptococcus pneumoniae (S. pneumoniae), and Moraxella catarrhais (M. catarrahalis). These bacteria have consistently been reported to show colony growth on agar. Recently, the analysis using polymerase chain reaction (PCR) has been reported to be much more sensitive for bacteria detection than previous methods, such as culture. In this study, we investigate the possible relationship between bacterial infection in adenoid tissue and middle ear effusion. MATERIALS AND METHODS: Total of 52 middle ear effusion and adenoids were collected from pediatric patients during ventilation tube insertion and adenoidectomy. All the patients had gone through multiple courses of antimicrobial therapies without success. PCR was applied to detect bacteria(H. influenzae, S. pneumoniae, M. catarrha lis) in the middle ear effusion and adenoids. RESULTS: Overall detection rates of bacteria were 57.7% and 46.2% for effusion and adenoids, respectively. Bacterial detection rates of H. influenzae, S. pneumoniae, M. catarrhalis in the middle ear effusion were 30.8%, 19.2%, 11.5%, and in the adenoid were 36.5%, 15.4%, 13.5%, and in both and effusion were 13.5%, 7.7%, 3.8%, respectively. CONCLUSION: PCR is the effective method for detection of bacteria in OME and adenoid tissue. The bacteria found in the adenoid tissue of chronic OME patients did not show any correlation with those found in the OME fluid.

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.

TEOAE as a Newborn Hearing Screening / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Hearing impairment is a common congenital disability of the newborn, which has an incidence of 1.5 to 3 per 1,000 infants each year. The identification of this problem is difficult and many of these children are not identified until 2-3 years of age if not screened at birth. The purpose of this study is to establish a common screening method adjusted to our country and to emphasize the importance of early diagnosis of neonatal hearing loss. MATERIALS AND METHODS: TEOAE were performed in 1,459 infants from March to December, 1998 at Ajou university hospital. The tests were performed daily until discharge if the infant had failed the first test, and were followed at the outpatient clinic. Hearing loss was confirmed by ABR. RESULTS: The average test time of TEOAE was 102.6 seconds. Test time after 24 hours of birth was shorter than before 24 hours, and was shorter in female compared to male infants. Pass rate after 24 hours was higher than before 24 hours and 86% of tested infants passed during admission. Thirty-one out of 213 infants failed to follow-up at the outpatient clinic. Two were diagnosed with unilateral hearing loss on ABR. CONCLUSION: TEOAE is a simple and useful screening method for the identification of hearing loss in infants.

Expression of PCNA in Experimental Cholesteatoma by Implanting Autologous Free Skin Graft in Mongolian Gerbil Middle Ear Cavity / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cholesteatoma in the middle ear is characterized by the presence of a keratinizing epithelium which is believed to have hyperproliferative properties. Among the various approaches for evaluating proliferative activity, proliferating cell nuclear antigen (PCNA) has been recently induced as an antigenic marker of cellular proliferation. In this study, we investigated the hyperproliferative characteristic of implanted skin in Mongolian gerbil middle ear cavity by comparing its mitotic activity with that of the retroauricular skin. A secondary purpose was to provide the morphological basis for future animal studies concerning cholesteatoma pathogenesis. MATERIALS AND METHODS: Using immunohistochemical technique with anti-monoclonal antibody, we investigated PCNA expressions of the implanted free skin and normal retroauricular skin of Mongolian gerbils. RESULTS: Experimental cholesteatoma induced by implanting free skin graft showed an average PCNA labeling index of 0.47+/-0.07 and normal retroauricular skin revealed 0.14+/-0.05. The labeling index of experimental cholesteatoma was 3.47 times higher than that of normal retroauricular skin. CONCLUSION: The epithelium of experimental cholesteatoma induced by implanting free skin graft in gerbil middle ear cavity proliferates at a higher rate than its normal retroauricular skin, suggesting that this animal model can be used for future study of epithelial proliferation of cholesteatoma.

Immunohistochemical Study of Thrombomodulin in Experimental Cholesteatoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The hyperproliferative character of human cholesteatoma epithelium was confirmed through various hyperproliferation associated antibody expressions. Among the various approaches for evaluating proliferative activity, thrombomodulin (TM) is a cell surface glycoprotein which forms a high affinity non-covalent complex with thrombin and is a differentiation marker for spinous layer keratinocytes. Several animal models have been introduced to study cholesteatoma pathogenesis, among which canal ligation model using Mongolian gerbils is of much interest, because it can potentially provide information on cell differentiation and proliferation of cholesteatoma. In this study, we investigated the hyperproliferative characteristics of canal ligation cholesteatoma by comparing deep meatal skin and retroauricular skin. Another purpose of this study was to provide the morphological basis for further animal studies concerning cholesteatoma pathogenesis. MATERIALS AND METHOD: Using immunohistochemical technique with anti-monoclonal antibody, we investigated TM expression in the canal ligation cholesteatoma, deep meatal skin and retroauricular skin of Mongolian gerbil. RESULTS: Experimental cholesteatoma induced by canal ligation and deep meatal skin showed TM expression especially in the suprabasal layers. TM expression of experimental cholesteatoma is much more intense than that of deep meatal skin. CONCLUSION: Experimental cholesteatoma revealed an altered differentiation in suprabasal layer, suggesting that this animal model can be used for further study in the epithelial differentiation and proliferation of cholesteatoma.