Detection of Fungus and Bacteria in Otitis Media with Effusion of Children Using Polymerase Chain Reaction and Its Correlation of Clinical Factors / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Several hypotheses have been proposed in the etiopathogenesis of otitis media with effusion (OME). The bacterial or fungal infection may also play a major role in the pathogenesis of OME. To investigate the relationship between bacteria and fungi as pathogens in OME and to analyze the incidence, the authors evaluated the pathogens of OME using polymerase chain reaction (PCR) technique, which is known to be more sensitive and specific than conventional bacterial and fungal culture. SUBJECTS AND METHOD: Twenty-three children (thirty ears), who were diagnosed with OME and had underwent ventilation tube insertion, were evaluated in the department of ORL-HNS, University Hospital, from May 2006 to March 2007. The middle ear effusion, obtained during the procedure, was evaluated for the identification of bacteria and fungi by PCR. RESULTS: Among 30 ears, viable pathogenic bacteria were detected in 20 ears (66.6%) and fungi in 13 ears (43.3%). The bacterial pathogens included Haemophilus influenzae (13 ears), followed by Streptococcus pneumonize (6 ears). The fungi detected from PCR were Candida albicans (4 ears-30.8%), Aspergillus niger (2 ears-15.4%) and Paecilomyces lilacinus (2 ears-15.4%). Additional pathogens include Basidiomycete yeast, Saccharamycete sp., Eurotium rubrum, Dothioraceae sp. and Stemphylium solani. Detection of fungal DNA was more common in patients with cleft palate and in recurrent cases with statistical significance. CONCLUSION: The use of PCR of middle ear effusion is effective for the detection of pathogens in patients with OME. While bacteria were thought to be the causative pathogen, this study suggests the etiological role of fungi in the pathogenesis of OME. However, the relationship between fungi and OME requires further studies.

A Comparative Study between Male and Female Patients with Obstructive Sleep Apnea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: OSA (obstructive sleep apnea) is considered a disorder that occurs predominantly in men. A thorough understanding of the sex difference in OSA can help the medical community in consultation, diagnosis and treatment of the diseases. So, differences between female and male should be taken into consideration in further evaluation and management of OSA. SUBJECTS AND METHOD: Three hundred and sixteen patients (47 women and 269 men), diagnosed as having OSA based on polysomnography (PSG) in the sleep disorder clinic between July 1994 and December 2002, were evaluated retrospectively. RESULTS: Female patients were older and had less severe OSA than men. In the group of patients showing the similar degree of sleep apnea measured according to RDI, female patients were significantly older, with more of them in the postmenopausal age; there were no difference with respect to obesity, except for the severe group. In the group of patients having the same age and obesity, males had more severe apnea, but females tended to have severe apnea over the age of 50. In terms of subjective symptoms, male patients noted more severe OSA symptom, daytime fatigue, attention deficiency than female patients, who noted morning headache and depression more often than their counterpart. CONCLUSION: Female patients showed less morbidity than male patients and also tended to be more obese. Current clinical evaluation of OSA must take into account this gender disparity

Prevalence of Middle Ear Disease in Cleft Palate Patients Using Tympanometry

There is no dispute on that the ear evaluation should be done continuously for cleft palate patients. But, there is a controversy about interrelation between otitis media and clinical factors. Therefore, we have analyzed the relationship between the prevalence of otitis media and several prospective clinical factors. In this study, 96 cleft palate patients(191 hearing ears with one atresia) were examined to evaluate middle ear function by tympanometry. In all cases, middle ear evaluation was performed before subsequent palatoplasty and then, the middle ear evaluation was performed again in 145 ears, at an average of 5.7 months after the procedure. The prevalence before palatoplasty in cleft palate patients shows that otitis media with effusion is present in 60 percent, and otopathologic feature tends to decrease with age. The prevalence of otitis media in submucous cleft palate was lower than that in incomplete or complete cleft palate patients, and the types of cleft palate seems statistically not related to any incidence of otitis media. There was statistical reduction in the prevalence of otitis media after palatoplasty. Our research indicates that the prevalence of otitis media in cleft palate patients was reduced by increased age and palatoplasty. Otological check up should be done continuously for the cleft palate patients.

Impact of Adenotonsillar Hypertrophy on Child Personality and Behavior / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although children's personality and behavior change caused by adenotonsillar hypertrophy have been thought to significantly relate with children's growth and learning capability, it has not been substantiated by any available standarized assessment. We aim to uncover the impact of adenotonsillar hypertrophy on children's personality and behavior by K-CBCL (Korean Child Behavior Checklist) and KPI-C (Korean Personality Inventory for Children). MATERIALS AND METHOD: Children aged 5 through 15 years old, a total of 33 (M: 18 F: 15) who were scheduled for T & A (Tonsillectomy and Adenoidectomy), were studied. The control group consisted of 42 healthy children (M: 22 F: 20) of the same age. Two standard questionnaires, K-CBCL and KPI-C, were given to the parents of the children to complete and then a statistical analysis carried out by a clinical psychologist for interpretation (p<0.05, by SPSS v10.0). RESULTS: According to K-CBCL, internalizing problems and total behavior problems were of statistical significance for the patient group compared to healthy children (p<0.05). KPI-C test revealed statistical significance on ERS (ego resilience scale), ANX (anxiety), SOM (somatization) and FAM (familial relationship)(p<0.05). In both groups, the results between gender were quite different. In female patient group, the total behavior problems were indicated, while in the male patient group, the total behavior problem, internalizing problem as well as somatic complaints were indicated. Especially, indications of ERS and SOM were of statistical significance (p<0.05). CONCLUSION: Children with adenotonsillar hypertrophy have difficulty in adaptation, and lack the ability to respond to situation, and easily get broken down by stress, and experience frequent anxiety.

Long-Term Polysomnographic Findings and Subjective Results in Sleep Apnea Patients Treated with Laser Assisted Uvulopalatoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Laser-assisted uvulopalatoplasty (LAUP) is well established in the treatment of snoring and obstructive sleep apnea syndrome (OSAS), although most reports are based on short-term follow-up results. This study was performed to determine the long-term effects on symptoms and polysomnographic measures in patients with OSAS after 5yrs of LAUP. MATERIALS AND METHOD: Fifty patients with OSAS underwent LAUP, and of these patients, 20 have completed postoperative polysomnographic studies. Questionnaires ranking snoring and apneic symptoms were completed by the patient and bed partner before LAUP. The parameters of measurement were apnea index (AI), respiratory disturbance index (RDI), SaO2, and sleep stages. The statistical analysis was performed using Wilcoxon signed rank test. RESULTS: Subjective questionnaires showed statistically significant improvements in snoring, falling asleep while day work, headache upon wakening. The symptomatic improvement persisted long time. The AI decreased from 15.9 to 10.5, RDI decreased from 23.2 to 14.9, and the mean, lowest O2 saturation increased from 85, 93 to 92, 97 (p<0.05). The RDI was reduced to 10 or less in 40% of patients. CONCLUSION: LAUP is an effective method for the management of mild OSAS. Authors have demonstrated long-term improvement in subjective and polysomnographic measures.

Computed Tomographic Measurements of the External Auditory Canal and the Temporal Bone / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: High-resolution computed tomography provides an excellent method for examination of the middle ear, inner ear anatomy and pathologic changes in the temporal bones. The purpose of this study was to get various measurements of the external auditory canal and temporal bones, and to compare the changes with age and sex. MATERIALS AND METHOD: The various measurements by CT of the external ear canal of normal 50 ears were done. RESULTS: The obtained results were as follows: 1) In both male and female group, the distance from the medial end of EAC to bony-cartilage junction, the distance from medial end of EAC to the lateral end of cartilage, the distance from the superior wall to the inferior wall (coronal EAC isthmus) and the distance from anterior wall to the posterior wall (axial EAC isthmus) increased significantly with age (p<0.05). 2) Compared with the female group, the male group had longer distance from the posterior tympanic plate to the sinus tympani with age (p<0.05). 3) Compared with male group, the female group had longer distance from the posterior EAC wall to the Sigmoid sinus and from the EAC superior wall to the tegmen tympani with age (p<0.05). 4) In both male and female groups, the anterior and inferior angles increased and the posterior and superior angles decreased with age (p<0.05). CONCLUSION: Computed tomographic evaluation can give us to information to operate external ear, middle ear, and inner ear surgery.