Changes in the Laterality of Functional Connectivity Associated with Tinnitus: Resting-State fMRI Study

PURPOSE: One of the suggested potential mechanisms of tinnitus is an alteration in perception in the neural auditory pathway. The aim of this study was to investigate the difference in laterality in functional connectivity between tinnitus patients and healthy controls using resting state functional MRI (rs-fMRI). MATERIALS AND METHODS: Thirty-eight chronic tinnitus subjects and 45 age-matched healthy controls were enrolled in this study. Connectivity was investigated using independent component analysis, and the laterality index map was calculated based on auditory (AN) and dorsal attention (DAN), default mode (DMN), sensorimotor, salience (SalN), and visual networks (VNs). The laterality index (LI) of tinnitus subjects was compared with that of normal controls using region-of-interest (ROI) and voxel-based methods and a two-sample unpaired t-test. Pearson correlation was conducted to assess the associations between the LI in each network and clinical variables. RESULTS: The AN and VN showed significant differences in LI between the two groups in ROI analysis (P < 0.05), and the tinnitus group had clusters with significantly decreased laterality of AN, SalN, and VN in voxel-based comparisons. The AN was positively correlated with tinnitus distress (tinnitus handicap inventory), and the SalN was negatively correlated with symptom duration (P < 0.05). CONCLUSION: The results of this study suggest that various functional networks related to psychological distress can be modified by tinnitus, and that this interrelation can present differently on the right and left sides, according to the dominance of the network.

Superficial Siderosis with Peripheral Dizziness: Report of 2 Cases / 대한평형의학회지

Superficial siderosis (SS) of the central nervous system is a rare disease, which is caused by the accumulation of iron from the hemoglobin in the superficial layer of the brain, spinal cord, and central parts of cranial nerves. The etiology of SS is the accumulation of hemosiderin in the subarachnoid space due to chronic or repeated hemorrhage resulting in progressive and irreversible neurological dysfunction. The cause of the disease is aneurysm, trauma, tumor, and vascular malformation. In most cases, the cause of bleeding is unknown. Clinical features include sensorineural hearing loss, cerebellar ataxia, and myelopathy. Until now, magnetic resonance imaging (MRI) has only been diagnosed and there is no standardized treatment. We will investigate clinical features and MRI findings of SS disease in the central nervous system using 2 patient cases.

Clinical Characteristics of the Patients with Dizziness after Car Accidents / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: With increasing frequency of car accidents, patients of dizziness caused by car accidents are also increasing. Various types of dizziness or vertigo can occur from car accidents depending on different injury mechanisms. Since accurate diagnosis is important for providing proper treatments, we evaluated clinical characteristics related to vestibular function of patients with dizziness caused car accidents. SUBJECTS AND METHOD: In this retrospective case review study that runs from January 2011 to March 2013, a total of 82 patients with dizziness following car accident were enrolled consecutively. We analyzed the final diagnosis of dizziness according to different mechanisms of injury during car accident through clinical record review. Patients who developed dizziness within one month of car accident were included, excluding those who had temporal bone fracture and previous history of dizziness. RESULTS: Of the different types observed, 36.6% was head injury, 24.4% whiplash injury, 3.7% complex injury, 2.4% others and the rest was unknown. In the final diagnosis, the different types included 36.6% benign paroxysmal positional vertigo (BPPV), 23.2% unclassifiable dizziness, 18.3% cervical vertigo, 7.3% labyrinthine concussion, 3.7% BPPV with labyrinthine concussion and the rest was others. Of the different types of dizziness symptoms, 58.5% was headache, 45.1% was audiologic symptoms, and others included earfullness, tinnitus and hearing disturbance. Tinitogram and pure tone audiogram results show that 2.9% (27 people) of patients have tinnitus and 7.3% (6 people) have hearing disturbance. CONCLUSION: An accurate diagnosis and timely management would be very important in forming a proper approach for post traumatic vertigo patients.

Association between Insomnia and Depression in Tinnitus Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: About one third of all people experience tinnitus in their life. And insomnia is the second most common symptom in tinnitus patients, following hearing disturbance. The aim of this study was to define the influence of insomnia on the clinical features of tinnitus patients and to assess the relation of tinnitus to insomnia and depression. SUBJECTS AND METHOD: The consecutive 197 patients with tinnitus were enrolled from May 2012 to May 2013 for this study. All patients with tinnitus filled out the following questionnaire, Visual Analogue Scale, Tinnitus Handicap Inventory (THI), Beck Depression Inventory (BDI), and Pittsburgh Sleep Quality Index (PSQI) for evaluating clinical features of tinnitus patients. Also we examined pure tone audiometry and tinnitogram for evaluating audiologic characteristics. RESULTS: When the insomnia was defined as more than five scores in PSQI, 46 of 197 patients had insomnia. Loudness of tinnitus was significantly higher in the tinnitus patients with insomnia group when compared to those of the tinnitus without insomnia group (p=0.018). The score of THI and BDI were significantly higher in the tinnitus with insomnia group, too (p=0.003, <0.001, respectively). A strong correlation (r=0.616, p<0.001) was shown between THI score and BDI score in both groups. CONCLUSION: It appears, due to the high possibility that depression and insomnia are related in tinnitus patients with insomnia, that proper evaluations about sleep disturbance and depression of tinnitus patients are necessary to produce better therapeutic results.

Clinical Differences in Types of Otalgia

BACKGROUND AND OBJECTIVES: Although otalgia is usually associated with ear problems, it may also originate outside the ear. We therefore assessed the clinical characteristics of patients with otalgia. SUBJECTS AND METHODS: We analyzed 294 patients who presented with otalgia. We assessed differences in otalgia between adults and children, differences in otogenic vs. referred otalgia between adults and children, differences between men and women. RESULTS: Of the 294 patients, 208 (70.7%) had otogenic otalgia and 86 (29.3%) had referred otalgia. Hearing disturbance and otorrhea were significantly more common in otogenic otalgia, whereas rhinorrhea, sore throat, and postnasal drip were significantly more common in referred otalgia. Children were more likely to have otogenic otalgia than adults. The proportion of patients with referred otalgia was significantly higher in adults than in children (p<0.05). Otogenic otalgia was more common in men, whereas referred otalgia was more common in women. Among patients with referred otalgia, neuralgia was significantly more frequent in women than in men (p<0.05). CONCLUSIONS: Otogenic otalgia was more frequent in men than in women and in children than in adults, whereas referred otalgia was more frequent in women and adults, indicating that types of otalgia were dependent on age and gender.

Ocular Vestibular Evoked Myogenic Potential in Vestibular Neuritis Patients: Comparative Study with Cervical Vestibular Evoked Myogenic Potential and Subjective Visual Vertical / 대한평형의학회지

BACKGROUND AND OBJECTIVES: Subjective visual vertical (SVV) reflects utricle and superior vestibular neural functions, and cervical vestibular evoked myogenic potentials (cVEMP) reflect saccule and inferior vestibular neural functions. But, origin and characteristics of ocular VEMP (oVEMP) remain controversial, especially in case of evoked by air conducted sound (ACS). Thus, the aim of this study was to identify the origin and characteristics of oVEMP by comparing with various otolith function tests. MATERIALS AND METHODS: Forty vestibular neuritis patients were enrolled from September 2012 to January 2013 in this study. We examined cVEMP, oVEMP using 500 Hz air-counducted sounds. And, we measured static and dynamic SVV. RESULTS: Abnormal cVEMP responses were observed in 6 (15%) patients, and abnormal oVEMP responses were observed in 28 (70%) patients. Abnormal static and dynamic SVV were observed in 18 (45%), 35 (87.5%) patients, respectively. There was strong correlation between oVEMP and dynamic SVV (p=0.009). CONCLUSION: ACS oVEMP responses showed different tendency from cVEMP responses in vestibular neuritis patients, but similar tendency with results of dynamic SVV. The results suggest that origin of oVEMP is different from that of cVEMP and maybe utricle and superior vestibular neuron.

Changing Patterns of Bacterial Strains in Adults and Children With Otitis Media in Korean Tertiary Care Centers

OBJECTIVES: Otitis media (OM) is an infectious disease that affects all age brackets. Aural discharge is a typical symptom, occurring in all subtypes of OM. We have compared the identity and antibiotic sensitivity of bacteria isolated from aural discharges of adults and children with various types of OM, including acute OM (AOM), OM with effusion (OME), chronic OM (COM), and cholesteatomatous OM (CSOM). METHODS: The study involved 2,833 patients who visited five tertiary hospitals between January 2001 and December 2010 and were diagnosed with AOM, OME, COM, or CSOM. The patients were divided into a pediatric group and an adult group, and the distribution of cultured bacteria and their antibiotic sensitivity were compared in the two groups. RESULTS: Bacterial detection rates were higher in adults than in children with OME and COM (P=0.000 each). The majority of the bacteria cultured from patients with AOM and OME bacteria were methicillin-susceptible Staphylococcus aureus (MSSA) and Streptococcus pneumoniae. Bacteria cultured from children were more susceptible to antibiotics (P=0.002) and had higher antibiotic sensitivity (P=0.001) than were bacteria cultured from adults. The majority of bacteria culture from patients with COM and CSOM were MSSA and pathogenic Pseudomonas aeruginosa. The frequency of methicillin-resistant Staphylococcus aureus was significantly higher in adults than in children, and more strains of bacteria isolated from adults were sensitive to the antibiotics septrin, vancomycin, and teicoplanin. CONCLUSION: Bacteria cultured from children were more susceptible to antibiotics and had higher antibiotic sensitivity than did bacteria cultured from adults.

Influence of Head and Neck Muscle Contraction on Tinnitus / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tinnitus can be classified into two types, otogenic and somatic tinnitus. Somatic tinnitus can occur even when the ear is normal, as it is known that tinnitus can occur after there is movement in the muscles of the head and neck. This study aims to characterize tinnitus and clarify the nature of tinnitus when it occurs from the contraction of the head and neck muscle. SUBJECTS AND METHOD: Thirty-five people with normal hearing, who had no history of otitis media or inner ear disease, were taken as subjects. First, we investigated whether the natural tinnitus occurred or not in the silent environment and checked its characteristics for five minutes. We then implemented eight different kinds of muscle contractions maneuver and measured whether the tinnitus occurred and the recorded the onset time, duration and location of the occurrence of the tinnitus. RESULTS: Among the total of 35 subjects inspected, 15 (42.9%) people felt the natural tinnitus. In terms of natural tinnitus, ringing was the most common characteristic and heard most often from both sides. Twenty (57.1%) subjects out of total 35 subjects inspected felt tinnitus after the contraction of the head and neck muscles. Tinnitus after the resistance to a force applied by the people to the occiput was the most common for 14 (40.0%) people, followed by parietal and right temporal area. The most common location was the left side for 6 (17.1%) subjects followed by right side and both sides. For the type of tinnitus after the contraction of muscles, ringing was observed the most by 6 (17.1%) subjects, followed by high frequency and pulsatile sound. The average onset time of the tinnitus was 8.8 seconds and the average duration was 29.6 seconds. CONCLUSION: The study showed that the muscle contraction of head and neck affects the occurrence of tinnitus for people who had no tinnitus. By clarifying the occurrence of tinnitus due to the contraction of muscles, the study identified the basic features of hearing and the role of the somatic tinnitus.

Agreement between the Facial Nerve Grading System 2.0 and the House-Brackmann Grading System in Patients with Bell Palsy

OBJECTIVES: We have analyzed the correlation between the House-Brackmann (HB) scale and Facial Nerve Grading System 2.0 (FNGS 2.0) in patients with Bell palsy, and evaluated the usefulness of the new grading system. METHODS: Sixty patients diagnosed with Bell palsy from May 2009 to December 2010 were evaluated using the HB scale and FNGS 2.0 scale during their initial visit, and after 3 and 6 weeks and 3 months. RESULTS: The overall intraclass correlation coefficient (ICC) was 0.908 (P=0.000) and the Spearman correlation coefficient (SCC) was 0.912 (P<0.05). ICC and SCC displayed differences over time, being 0.604 and 0.626, respectively, at first visit; 0.834 and 0.843, respectively, after 3 weeks; 0.844 and 0.848, respectively, after 6 weeks; and 0.808 and 0.793, respectively, after 3 months. There was a significant difference in full recovery, depending on the scale used (HB, P=0.000; FNGS 2.0, P<0.05). The exact agreements between regional assessment and FNGS 2.0 for the mouth, eyes, and brow were 72%, 63%, and 52%, respectively. CONCLUSION: FNGS 2.0 shows moderate agreement with HB grading. Regional assessment, rather than HB grading, yields stricter evaluation, resulting in better prognosis and determination of grade.

Short Term Effects of Repetitive Transcranial Magnetic Stimulation in Patients with Catastrophic Intractable Tinnitus: Preliminary Report

OBJECTIVES: The short-term effects of low-frequency repetitive transcranial magnetic stimulation (rTMS) in the patients with catastrophic and intractable tinnitus were investigated. METHODS: Fifteen participants were recruited among patients with catastrophic intractable tinnitus to receive 1 Hz rTMS treatment. Tinnitus severity was assessed before rTMS and directly after sham or real rTMS using the tinnitus handicap inventory (THI) and visual analog scale (VAS). RESULTS: There was no statistical difference in the THI score before and after sham stimulation. However, after 5 replications of real rTMS there was statistically significant reduction in THI score. Eight patients showed a decrease of more than 10 in THI score. Patients who showed a vast change in THI score after rTMS also showed a large decrease in their VAS score (r=0.879, P<0.001). Duration of tinnitus and change of THI score showed statistically significant moderate negative correlation (r=-0.637, P=0.011). But in case of VAS, there was no significant difference between VAS and duration of tinnitus. CONCLUSION: Among total 15 patients with catastrophic intractable chronic tinnitus, eight patients showed some improvement in symptoms after 1 Hz rTMS. rTMS can be considered management modality for intractable tinnitus even with distress as severe as catastrophic stage.

Decreased Expression of TLR-9 and Cytokines in the Presence of Bacteria in Patients with Otitis Media with Effusion

OBJECTIVES: Toll-like receptor (TLR)-9 recognizes unmethylated cytidine-phosphate-guanosine (CpG) motifs in bacteria. Therefore, the expression of TLR-9 may differ according to the results of bacterial culture, and thus a change in proinflammatory cytokine induction can also be expected. The authors aimed to assess the differences and relationships between the expression of TLR-9, cytokines, and nitric oxide synthase (NOS) in otitis media with effusion (OME) based on bacterial culture results. METHODS: Sixty-eight patients with OME were divided into culture-positive and culture-negative groups based on middle ear culture results. mRNA expression of TLR-9, NOS, and cytokines was measured and analyzed. RESULTS: Bacteria were detected in 38.2% of patients, and the distribution was as follows: coagulase negative Staphylococcus (10.3%), Staphylococcus aureus (8.8%), Streptococcus pneumonia (5.9%), and Bacillus spp. and Haemophilus influenza combined (2.9%). There were no significant differences in epidemiologic characteristics according to the culture results. Down-regulation of TLR-9 was observed in the culture-positive group (P=0.019). Cytokines including interleukin (IL)-12 (r=-0.582), tumor necrosis factor (TNF)-alpha (r=-0.569), interferon (IFN)-gamma (r=-0.442), IL-6 (r=-0.395) and inducible NOS (r=-0.256) tended to decrease with the detection of bacteria. CONCLUSION: The expression of TLR-9 significantly decreased in OME with confirmed bacterial pathogens. IL-12, TNF-alpha, IFN-beta, IL-6 expression tended to decrease with the detection of bacteria. The presence of bacterial pathogens in OME may be related to abnormalities in the innate immune system.

Short-Term Effect of Single Session Repetitive Transcranial Magnetic Stimulation in Chronic Unilateral Tinnitus / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The repetitive Transcranial Magnetic Stimulation (rTMS) is generally performed over the course of several weeks, as its theoretical and experimental validity has been identified in repetitive procedures. If short term application of rTMS is proven to be significantly effective, more effective treatment of tinnitus can be expected. This study was conducted to measure the effect of one session of sham rTMS & one real trial of rTMS in chronic unilateral tinnitus patients. SUBJECTS AND METHOD: rTMS stimulation of 1 Hz and 100% magnitude was given 1200 times per day to 33 patients with chronic unilateral tinnitus on their left side, between T3 and C3/T5, following the convention of the 10-20 International EEG system. Visual Analogue Scale (VAS) and Tinnitus Handicap Inventory (THI) scores were measured four times-immediately before rTMS, immediately after sham rTMS, immediately after real rTMS and two weeks after real rTMS. RESULTS: VAS and THI scores were found to show a tendency of declining. Immediately after real rTMS application, a significant decrease in VAS and THI scores was observed compared to those measured immediately before rTMS (p0.05) attributable to the direction of tinnitus were observed. CONCLUSION: A single session rTMS is thought to be a possible adjunctive treatment for tem-porary relief of tinnitus.

Rate of Isolation and Trends of Antimicrobial Resistance of Multidrug Resistant Pseudomonas Aeruginosa from Otorrhea in Chronic Suppurative Otitis Media

OBJECTIVES: To assess the rate of isolation of Pseudomonas aeruginosa (PA) and multidrug-resistant PA (MDR-PA) from patients with chronic suppurative otitis media (CSOM) otorrhea and the annual trend of antibiotic-resistance. METHODS: Otorrhea samples were collected aseptically from 1,598 CSOM patients. The rate of bacterial isolation and the results of antibiotic susceptibility testing were evaluated retrospectively. RESULTS: The PA isolation rate from CSOM otorrhea was 24.4%. Of the 398 isolated strains tested for their susceptibilities to 10 antibiotics, 395 strains showed definitive results. Of these, 183 (46.3%) were susceptible to whole antibiotics and 212 (53.7%) was resistant to more than 1 antibiotics, with the frequency of antibiotics-resistance increasing significantly over time. Although strains susceptible to all antibiotics decreased over time, the rate of isolation of MDR-PA did not change significantly. Resistance to aminoglycosides and quinolones was higher than to other antibiotics and significantly increased over time, whereas resistance to other antibiotics showed no trend. CONCLUSION: MDR-PA, assessed using five individual antibiotics and six antibiotic-classes, showed no tendency to increase or decrease over time. This may have been due to increased concern about antibiotic-resistant bacterial strains, leading to improved infection control within hospitals and healthcare centers.

Clinical Manifestations of Aural Fullness

PURPOSE: Even though aural fullness is ubiquitous among patients presenting to otolaryngology clinics, the association between aural fullness and disease development has not yet been clearly determined. MATERIALS AND METHODS: Our study was performed on outpatients from June 2006 to February 2010 whose major complaint was "ear fullness", "aural fullness", or "ear pressure". We assessed their demographic and clinical characteristics, including sex, associated diseases, symptoms, otoscopic findings, audiology test results, and final diagnoses. RESULTS: Among 432 patients, 165 (38.2%) were males and 267 (61.8%) were females, with mean ages of 42+/-19 years and 47+/-17 years, respectively. Tinnitus, hearing disturbance, autophony (p<0.01) as well as nasal obstruction and sore throat (p<0.05) showed a statistically significant correlation with aural fullness. Among patients who complained of hearing fullness, tests and measures such as impedance audiometry, speech reception threshold, and pure tone audiometry generated statistically significant results (p<0.05). Ear fullness was most frequently diagnosed as Eustachian tube dysfunction (28.9%), followed by otitis media with effusion (13.4%) and chronic otitis media (7.2%). However, 13.4% of patients could not be definitively diagnosed. CONCLUSION: Among patients complaining of ear fullness, Eustachian tube dysfunction, otitis media with effusion, chronic otitis media were most commonly observed. Performance of otoscopy, nasal endoscopy, the Valsalva maneuver, and additional audiological tests is necessary to exclude other diseases.

Analysis of Associated Symptoms of Bell's Palsy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We aimed to evaluate associated symptoms in patients with Bell's palsy and prognosis according to associated symptoms. SUBJECTS AND METHOD: Seventy-four patients with Bell's palsy were enrolled in this study. We evaluated the degree of facial palsy with Facial Nerve Grading System 2.0. The grade of facial palsy was determined as initial facial palsy at admission and as final facial palsy at visit after 3 months. Afterwards, we examined symptoms (such as otalgia, facial numbness, taste disturbance, eye problems, hyperacusis, and tinnitus) and co-morbid diseases (such as diabetes mellitus and hypertension) associated with facial palsy. After 3 months of the onset of facial palsy, we examined the changes in the associated symptoms. RESULTS: At admission, 71.6 percent of all patients had symptoms associated with facial palsy. Of the associated symptoms, facial numbness and taste disturbance were the most common, which were still found in 23% of the patients after 3 months of the onset of facial palsy. Patients with a high initial grade of facial palsy were accompanied by taste disturbance and hyperacusis more than by other symptoms. Also patients who had auricular pain during the recovery period of Bell's palsy showed poor prognosis. Compared to non-hypertension patients, for patients with hypertension, taste disturbance was more common during the early period whereas eye problems were more common during the recovery period. CONCLUSION: Patients with Bell's palsy had diverse symptoms associated with facial palsy. During the early period of Bell's palsy, we concluded that there was no correlation between the symptoms and the prognosis. However, patients with pain around the ear during the recovery period showed poor recovery of facial palsy.

Possibility of Discriminating the Presence of Tinnitus through Repeated Tinnitograms

BACKGROUND AND OBJECTIVES: The evaluation of tinnitus is becoming increasingly important in assessing the degree of disability. However, until now, there are no tools to verify the presence of tinnitus. The aim of this study was to identify the possibilities in discriminating the presence of tinnitus through tinnitus test, pitch match test and loudness balance test. MATERIALS AND METHODS: Typically, 50 patients who have suffered from continuous tinnitus and 20 subjects with normal hearing ability who did not suffer from tinnitus were selected for the present investigation. All the patients underwent the tests for pitch match and loudness balance, which were replicated thrice with 1-minute intervals with a TDH 49 headphone and an oribiter model 922, GN otometrics in a soundproof room. Non-tinnitus group that didn't have tinnitus chose virtual tinnitus based on their own discretion. RESULTS: The most similar sounds mimicking tinnitus were of pure tone in both the groups. However, subjects of the tinnitus group were exposed to a greater variety of sounds than those of the non-tinnitus group. Moreover, the most common frequency of tinnitus was 4 and 8 kHz in the tinnitus group, but 1 kHz in the non-tinnitus group. The mean loudness of tinnitus was 7.28 dBSL in the tinnitus group and 13.6 dBSL in the non-tinnitus group. The loudness of tinnitus in the tinnitus group was less than that in the non-tinnitus group in a statistically significant manner (p<0.05). Loudness in each repeated tinnitus tests was identical in tinnitus group, but significantly different in non-tinnitus group (p<0.05). CONCLUSIONS: We concluded that repeated tinnitus tests for loudness matching were helpful in identifying the presence of tinnitus.

A Human Immunodeficiency Virus-Positive Patient with Dizziness and Peripheral Facial Palsy / 대한평형의학회지

Various neurological complications occur in association with human immunodifiency virus (HIV) infection. These complications occur at all stages of infection and any level of central and peripheral nervous system. Neurological complications, such as aseptic meningitis, encephalopathy, neuropathy, myelopathy, and brachial neuritis, develop in association with primary HIV infection. We here in report a case of peripheral facial palsy with suspicious peripheral vertigo manifested as initial symptoms of primary HIV infection.

Changes of Mastoid Gas Physiology in Virtual Mastoidectomy Model / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is essential to understand gas physiology of mastoid cavity to study the pathophysiology of middle ear diseases, and the surface area and volume of mastoid mucosa are important parameters for evaluating gas physiology. However, the surface area and mastoid volume of the mastoid cavity have not been practically measured yet. Therefore, we measured and compared surface area and volume of the mastoid cavity before and after mastoidectomy using a virtual mastoidectomy model. SUBJECTS AND METHOD: We performed a virtual mastoidectomy using 10 cases of temporal bone CT indicating pneumatic mastoid. First, we removed all air cells after outlining with irregular AOI function after loading axial CT images to Image-Pro Plus 4.0. Then we filled the removed area with equal planes using local equalization filter. Finally, we calculated and compared the total surface area, volume and area to volume (A/V) ratio by estimating their circumference and area. RESULTS: The mean surface area of pneumatized mastoid cavity was 127.8 cm2 (range: 94.2-165.3 cm2), and the mean volume was 7.1 cm3 (range: 5.2-11.0 cm3). The mean surface area and volume were altered to 42.8 cm2 (range: 35.9-55.0 cm2) and 12.6 cm3 (range: 10.3-18.7 cm3), respectively, after virtual mastoidectomy. As a result, the A/V ratio decreased from 18 to 3.4 after a virtual mastoidectomy in the pneumatic mastoid cavity. CONCLUSION: When a complete mastoidectomy is performed in the pneumatic mastoid, the surface area is decreased by one third compared to a relatively minor increase in volume. Therefore, the surface area per unit volume is expected to greatly decrease after mastoidectomy. Some physiologic problems occurring after mastoidectomy could be more accurately explained using a virtual mastoidectomy model.

Immunoglobulin E and Transcription Factor in Adenoid of Children with Allergy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Immunoglobulin E (IgE) production in adenoid has been debated and the role of adenoid in development of allergy remains largely unknown. To examine the production of local IgE in adenoid involved with IgE-mediated sensitization, we evaluated IgE production and the expression of the transcription factor B cell leukemia/lymphoma-6 (BCL-6) and B lymphocyte inducer of maturation program 1 (Blimp-1) in adenoids. SUBJECTS AND METHOD: Ten children with allergic rhinitis (AR) and ten children without any history of AR were enrolled. Immunohistochemical studies of adenoid for IgE, BCL-6 and Blimp-1 were performed. RESULTS: IgE was stained mainly in the germinal center and submucosal area and the stainingscores of antibody to IgE did not differ signigicantly between children with AR and control. BCL- 6 was mainly stained in mucosa and germinal center and Blimp-1 in mucosa. The scores of antibody to BCL-6 and Blimp-1 in children with AR and control did not show significant differences. CONCLUSION: We found that allergic rhinitis was not involved in the production of IgE nor the expression of the transcription factor BCL-6 and Blimp-1 in adenoid

Clinical analysis of Bell's palsy in pregnancy / 대한산부인과학회지

OBJECTIVE: Although Bell's palsy is not common in pregnancy, it is more prevalent among pregnant women than among non-pregnant women. Since the exact clinical characteristics of this condition are not fully understood, we evaluated the epidemiology, pathophysiology, onset time, as well as the recovery rate according to treatment modality of Bell's palsy in pregnancy, and compared them to those of the non-pregnant population in this study. METHODS: Between March 1996 and February 2006, we identified 43 patients who suffered from Bell's palsy during pregnancy and postpartum with a minimum 6 month follow up at Kyung Hee University Hospital. We conducted retrospective medical records analysis and compared them to similary chosen Bell's palsy case in non pregnant women who were matched for age. RESULTS: The median gestational age at the onset of Bell's palsy was 32 weeks. Among the 43 patients who had been diagnosed with Bell's palsy in pregnancy, 81.4% (35 of 43) showed a satisfactory outcome. Among the 36 patients with complete palsy, 77.8% (28 of 36) showed a satisfactory recovery. Recovery rate according to treatment modality in pregnant patients with Bell's palsy were 28/35 (80.0%) in the acupuncture group, 3/3 (100%) in the steroid therapy group, and 4/5 (80.0%) in the combined acupuncture and steroid therapy group, respectively. CONCLUSION: We did not detect any difference in clinical characteristics of Bell's palsy in the pregnant group compared with the non-pregnant group. Further study will be needed to select the method of treatment for Bell's palsy in pregnant women.