Change of Subjective Visual Vertical (SVV) in Patients of Vestibular Neuritis

BACKGROUND AND OBJECTIVES: Measurement of subjective visual vertical (SVV) in darkness with the head upright is one of the static function test of the otolithic system and is simple to perform in the patients. Changes of SVV were measured during the recovery period of vestibular neuritis to investigate the relation between SVV and the subjective improvements reported by the patients. MATERIAL AND METHODS:Sixty-two patients with unilateral vestibular neuritis were investigated. All the patients were diagnosed by physical examination with electronystagmography and the SVV were assessed during the acute period and sequentially followed during the recovery period. At the same time, the subjects were questioned in five scale of symptom improvement which were "Level 5: I am so dizzy to open my eyes", "Level 4: I am dizzy not moving my head", "Level 3: I am not dizzy if I don't move my head", "Level 2: I am not dizzy with head moving", "Level 1: I am not dizzy at all". RESULTS: The calibrated mean values were 5.72+/-4.77 degree in vertical deviated toward the lesion side. There was no relation between the canal paresis and the tilt of SVV. As the SVV reaches the normal value, the symptom scale improved to level 2 (p=0.018). The mean recovery time could be obtained by calculating the regression curve of the well compensated groups. CONCLUSION: These results show that SVV correlated with clinical improvement of dizziness symptoms in vestibular neuritis. Therefore, this method can be used to evaluate vestibular neuritis during the follow up.

A Case of Masson's Hemangioma of the Buccal Mucosa / 대한이비인후과학회지

Masson's hemangioma, which is also called intravascular papillary endothelial hyperplasia (IPEH), is a benign, vascular lesion that is characterized histologically by papillary fronds lined by proliferating endothelium. It is thought to represent an unusual form of organizing thrombus. It may deveolop in a distended vessel or in association with other vascular lesions. The main singnificance of Masson's hemangioma is its microscopic resemblance to angiosarcoma and possible misinterpretation as such. We report the case of a 42-year-old woman who had such a lesion in the left buccal mucosa and discuss the management of this lesion, with an emphasis on radiologic and histologic assessment and the differential diagnosis.

Effect of Electrical Stimulation on Vestibular Compensation in the Unilateral Labyrinthectomized Rats / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The effect of electrical stimulation (ES) on vestibular compensation was investigated for 28 days after unilateral labyrinthectomy (Lx) in 24 rats. MATERIALS AND METHOD: The rats were divided into 4 groups and were treated as follows: A) Lx only, B) Lx with ES (0.6 mA) for 2 days, C) Lx with ES (0.6 mA) for 7 days, D) Lx with ES (1.2 mA) for 2 days. ES with pulse wave (10 Hz) was applied to temporal portion bilaterally (8 hr/day). Cathodal currents were transmitted to the electrode on the destructive side, anodal to that on the intact side. Postoperatively, spontaneous nystagmus (SN) was recorded with the video camera and yaw and roll head tilt (YHT, RHT) were measured using photo images. Horizontal vestibulo-ocular reflex (VOR) was evaluated at various frequencies (0.05, 0.1, 0.5, 1, 2, 3 Hz with peak angular velocity of 40degrees/sec) with the magnetic search coil system. Locomotor movement was monitored with a video camera. RESULTS: The ES groups showed faster compensation in SN, YHT, and RHT than the Lx group. At 3 days after Lx, the ES groups showed significant improvement in the gain over the whole frequency and asymmetry at low frequency compared to that of the Lx group. But the ES group had no effect on compensation of gain and asymmetry on and after 7 days of post-labyrinthectomy. There was no significant difference in vestibular compensation with respect to duration and intensity of ES. ES had no significant effect on the mean velocity and mean deviation of locomotor movements. CONCLUSION: These results suggest that ES has a favorable effect on the suppression of early static symptoms but has no effect on the compensation of dynamic symptoms after the recovery of resting discharge of the vestibular nuclei neurons.

Morphophysiology of Primary Vestibular Afferents Recorded from an in vitro Preparation of Mouse Inner Ear / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We are developing an in vitro preparation of the mouse inner ear so as to study morphophysiologic character of primary vestibular afferents and synaptic transmission within the vestibular epithelium. MATERIALS AND METHOD: We have intra-axonally recorded from over 300 ampullary fibers, close to the base of their respective anterior and lateral crista (<500 micrometer from hair cell/afferent nerve synapse), and labelled as a sub-set of these with biocytin (n=71). Discharge activity can be classified as regular or irregular based on the variation of the interspike interval (coefficient of variation). Using a micropusher to indent exposed windows of membranous labyrinth, we have characterized the response properties of both anterior and horizontal canal afferents. We studied afferent activity in response to sinusoidal indentations of anterior and horizontal membranous canal. RESULTS: The majority of labelled units were dimorphic (56 out of 71), having both calyx and bouton terminals and there was no labelled bouton terminal. Whether action potentials (Aps) were spontaneous or elicited with current, a heterogeneity of discharge activity was observed and these were similar to those previously reported in in vivo recordings from other mammalian species. In recordings over a range of frequencies from 0.01 to 10.0Hz, afferents responded with sinusoidal changes at discharge rates and modulation of membrane potential in a predictable manner. The phase response of the afferent discharge was characterized by frequency-dependent shifts in peak activity. The peak activity of anterior canal was in advance of the maximum indentation (180dgrees out of phase), with largest phase leads at 0.01 Hz (59.2+/-14.1dgrees) and the smallest phase leads occurring at 1.0 Hz (13.4+/-9.3dgrees), while maximum indentation was in advance of the peak activity at 10.0 Hz (-17.6+/-9.1dgrees). These phase shifts were similar to those reported in in vivo recordings from mammals, despite our use of artificial rather than natural rotational stimuli. CONCLUSION: We developed an in-vitro mouse model to study morphophysiologic characteristics of primary vestibular afferent nerve and synaptic transmission.

Three Dimensional Analysis of Caloric, Spontaneous, Positional, Positioning and Post Head Shaking Nystagmus in Bilateral Vestibulotoxic Cats / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Vestibular toxicity can be usually monitored by a caloric test, but measuring eye movements including nystagmus is also helpful in the evaluation of vestibulotoxic process. To understand the vestibular signs during bilateral vestibulotoxic process, we observed three dimensional serial changes of eye movements and the results of caloric test in cats using a magnetic search coil system. MATERIALS AND METHODS: Three-dimensional (3-D) eye movement responses to ice water caloric stimulus and spontaneous, positional, positioning, and post head shaking nystagmus in five cats were serially evaluated at 3, 7, 10, 14, 21, 28 days, 2, 3, 4, 5, 6 months after inducing bilateral vesitibulotoxicity by subcutaneous injection of streptomycin. Histologic changes of vestibular system were also observed. RESULTS: Bilateral vestibulotixicity which showed no response to ice water caloric stimulus was induced within 2 weeks with streptomycin injection. Positional, positioning and post head shaking nystagmus were present during vestibulotoxic process. Caloric nystagmus did not reappear within 6 months and histologic finding in crista ampullaris of lateral semicircular canal showed marked degeneration of the hair cells and nerves. CONCLUSION: Observation of positional, positioning and post head shaking nystagmus as well as ice water caloric test will be helpful to monitor vestibulotoxic process.

Effect of Nitric Oxide and Peroxynitrite in Mucociliary Transport Function of Experimental Otitis Media with Effusion / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nitric oxide (NO) is generally beneficial but potentially toxic to host. It has been suggested that NO is an important mediator in the pathogenesis of otitis media with effusion. The harmful effect of NO is related with NO-derived intermediates such as peroxynitrite (OONO-). The author investigated the role of NO and peroxynitrite on mucociliary activity in experimental otitis media with effusion. MATERIALS AND METHOD: Otitis media with effusion was induced by injecting lipopolysaccharide (LPS) transtympanically in guinea pigs. In the N(G)-nitro-L-arginine methyl ester (L-NAME) group, L-NAME was additionally injected intratympanically and intramuscularly. Uric acid (UA) group was treated with intraperitoneal injection of UA 3 times. After 24 hours, dye transfer time was measured and temporal bones were taken for histopathologic examination. Expression of peroxynitrite was determined by immunohistochemical stain for 3-nitrotyrosine (3-NT). RESULTS: Transfer time of dye was prolonged in LPS group, whereas it was significantly reduced in L-NAME or UA treatment group. Inflammatory cell infiltration and mucosal edema were less in the treatment groups than LPS group, but it was not statistically significant. 3-NT was expressed intensely in subepithelial layer of LPS group, and decreased to mild to moderate degree in the treatment groups. CONCLUSION: LPS induced mucociliary dysfunction in the middle ear by NO and peroxynitritemediated pathways. This study suggests that inhibition of NO synthesis or scavenging of peroxynitrite may have an adjunctive role in the future treatment of otitis media with effusion.

Three dimensional analysis of caloric nystagmus and effect of visual suppression in cats / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The caloric test is considered to be one of the most sensitive parameters in the diagnosis of peripheral vestibular disorders, although it can test only the function of the lateral semicircular canals. In this study, the authors measured the eye movements and visual suppression of caloric nystagmus in cats three dimensionally using a magnetic search coil system. MATERIALS AND METHOD: Three-dimensional (3-D) eye movement responses to an ice water caloric stimulus were studied with the six normal cats positioned in an upright position (lateral semicircular canal vertical). Visual suppression of caloric nystagmus was also investigated. RESULTS: All animals showed eye movements in the horizontal, torsional and vertical planes. Of the three nystagmus components, the horizontal component showed the fastest eye velocity during caloric stimulation. In light, a slight, but certain degree of visual suppression in was recognized in cats. CONCLUSION: The caloric nystagmus response involves a complex eye movement response comprising the horizontal, vertical and torsional nystagmus components. The 3-D analysis system with a magnetic search coil is useful to investigate the eye movement during caloric stimulation when the cat is awake.

Short Term Hearing Results of Assembled Allograft Septal CartilageOssiculoplasty of PORP and TORP Configuration / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Various techniques of ossicular reconstruction have been advocated for hearing restoration in the chronic otitis media and cholesteatoma. Although cartilage has good biocompatibility to minimize extrusion or displacement, and is readily available, versatile to use, the hearing results with cartilage graft are poorer than that with plastic materials. The author believed this was due to the sculpturing problem of cartilage, and has devised an assembled type of cartilage ossiculoplasty of PORP and TORP configuration. The technique and short term results are reviewed. METHODS: Of the patients who underwent ossiculoplasty between 1998 and 2000, 103 ears of 95 patients, aged 3-66 years (mean 38.9) were analysed retrospectively. The follow-up period was from 3 to 30 months (mean 9.5). Fifty-one ears were found to be in the second stage and 52 ears were in the first stage. Allograft septal cartilage was sculptured separately and assembled as head and shaft. The average threshold in the frequencies of 500, 1000 and 2000 Hz was used for determination of results. RESULTS: The preoperative mean air-bone gap (ABG) was 42.86+/-8.79 dB and postoperative ABG was 21.22+/-11.33 dB. Gain of ABG was 21.63+/-11.11 dB. Closure of the ABG to within 10 dB, 20dB and 30 dB were achieved in 25.24%, 55.34% and 83.50% respectively. Gain of the ABG did not differ between the one staged and the two staged ossiculoplasty. Patency of eustachian tube orifice and presence of superstructure of stapes did influence the hearing results of this type of ossiculoplasty. CONCLUSION: The assembled type of cartilage ossiculoplasty of PORP and TORP configuration with allograft septal cartilage ossiculoplasty shows satisfactory short term hearing results and represents an excellent alternative to biocompatible prosthesis for ossicular recon-struction.

Acoustic analyses of monosyllabic words which are difficult to discriminate in the high frequency hearing loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Speech discrimination testing has been used to evaluate the communication disability, select hearing aid candidacy and appropriate amplification, plan and evaluate aural rehabilitation programs and assist in the determination of the site of lesion. Since the words of speech discrimination tests were made on the basis of the linguistic aspects and used till now, they underestimate the disability of high frequency hearing loss (HFHL). To ameliorate this problem, we analysed the words which were difficult to discriminate in FHL in a commonly used speech testing material using the acoustic analysis method. Also, the words were assorted to establish a basic data for a new speech material which could estimate the disability of HFHL. METHODS: 20 HFHL subjects (age 20-70), selected on the basis of pure tone audiometry, were found to be the descending type. They were tested to repeat the monosyllabic words at 10-15dB HL above the puretone threshold of 1000Hz and checked with the error responses. These words were sorted out according to the error response or the confusion rate and analyzed by consonants and vowels. The words were recorded with an audiologist's voice using a GSI 10 audiometer connected to the personal computer. This was analyzed by the acoustic analysis program that has the MATLAB function. With this program, a word was analyzed by an initial consonant, a vowel, and a final consonant for the intensity, the formant peak frequency and the time course. RESULTS: The words which were difficult to discriminate for HFHL were sorted out by the confusion rates. The words of articulation score 15-50% were revealed to have low intensity with short duration, and the peak frequency spectrum above 3 kHz. Also the consonant-vowel transition frequency was located above 3 kHz. CONCLUSION: These results could be used as a basic clinical data to make a new speech discrimination material which evaluates the disability of HFHL more accurately.

Normal variation of subjective visual vertical and horizontal in human / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Otolithic system which senses the head position and linear movement according to gravity acceleration force, plays an important role in maintaining the position of eyeball by otolith-ocular reflex. Measurement of subjective visual vertical and horizontal in darkness with the head upright is one of the static function test of the otolithic system and is simple to perform in man. Several papers reported that perceptual visual vertical and horizontal stays within small range in normal person but numbers of test subjects were limited. Furthermore the effect of age and sex are unknown. MATERIAL AND METHODS: One hundred forty normal subjects(male:70, female:70 ; age 5-70) were selected on the basis of medical history and neurologic examination. The subject was seated upright 100 cm from LED bar(1 mm width , 80 cm length)in the dark. The supporting frame of LED bar was motor driven with minimum rotating angle of 0.01 degree in both directions. After several practice, each subject set the LED bar from random position to subjective vertical or horizontal twice in one session with a motor control switch. Five sessions were repeated with a minimum interval of 5 minutes. RESULTS: The calibrated mean values were 1.06+/-0.45 degree in vertical and 1.00+/-0.52 degree in horizontal and did not demonstrate any difference in plane and direction of adjustment. Age under 10 and over 60 had a significant higher mean value compared with the mean of all subjects but the difference between over 10 and below 60 was not noted. Female had higher mean values than male. Five repeated tests showed high reproducibility. The direction of adjustment did not show any significant difference. CONCLUSION: These results would be a useful clinical data for evaluating the static otolith-ocular reflex.

Effects of Testosterone in the Treatment of Immune-mediated Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVE: Previous reports suggest that some cases of sensorineural hearing loss (SNHL) may be the results of abnormal immune reaction. However, specific diagnostic tests and treatment have not been established. This study was performed to evaluate the effect of testosterone in the treatment of immune-mediated SNHL. MATERIALS AND METHODS: Immune-mediated SNHL was induced in female Wistar rats by sensitizing with bovine inner ear antigen 3 times weekly. Two fifty microgram of testosterone propionate was injected subcutaneously 3 times a week from one week before and after the first sensitization. Auditory brainstem response (ABR) and collection of blood were performed prior to each antigen challenge at 1, 2, 3, 4, 6, 8 weeks following sensitization. Collected sera were analyzed using the western blot immunoassay against bovine inner ear antigen preparation. RESULTS: Testosterone-treated animals showed better hearing than the controls, but they also showed incidence of hearing loss over 20 dB (25.0% vs. 53.3%). None of testosterone-treated animals showed hearing loss over 30dR, whereas 40% of control animal revealed hearing loss over 30dB. Five of 9 animals (55.5%) with hearing loss over 20 dB showed a band at 68kD MW, while only one of 14 testosterone-treated animals displayed a band at 68kD MW. CONCLUSION: These results suggest that testosterone may be effective in prevention, and early recovery from immune-mediated SNHL can be used as one of the treatment modalities for immune-mediated hearing loss in the future.

A Case of Acute Myelogenic Leukemia Accompanying Facial Nerve Paralysis / 대한이비인후과학회지

Leukemic involement of the temporal bone is not uncommon, but facial paralysis is rare as the presenting sign. A 16-year-old boy suddenly developed otalgia, facial nerve paralysis, tinnitus and vertigo. Four months ago, acute myelogenic leukemia was detected and chemotherapy was done with incomplete resolution. The initial examination revealed facial nerve paralysis, mixed hearing loss, spontaneous nystagmus but peripheral blood picture was normal. On the fourth hospital day, simple mastoidectomy was performed for drainage and diagnosis. The harvested tissue showed leukemic infiltration and subsequent peripheral blood picture revealed immature cells. Patient refused further evaluation and chemotherapy, and three months later he died of intracranial hemorrhage. We report a case of acute myelogenic leukemia with facial nerve paralysis.

A case of congenital cholesteatoma with anomaly of the bonylabyrinth presenting facial paralysis / 대한이비인후과학회지

No abstract available.