Positional Vertigo Showing Direction-Changing Positional Nystagmus after Chronic Otitis Media Surgery: Is It Benign Paroxysmal Positional Vertigo? / 대한평형의학회지

This case report describes a patient who developed positional vertigo after surgery for chronic otitis media on the right side. Canal wall up mastoidectomy was performed, and the stapes was moderately mobilized during removal of the inflammatory granulation tissues that were attached to it. Immediately after the surgery, positional vertigo developed. The patient showed weakly left-beating spontaneous nystagmus in a seated position. Examination of positional nystagmus revealed geotropic direction-changing positional nystagmus with a prolonged duration and weak intensity in a supine head-roll test, which may be caused by a change in inner ear fluids due to a disruption of inner ear membrane around the oval window or penetration of toxic materials into the labyrinth during surgery.

The Light Cupula: An Emerging New Concept for Positional Vertigo

Benign paroxysmal positional vertigo (BPPV) is the most common type of positional vertigo. A canalolithiasis-type of BPPV involving the lateral semicircular canal (LSCC) shows a characteristic direction-changing positional nystagmus (DCPN) which beats towards the lower ear (geotropic) on turning the head to either side in a supine position. Because geotropic DCPN in LSCC canalolithiasis is transient with a latency of a few seconds, the diagnosis can be challenging if geotropic DCPN is persistent without latency. The concept of “light cupula” has been introduced to explain persistent geotropic DCPN, although the mechanism behind it requires further elucidation. In this review, we describe the characteristics of the nystagmic pattern in light cupula and discuss the current evidence for possible mechanisms explaining the phenomenon.

Prevalence of Allergic Disease in Korean Adults: Results from the Korea National Health and Nutrition Examination Survey (2010–2012) / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In this study, we evaluated differences in the prevalence of allergic rhinitis, asthma, atopic dermatitis and specific immunoglobuline E (IgE) value for some respiratory antigens in Korean adults. SUBJECTS AND METHOD: The study was conducted using data from the 5th National Health and Nutrition Survey (2010-2012). All subjects who were aged 19 years or older completed questionnaires on asthma, atopic dermatitis and allergic rhinitis. The subjects were first divided into male and female, and then into age groups of 19-29, 30-39, 40-49, 50-59, 60-69, ≥70 each. The lifetime and current prevalence rates for allergic rhinitis, asthma, and atopic dermatitis were calculated for each age group. The total and specific IgE level for Dermatophagoides farinae (DF), cockroach, and dog dander were also calculated. RESULTS: Final participants of 17542 were analyzed for the prevalence rate among the total of 25534 participants. The mean IgE level was calculated from 2028 subjects from the final participants. In asthma, the lifetime prevalence and current prevalence increased with age, but decreased with atopic dermatitis and allergic rhinitis. Total IgE level increased with age, but IgE level of DF reached its peak at 20-29 years, and then decreased rapidly thereafter. There was no clear trend for cockroach and dog dander. CONCLUSION: The prevalence of allergic diseases in adults varies widely by age group. Asthma has a low prevalence after age 20 and gradually increases after age 50. Atopic dermatitis and allergic rhinitis are the most prevalent in their 20s and gradually decrease thereafter.

The Effect of Sleep Disordered Breathing on Olfactory Functions: Analysis by Apnea-Hypopnea Index

OBJECTIVES: One hypothesis of obstructive sleep apnea syndrome (OSAS) is that long-standing snoring vibrations and hypoxia of the nerves cause a local neuropathy in the upper airway during sleep. The aim of this study was to investigate olfactory function in subjects comprising snorers and untreated subjects with OSAS, and to correlate data with polysomnographic parameters. METHODS: Sixty-nine patients were evaluated for snoring from January 2010 to December 2013. The mild group (apneahypopnea index [AHI]<15) consisted of 19 subjects, and the moderate-severe group (AHI≥15) consisted of 50 subjects. Exclusion criteria were conductive olfactory dysfunction, previous tonsil or soft palatal surgery, central sleep apnea, and medications that are known to affect peripheral nerves. Nocturnal polysomnography and olfactory function test such as Korean version of Sniffin’s stick test I, II (KVSS I, II) were performed. RESULTS: There was a significant difference in body mass index, average oxygen saturation (SaO2), lowest SaO2, average snoring duration, and KVSS I, II between the two groups. AHI was related to odor threshold score, and average SaO2 was related to odor discrimination score. But, odor identification score showed no relation with AHI and average SaO2 except for age. Average SaO2 and AHI were closely related to the function of smell. CONCLUSION: Hypoxia and low nasal airflow caused by OSAS may have an effect on the olfactory function. On comparison between the two groups, patients with a high AHI, especially those with OSAS, had an olfactory dysfunction. Also, low average oxygen is the main risk factor in determining the olfactory function. In people with OSAS, the possibility of olfactory dysfunction should be considered and an olfactory function test should be performed.