Analysis of Snoring Sound in Obstructive Sleep Apnea Patients Based on Obstruction Site / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The detection of obstruction site is very important for the surgical treatment of obstructive sleep apnea (OSA). Among the various diagnostic modalities for detection that have been tried, an analysis of snoring sound could be a simple and safe alternative. This study evaluates the usefulness of sound analysis in OSA as a detection tool of obstruction site. SUBJECTS AND METHOD: Fifteen patients who had been enrolled for the suspicion of OSA were studied. They were examined by videofluoroscopy and polysomnography to evaluate the obstruction site. During videofluoroscopy, snoring sound was recorded simultaneously. The snoring sound was analyzed by using Matlab program and its sonic characteristics were evaluated on the basis of the results in polysomnography and videofluoroscopy. RESULTS: According to the videofluoroscopy, 5 out of 15 patients showed narrowness only in the soft palate, while the rest of the 10 patients showed narrowness both in the soft palate and tongue base. Most of the snoring sound from the soft palate was of a low tone, under 1000 Hz, while the snoring sound from both soft palate and tongue base showed a high tone band, over 1000 Hz frequently and hump around 10 kHz. There was no specific correlation between apnea-hypopnea index and sonic characteristic. CONCLUSION: The analysis of snoring sound may be a useful tool for detecting the obstruction site in OSA.

The Effect of the Combined Use of Immunotherapy and Topical Steroid on the Quality of Life in Allergic Rhinitis Patients

BACKGROUND AND OBJECTIVES: The management of allergic rhinitis includes allergen avoidance, pharmacotherapy, and immunotherapy. Only a few studies have compared the clinical efficacy of the two treatments. We conducted a study to compare the efficacy of immunotherapy (IT), a topical steroid (TS), and combined therapy (IT+TS) in allergic rhinitis. MATERIALS AND METHODS: The three groups (IT:11 patients, TS:ten patients, IT+TS:ten patients) were treated for six months and were evaluated using questionnaires and a physical exam before and after treatment. RESULT: Overall symptoms were reduced after six months of treatment in all groups. In the IT+TS group, signs and symptoms diminished more than those in the IT or TS groups. Difference in skin test sensitivity among the groups was not statistically significant. CONCLUSION: Combined use of immunotherapy and a topical steroid was more effective than either therapy alone in reducing the signs and symptoms of allergic rhinitis.

Hearing Results of Tympanoplasties in 175 Patients with Chronic Otitis Media / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To report the hearing results of tympanoplasty for chronic otitis media with or without cholesteatoma. SUBJECTS AND METHOD: One hundred and seventy-five patients presenting chronic otitis media with or without cholesteatoma were involved in a retrospective study. Tympanoplasties were performed by the same surgeon over a 30-month period. Audiometric results were reviewed. Audiometric results according to the following techniques were measured: tympanoplasty type 1 (T1), interposition (Si) and/or columella (Sc) over stapedial head, and interposition or columella (Fic) over footplate. The follow-up period ranged from 6 to 32 months. Audiological parameters using the average of four frequencies were assessed pre- and post-operatively. RESULTS: Overall hearing results showed postoperative air-bone gaps (ABG) < or =20 dB in 69% of cases. ABG was closed to within 20 dB in 89% for T1, 67% for Sc, 58% for Si, and 30% for Fic. ABG was closed to within 30 dB in 95% for T1, 67% for Sc, 83% for Si, and 70% for Fic. There was a significant improvement between preoperative and postoperative ABGs. The overall improvement of the air-bone gap was 8+/-13 dB. There was no significant functional difference between different surgical techniques. CONCLUSION: Our hearing results after tympanoplasties were similar to those from other studies. The hearing results observed in this study confirmed that successful results can be obtained by applying the current principles and approach to ossicular reconstruction.

Results of Air Caloric and Other Vestibular Tests in Patients with Chronic Otitis Media

OBJECTIVES: Air caloric results are supposed to be influenced by anatomic changes of the middle ear. The aims of our study were to evaluate the incidence and characteristics of abnormal air caloric results in patients with unilateral chronic otitis media and without any history of vertigo, and to compare caloric results with there of other vestibular function tests (VFTs). METHODS: Twenty five patients with unilateral chronic otitis media (COM) who were scheduled for surgery underwent VFTs preoperatively. Hearing was assessed using pure-tone audiometry and vestibular function was assessed using a set of VFTs: air caloric, head-shaking nystagmus (HSN), vibration-induced nystagmus (VIN), and subjective visual vertical (SVV) tests. RESULTS: Six patients (24%) showed pathologic canal paresis (CP) on COM-sided ears. Two patients showed pathologic CP on the contralateral side. However, both of the two showed inverted nystagmus to warm air stimulation on the COM-side and hyperactive nystagmus to cold air stimulation on the COM-side, which means that the COM-sided ear was stimulated too much. There was pathologic HSN in 12 patients (48%), pathologic VIN in 7 (28%), and pathologic SVV in 5 (20%). Overall, 20 (80%) patients showed abnormal findings through a set of VFTs. Patients with an interaural difference of bone-conduction hearing thresholds > or =10 dB tended to show more abnormal VFT results than those for whom the interaural difference of bone-conduction hearing thresholds was <10 dB. CONCLUSION: Our data show that one-fourth of patients with unilateral COM show abnormal caloric results on the COM side. However, subclinical latent vestibular imbalances were found to be common, which might be related to the gradual vestibular involvement in inflammatory processes, regardless of the caloric results. Results of a set of VFTs should be referred to when determining vestibular imbalance in patients with COM.

Follow-up Changes of Eye Movements by Caloric Stimulation in Patients With Vestibular Neuritis

BACKGROUND AND OBJECTIVES: A significant recovery of resting activity in the vestibular nuclei ipsilateral to the unilateral labyrinthectomy has been reported by the time symptoms such as spontaneous nystagmus and roll head tilt have largely disappeared. However, the dynamic vestibular response after unilateral vestibular loss to passively imposed vestibular stimuli does not recover. MATERIALS AND METHODS: We investigated changes of the caloric responses in 32 patients with vestibular neuritis during in- and out-patient visits separated by 2 months in an attempt to identify changes brought about by peripheral and/or central compensation processes. RESULTS: The slow-phase eye velocities stimulated by warm caloric stimulation at acute and follow-up stage were 6.6+/-6.6 degrees/s, 9.5+/-9.9 degrees/s in the lesioned side; 28.4+/-19.1 degrees/s, 24.5+/-11.6 degrees/s in the intact side. The slow-phase eye velocities stimulated by cold caloric stimulation at acute and follow-up stage were 5.9+/-7.7 degrees/s, 10.3+/-8.2 degrees/s in the lesioned side; 19.8+/-10.3 degrees/s, 18.8+/-9.9 degrees/s in the intact side. CONCLUSION: Our findings show that the recovery of caloric responses comes mostly from the recovery of the eye responses to the caloric stimulation in the lesioned side and the eye responses to the caloric stimulation in the intact side does not change over time after vestibular neuritis.

Tympanometry and CT Measurement of Middle Ear Volumes in Patients with Unilateral Chronic Otitis Media

OBJECTIVES: The goals of the study were to compare the middle ear (ME) volumes from both normal and lesioned ears, and these ME volumes were measured by a digital image processing computed tomography (CT) program in patients with unilateral chronic otitis media, and we wanted to compare the ME volumes of the lesioned ears by comparing the ME volumes obtained by tympanometry with those ME volumes measured by the digital image processing CT program. METHODS: Forty-four patients who had unilateral chronic otitis media (COM) and contralateral normal tympanic membranes (TM) and 100 subjects with normal TMs were included in the study. The normal volumes of the external auditory canal (EAC) were measured in the normal group. The tympanometric ME volumes in the ears with a perforated TM were calculated as the difference of the tympanometric volumes measured from the both ears in patients with unilateral COM. The CT ME volumes were measured by a digital image processing program. RESULTS: The tympanometric volumes of the EACs in the ears with normal TMs were 1.4+/-0.3 mL. There were no significant differences according to gender, age and the side of the face the ear was on. The tympanometric volumes of the EAC in the normal-side ear of the patients with unilateral COM showed no significant differences when compared with those from the normal group. The ME volumes of the intact ears, as measured by CT, showed significantly higher values than those ME volumes of the lesioned ears. The ME volumes of the lesioned ears, as measured by tympanometry, showed a strong, significant linear correlation with those ME volumes calculated by CT; however, the ME volumes of the lesioned ears, as measured by tympanometry (1.5+/-1.4 mL), were significantly larger than those ME volumes measured by CT (1.1+/-0.8 mL). CONCLUSION: Our results show that chronic otitis media causes reduced ME volumes compared to those ME volumes of the contralateral normal ears. Tympanometry can provide a valuable estimation of the ME volumes in chronic ears, although it tends to overestimate the ME volumes, and especially for the ears with a larger ME volume.

Results of Vestibular Function Tests in Patients with Cerebello-Pontine Aangle Tumors

BACKGROUND AND OBJECTIVES: Acoustic neuroma (AN) is commonly encountered in the cerebello-pontine angle (CPA) and AN arises principally from the vestibular division of the nerve, which can show not only hearing disturbance but also various vestibular symptoms and laboratory findings by affecting central and peripheral vestibular system. Vestibular testing is reported not to be a useful screening test for AN, but can be helpful in defining whether the tumor arises from the superior or inferior division and identifying the cause of dizziness or vertigo. MATERIALS AND METHOD: We are presenting four patients with CPA tumors accompanied by various abnormal findings of vestibular function tests including head-shaking nystagmus, vibration-induced nystagmus, hyperventilation- induced nystagmus and vestibular evoked myogenic potential and subjective visual vertical, which can enable us to understand the pathomechanism of the abnormal results. RESULTS: All patients presented hearing loss and mild dizziness. Caloric test, head thrust test and vibration-induced nystagmus was helpful in localizing the disease, but head-shaking nystagmus and hyperventilation-induced nystagmus was less helpful. Otolith tests did not always show abnormal results. CONCLUSION: We should consider abnormal results of the vestibular function tests in a whole to estimate the status of vestibular compensation in patients with CPA tumors.

A Model of Human Nose and Paranasal Sinuses for the Study of Sinus Ventilation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The pathogenesis of chronic paranasal sinusitis has been gradually clarified, but there have been conflicting arguments on the ventilation of paranasal sinus. The aim of the present study is to establish an objective, quantitative and reproducible method for the investigation of the ventilation of paranasal sinuses. MATERIALS AND METHODS: With the axial images of high resolution computed tomography, a fine model of human paranasal sinus was made. The model was fitted with pressure sensors, and the pressure changes in the nasal cavity, frontal, maxillary and sphenoid sinuses were measured by pressure sensors and digital physiograph during nasopharyngeal respiration. RESULTS: Results demonstrated negative pressures compared to the atmospheric pressure during inspiration and positive pressures during expiration in the sinonasal cavities, and the highest and lowest pressures were measured in the nasal cavity. CONCLUSION: This study introduces another method for the investigation on the sinus ventilation through a model study. And this study model has demonstrated that the ventilation of paranasal sinuses depends on nasal respiration. Furthermore, the method is useful to evaluate the results of nasal and sinus surgeries in the case of an obstructed ostium, deviated septum or hypertrophied turbinates.