Retraction: Systematized Intraoperative Facial Nerve Monitoring in Middle Ear and Mastoid Surgery; 'Surgical Dehiscence' and 'Electrical Dehiscence' / 대한이비인후과학회지

No abstract available.

Retraction: Expression Pattern of Gap Junction Protein, Connexin 26 and 43 in Human Middle Ear Cholesteatomas / 대한이비인후과학회지

No abstract available.

Management for the Children with Otitis Media with Effusion in the Tertiary Hospital

OBJECTIVES: Recently, new evidence-based recommendations have been introduced for diagnosing and managing otitis media with effusion (OME) in children. However, there are some difficulties to follow the general guidelines in the tertiary hospitals. The purpose is to evaluate the efficiency of antibiotics or antihistamines for treatment of children with OME in the tertiary hospital with a randomized prospective clinical study. METHODS: Eighty-four children with OME who had been diagnosed in the tertiary hospital were randomized to receive 5 different medications for 2 weeks. We prescribed antibiotics (amoxicillin-clavulanate syrup) in Group I (n=16), antibiotics/steroids (prednisolone) in Group II (n=18), antibiotics/antihistamines (ebastine) in Group III (n=15), antibiotics/steroids/antihistamines in Group IV (n=17), and mucolytics (ivy leaf extract) in Group V (n=17) for control. We followed-up children every 2 weeks and evaluated the state of OME at 3 months. RESULTS: Thirty six (42.9%) of 84 children were resolved within average 6.9 weeks after the treatments. Thirty-six (42.9%) were treated with ventilation tube insertion and 12 patients (14.3%) were observed. There was no difference in the resolution rates of OME among the five different protocols (P>0.05). There was no difference in the resolution rates among groups who used steroids, antihistamines, steroids and antihistamines, or other medications to manage 42 children with allergies (P>0.05). CONCLUSION: In the tertiary hospital, the cure rate of children with OME was not as high as well-known, and antibiotics or anti-allergic medications were not more effective than control. We may, therefore, need any other guidelines which are different from the previous evidence-based recommendations, including early operation in the tertiary hospitals.

Systematized Intraoperative Facial Nerve Monitoring in Middle Ear and Mastoid Surgery: 'Surgical Dehiscence' and 'Electrical Dehiscence' / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The use of intraoperative facial nerve monitoring (IOFNM) improves facial nerve outcomes in acoustic neuroma surgeries, but the role of IOFNM in middle ear and mastoid surgeries is poorly defined. This study was performed to evaluate the role of IOFNM in middle ear and mastoid surgeries and to systemize IOFNM. SUBJECTS AND METHOD :We carried out a prospective study of 83 patients who undertook middle ear and mastoid surgeries with IOFNM. We checked the facial nerve dehiscence and estimated its location and length using a surgical microscope ('surgical dehiscence'). We stimulated the facial nerve with constant current, unipolar stimulation using Nerve Integrity Monitor (NIM)-2(TM) (Xomed (TM), U.S.A.) and estimated the minimal threshold of electric current making the electromusculography of facial muscle changes. RESULTS: Thirty six (43.4%) of 83 cases showed 'surgical dehiscence' and all responded to 0.7 mA or less of electrical stimulation. The most common site of 'surgical dehiscence' was middle portion of the tympanic segment. We defined the response to electrical stimulation within 0.7 mA as 'electrical dehiscence.' 'Electrical dehiscence' was presented in 63 (75.9%) cases and 82.5% of these cases responded to stimulation of 0.4 mA or less. The mean threshold of minimal electrical stimulation was 0.28 mA for tympanic segment and 0.48 mA for mastoid segment. CONCLUSION: "Electrical dehiscence" based on responses of electrical stimulation is safer than "surgical dehiscence," which is based on microscopic observation in middle ear and mastoid surgery. Based on this study, we recommend the electrical stimulation of 0.7 mA for first screening and 0.4 mA for second exploration in defining facial nerve using intraoperative NIM-2(TM) monitoring in middle ear and mastoid surgeries.

Expression Pattern of Gap Junction Protein, Connexin 26 and 43 in Human Middle Ear Cholesteatomas / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A human cholesteatoma in the middle ear is characterized by the presence of a keratinizing epithelium from hyperproliferative properties. It needs intercellular signal exchange through gap junctions as well as intracellular signal pathway for hyperproliferation. Connexin (Cx) is a gap junction protein for intercellular communication, and especially Cx26 and Cx43 are plenty in human epithelial cells. The objective of this study was to analyze the expression pattern of Cx43 and Cx26 in human middle ear cholesteatomas against normal epitheliums. SUBJECTS AND METHOD: Ten retroauricular skins (RAS), ear canal skins (ECS), and cholesteatomas were taken during middle ear operations at the Department of Otolaryngology. Immunohistochemical staining, reverse transcription-polymerase chain reaction (RT-PCR), and Western blotting were used to detect Cx43 and Cx26. RESULTS: In human cholesteatomas, Cx43 were expressed in the whole suprabasal layers, especially in the middle portion, except in the basal layer, and Cx26 were usually expressed in the supra layer and in the basal layers. But normal RASs showed weak expression of Cx43 in the upper spinosal and granular layers, but not in the basal layers, and the restricted localization of Cx26 in the basal layer. The expression of Cx43 and Cx26 in EASs was weak but showed similar patterns to that of cholesteatomas. In RT-PCR and Western blot, the expression of Cx43 and Cx26 were increased in cholesteatomas than in RASs. CONCLUSION: Human middle ear cholesteatomas showed upregulated expression and different localization of Cx43 and Cx26, gap junction proteins for intercellular communication, compared with normal RASs, suggesting that perturbations of intercellular communication through gap junctions may be associated with the pathology of human middle ear cholesteatomas.

Benign Paroxysmal Positional Vertigo of Childhood

BACKGROUND AND OBJECTIVES: Episodic vertigo and/or dizziness in children are not frequent symptoms. Causes of benign episodic vertigo in pediatric age include bengin paroxysmal vertigo of childhood(BPV) and bengin paroxysmal positional vertigo(BPPV). While BPPV has been frequently observed in adult, less frequently observed in children. The aim is to review the clinical manifestations in children with BPPV. MATERIALS AND METHOD: 154 children with dizziness or vertigo, who visited the Dizziness Clinic in the Department of Otolaryngology, Ajou University Hospital, Suwon, Korea between January 2001 and November 2006 were selected for this study. From all the patients, a comprehensive history was obtained, followed by clinical examination of the ears, nose, and throat and a complete audiologic and neurotologic examination including electronystagmography. All patients were treated with an appropriate canalith repositioning maneuver(CRP), depending on the type of BPPV. RESULTS: Seven (4.5%) of 154 children with dizziness or vertigo showed typical BPPV. The mean age was 11.8 years old (9-15 years). The horizontal and anterior semicircular canals were involved in 6 (85.8%) whereas the multiple semicircular canals were involved in 1 (14.2%) patients. Vertigo symptom subsided immediately in 6 (85.7%) patients after one or two trials of CRP, but 1(28.6%) patient showed recurred vertigo, that was treated with retrial of CRP. CONCLUSION: The incidence of BPPV in children were much lower than that of adult BPPV, but it was higher than we expected before. We recommend that clinical tests such as Dix-Hallpike maneuver and head rolling test should be performed on all children with dizziness to establish the diagnosis of BPPV

The New Method to Determine the Causing Site of Horizontal Canal Benign Paroxysmal Positional Vertigo: "Bowing and Leaning Nystagmus"

BACKGROUND AND OBJECTIVES: One of problems for the management of horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV) is the difficulty of determining the affected ear using Ewald's second law. The purpose of this study is to develop the new "Bow and Lean Test (BLT)" to determine easily the affected ear of HSC-BPPV and evaluate its efficiency. MATERIALS AND METHOD: We compared the efficiency between the classical method and BLT in 26 patients with HSC-BPPV. The classical method is based on Ewald??s second law comparing the intensity of nystagmus or symptoms in head roll test. BLT is based on the direction of both "bowing nystagmus" and "leaning nystagmus" at head's bowing and leaning state on sitting position. The affected ear is the same direction of bowing nystagmus in canalolithiasis and the same direction of leaning nystagmus in cupulolithiasis. RESULTS: In 26 patents (15 canalolithiasis, 11 cupulolithiasis), 3 (11.5%) patients did not show a prominent affected ear in the classical method, and 7 (26.9%) patients showed the different affected ear between two methods. All 10 patients were successfully treated with just one trial of barbecue rotation based on the affected ear in BLT. Three patients did not show any bowing or leaning nystagmus. The side with canal paresis in all 4 patients, who showed significant canal paresis in bithermal caloric tests, was equal to the affected ear based on BLT. CONCLUSION: "Bow and Lean Test" (also called "Choung's test") is a new method which can easily determine the affected ear of HC-BPPV.

The New Method to Determine the Causing Site of Horizontal Canal Benign Paroxysmal Positional Vertigo: "Bowing and Leaning Nystagmus"

BACKGROUND AND OBJECTIVES: One of problems for the management of horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV) is the difficulty of determining the affected ear using Ewald's second law. The purpose of this study is to develop the new "Bow and Lean Test (BLT)" to determine easily the affected ear of HSC-BPPV and evaluate its efficiency. MATERIALS AND METHOD: We compared the efficiency between the classical method and BLT in 26 patients with HSC-BPPV. The classical method is based on Ewald??s second law comparing the intensity of nystagmus or symptoms in head roll test. BLT is based on the direction of both "bowing nystagmus" and "leaning nystagmus" at head's bowing and leaning state on sitting position. The affected ear is the same direction of bowing nystagmus in canalolithiasis and the same direction of leaning nystagmus in cupulolithiasis. RESULTS: In 26 patents (15 canalolithiasis, 11 cupulolithiasis), 3 (11.5%) patients did not show a prominent affected ear in the classical method, and 7 (26.9%) patients showed the different affected ear between two methods. All 10 patients were successfully treated with just one trial of barbecue rotation based on the affected ear in BLT. Three patients did not show any bowing or leaning nystagmus. The side with canal paresis in all 4 patients, who showed significant canal paresis in bithermal caloric tests, was equal to the affected ear based on BLT. CONCLUSION: "Bow and Lean Test" (also called "Choung's test") is a new method which can easily determine the affected ear of HC-BPPV.

Analysis of the Vestibular Function in Children with Otitis Media with Effusion

BACKGROUND AND OBJECTIVES: Otitis media with effusion (OME) is one of the most common diseases in children and may be frequently related with dizziness. However, the association between OME and dizziness seems to be not clear and remains controversy. The purpose of this study was to determine the incidence of dizziness in children with long lasting OME, and to investigate the difference in vestibular functions between children with long lasting OME and the control group. MATERIALS AND METHOD: Thirty one children who had long-lasting OME over than 6 months (study group) and 28 normal hearing children without OME who were scheduled for adenotonsillectomy (control group), were given questionnaires and vestibular function tests (VFT) including electronystagmography (ENG) and rotation chair test (RCT). Statistical analysis was performed with chi-square test. RESULTS: Dizziness was found in 7 (22.6%) of 31 children in the study group and 2 (7.1%) of 28 children in the control group (p>0.05). The difference of abnormal findings in VFT between the study group and the control was not significant except visual vestibulo-ocular reflex (VVOR) in RCT. Most of the correlations in the study group, bilateral vs. unilateral OME, OME with dizziness vs. OME without dizziness, and preoperative vs. postoperative, were not significant. CONCLUSION: We did not find any evidences of significant difference of the incidence of dizziness and findings of VFT between children with long lasting OME and children without OME. However, there was a significant abnormal response in VVOR in RCT in children with long-lasting OME, suggesting the children with OME may be more dependent on the nonvestibular system including visual compensation to maintain balance.

Analysis of Chromosomal Aberrations in Thyroid Papillary Carcinomas Using Comparative Genomic Hybridization (CGH) / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cancer of the thyroid is the sixth common cancer in Korea, and fourth common among the Korean women, in particular. Aming the prevalent carcinomas of thyroid, the papillary thyroid carcinoma is the most frequent type. Genomic instability is the characteristic of nearly all tumors as well as thyroid cancers. However, despite the high frequency of papillary thyroid carcinomas, their chromosomal alterations are poorly characterized in Korea. Comparative genomic hybridization (CGH) is a new fluorescence in situ hybridization (FISH) technique to identify genomic imbalances in cancers. In this study, CGH was carried out with the aim of analyzing non-random chromosomal aberrations involved in papillary thyroid carcinomas. MATERIALS AND METHOD: CGH was carried out. Biotin-labeled tumor DNA and digoxigenin-labeled normal DNA were co-hybridized to normal metaphase cells. Then, the ratio of fluorescence was analyzed by an image analyzer. In array-CGH, Cy3 labeled tumor DNA and Cy5 labeled normal DNA were hybridized to microarray template, and then image analysis was performed by microarray image analyzer. RESULTS: Gains of 22q13, 6p24, 7p13, 7q21, 7q31, 8q24, 17q24 and 19p13.3 were found frequently. CONCLUSION: Non-random aberrations which were disclosed in this study might be candidate regions for the abnormal genes involved in papillary thyroid cancer.

Acute Vestibular Neuritis in Children

The acute vestibular neuritis is rarely seen in children and it is hard to find the related reports. In this paper, we report three cases of acute vestibular neuritis less than 15 years old that we experienced during last 10 years. The three cases are 14 and 11-year old boys and a 12-year-old-girl. They complained vertigo without hearing loss. Only one of three cases had previous common cold history and they showed all negative reactions in virus blood tests. After medical treatment and early rehabilitation, vertigo was completely controlled within 3 weeks and there was no recurrent symptoms so far. This recovery in children seems to be faster and more complete than in adults.

Is It Possible to Replace Alternative Binaural Bithermal Caloric Test by Monothermal Caloric Test in the Diagnosis of Dizzy Patients? / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The alternative binaural bithermal (ABB) caloric test by Fitzgerald and Hallpike has become a standard procedure in caloric tests. But it brings patient discomfort and is a time consuming procedure. This study was aimed to investigate the efficacy of the monothermal caloric test as a replacement of ABB caloric test. MATERIALS AND METHOD: The results of 690 complete ABB caloric tests collected from 1997 through 1999 were analyzed retrospectively. We have examined the correlations between canal paresis value (CP) derived from an ABB caloric test and compared with the canal paresis value (CPmono) derived from the monothermal caloric component of a bithermal caloric test. RESULTS: There was a stronger correlation between CP and CPmono of warm monothermal component (Pearson correlation coefficient=0.86) than that of cold monothermal caloric test (Pearson correlation coefficient=0.55). Excluding cases with spontaneous nystagmus (n=553), similar results was observed. A warm monothermal caloric test has higher sensitivity and specificity than a cold monothermal caloric test. When the sensitivity of warm monothermal caloric test was more than 90%, the false positive rate was more than about 20%. The false positive rate was unacceptably high. CONCLUSION: The monothermal caloric test cannot be used as a replacement of ABB caloric test.

Conventional, Laser-Assisted and Coblation-Assisted Uvulopalatopharyngoplasty/Uvulopalatoplasty: Their Advantages and Disadvantages / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Uvulopalatopharyngoplasty (UPPP) is performed conventionally with cold knifes and electrocautery under general anesthesia. Although laser-assisted uvulopalatoplasty (LAUP) reduced the need of general anesthesia and bleeding, it still has such problems as severe pain or scar contracture. Coblation electrosurgery is known to be less painful by thermal ablation with low heat. However, comparative studies on the merits and demerits between various surgical techniques are lacking. The aim of this study is to evaluate the advantages and disadvantages of each surgical method by comparing the surgical outcomes between conventional UPPP and Coblation-assisted UPPP (CUPPP), and between LAUP and Coblation-assisted uvulopalatoplasty (CAUP). MATERIALS AND METHOD: Conventional UPPP (N=25) and CUPPP (N=18) were performed on 43 patients with obstructive sleep apnea (OSA), and LAUP (N=21) and CAUP (N=7) on 28 patients with mild OSA or snoring, respectively. Postoperative subjective degrees of apnea, snoring and pain, operation time, amount of intraoperative bleeding and episodes of delayed bleeding were compared between the two groups. RESULTS: Early postoperative pain and intraoperative bleeding were observed less in the CUPPP group than in the conventional UPPP group. Operation time was shorter and intraoperative bleeding was less in the LAUP group than in the CAUP group. Early postoperative pain was less in the CAUP group than in the LAUP group. CONCLUSION: Thorough knowledge regarding advantages and limitations of different UPPP or uvulopalatoplasty methods is required for clinicians to make appropriate use of surgical tools.

Choanal Polyps Originating from the Ethmoid Sinus: Ethmochoanal Polyps? / 대한이비인후과학회지

Sinochoanal polyp is an inflammatory polyp that originates in the paranasal sinus, passes through a sinus ostium, and extends into the choana. While antrochoanal polyp is the most common type of sinochoanal polyp, sphenochoanal polyp is rare and ethmochoanal polyp is extremely more rare to find. To minimize postsurgical recurrence, it is essential to completely remove the polyp together with the base of its origin. We have recently experienced and successfully managed three cases of ethmochoanal polyp by endoscopic sinus surgery. It was difficult to histologically differentiate ethmochoanal polyp from sinonasal polyps associated with chronic rhinosinusitis. For this reason, ethmochoanal polyp should be suspected and completely removed together with the base of its origin when a large polyp originates from the ethmoid sinus and extends into the choana. Now we report three cases of ethmochoanal polyp with a brief review of the related literatures.

The Relationship between Functional Recovery and Reorganization of Nucleus Ambiguus Following Laryngeal Reinnervation in Rats / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Ideally, treatment for vocal cord paralysis should restore normal physiologic and dynamic movement of the vocal fold. Recently, numerous studies of laryngeal reinnervation have been designed to restore function of the paralyzed larynx. None of these approaches have been consistently successful, probably due to synkinesis and an inadequate number of regenerated axons. In previous study, we confirmed the efficacy of PEMS on the early functional recovery in rats with surgically transected and reanastomosed recurrent laryngeal nerve. In this study, the relationship between functional recovery and reorganization of nucleus ambiguus following laryngeal reinnervation in rats was evaluated by retrograde double tracing technique and electron microscope. MATERIALS AND METHOD: Transections and primary anastomosis were done on left recurrent laryngeal nerves of 86 healthy male Sprague-Dawley rats. Rats were then randomly assigned to 2 groups (the group A: stimulation with PEMS, the group B: non-stimulation with PEMS). Functionally recovered status was confirmed with laryngo-videostroboscopy and laryngeal EMG. And then, functional reorganization of laryngeal motoneuron in the nucleus ambiguus (NA) was evaluated using retrograde double tracing techniques. Morphological changes of the degeneration and regeneration processes following injury was observed by electron microscopy. RESULTS: 20 rats (63%) in group A and 5 rats (17%) in the group B showed recovery of vocal fold motion. The functional reorganization of laryngeal motor neurons in the NA was observed in the rats with functional recovery (n=8), but not in the rats without functional recovery (n=8). In the electron microscopic finding, the nerve fibers of functional recovered rats were relatively well regenerated. But the configuration of the nerve fibers of non-functionally recovered rats was markedly irregular and the total axon population was smaller than that of the recovered rats, except for some cases. CONCLUSION: This study shows that failure of functional recovery of vocal fold movement following laryngeal reinnervation is probably due to not only the misdirected reinnervation, but also the incomplete axonal regeneration.

Efficiency of Short-term Admission Medical Records in Patients with Common Otolaryngologic Diseases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A more simple medical record form has been needed for a more qualified and cost-effective health care. A short-term admission medical record (SAMR) is a standard fill-in-the-blank form on the patients' conditions for common otolaryngologic diseases. The aim of this study is to determine the efficiency of the SAMRs. MATERIALS AND METHOD: Nineteen doctors who had residency training in the Department of Otolaryngology of Ewha Womans University Mokdong Hospital from the year 1995 through 2000 were included in this study. Questionnaires consisted of 11 comparative questions: the subjects were instructed to express their degrees of satisfaction with conventional medical records (CMRs) and SAMRs on a 100mm visual analogue scale for each question. The degrees of satisfaction with SAMRs were compared to those with CMRs. RESULTS: There were no statistically significant differences in the degrees of satisfaction between the two types of records for accurate evaluation of patients' condition, efficient communication between medical and paramedical personnels, and the value of verified records in the medicolegal conflicts and insurance claims. However, the degrees of satisfaction with SAMRs were higher than those with CMRs for communication between doctors, the value in medical research, time-saving, simplicity, paper-saving and their convertibility into electronic medical records. CONCLUSION: SAMRs provides patients of common otolaryngologic diseases with not only the necessary conditions of medical records, but also the basis of computer-based patient records. In addition, SAMRs may be also be more cost-effective than CMRs.