The Effect of Early Canalith Repositioning on Benign Paroxysmal Positional Vertigo on Recurrence

OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) can be treated using a simple repositioning maneuver. This study demonstrates the effects of early repositioning therapy in patients with BPPV, especially with regard to recurrence. METHODS: We enrolled 138 consecutive patients who had been diagnosed with BPPV in the emergency rooms and ENT out-patient clinics of Chung-Ang University Hospital and Samyook Medical Center from January to June 2009. All patients immediately underwent appropriate canalith repositioning procedures (CRPs) depending on canalith type and location. The CRPs were performed daily until the patient's symptoms were resolved. The patients were classified into two groups according to the duration between symptom onset and initial treatment: less than 24 hours (early repositioning group, n=66) and greater 24 hours (delayed repositioning group, n=72). We prospectively compared the numbers of treatments received and the recurrence rates between the two groups. RESULTS: Follow-up periods ranged from 8 to 14 months, 77 cases involved posterior canal BPPV, 48 cases were lateral canal BPPV (of which 20 cases were cupulolithiasis), and 13 cases were multiple canal BPPV. BPPV recurrence was found in a total of 46 patients (33.3%). The necessary numbers of CRPs were 2.3 for the early repositioning group and 2.5 for the late repositioning group, a difference that was not statistically significant (P=0.582). The early repositioning group showed a recurrence rate of 19.7%, and the delayed repositioning group showed a recurrence rate of 45.8% (P=0.002). CONCLUSION: Performing repositioning treatments as soon as possible after symptom onset may be an important factor in the prevention of BPVV recurrence.

A Case of Giant Neurofibroma Arising from the Scalp / 대한이비인후과학회지

Neurofibromatosis 1 (NF-1) is an inherited neurocutaneous disorder arising from the chromosome 17q with a prevalence of one in 4,000. Neurofibroma, Cafe-au-lait spots, freckles in axilla, Lisch nodule and bony dysplasia are features of NF-1. It is diagnosed preoperatively by history taking, physical examination, CT, MRI and intraoperatively by tissue biopsy. Scalp neurofibroma accompanying pain, motor disturbance, rapid growth, and suspicious of malignancy are indications for surgical removal. We present a case of NF-1 with two giant neurofibromas (15x7x4 cm, 3x5x2 cm) on the left scalp in a patient suffering from a head injury after falling down. The neurofibromas were successfully removed after diagnosed by MRI and histology.

The Clinical Effectiveness of Open Septorhinoplasty for Primary Treatment of Nasal bone Fracture

BACKGROUND AND OBJECTIVES: Closed reduction has been a primary treatment procedure for nasal bone fracture, but the post-operative results have not always been satisfactory. We compared the satisfaction rate of closed reduction with that of open septorhinoplasty for the treatment of nasal bone fracture and evaluated the effectiveness of open septorhinoplasty for the primary treatment of nasal bone fracture. MATERIALS AND METHOD: We performed a retrospective review of patients who underwent a closed reduction treatment for nasal bone fracture from March 2004 to February 2006 and conducted telephone surveys to monitor their post-operative cosmetic and functional problems. We estimated the factors that were involved in the low satisfaction rate and determined the indications of open septorhinoplasty. Prospectively, the patients who underwent open septorhinoplasty from September 2006 to August 2007 were interviewed for their cosmetic and functional satisfaction rate. RESULTS: Forty percent of the patients who underwent closed reduction had cosmetic concerns and twenty percent had functional concerns. The factors involved in the low satisfaction rate were septal fracture, associated fractures, and multiple fragmentation. Eight percent of the patients who underwent open septorhinoplasty had cosmetic concerns and other eight percent had functional concerns. CONCLUSION: A careful pre-operative evaluation of the type of fracture is important for the treatment of nasal bone fracture. Also, when nasal bone fracture is combined with septal fracture, associated fracture or unilateral fragmentation, open septorhinoplasty has to be considered to reduce secondary deformities and to improve the satisfaction rate of the patients.

A Case of Schwannoma Arising in Pterygopalatine Fossa / 대한이비인후과학회지

Schwannoma, also referred to as neurilemmoma, is an encapsulated benign soft tissue tumor arising from the schwann cells of the nerve sheath. Although 25 to 45% of schwannomas arise in the head and neck region, pterygopalatine fossa is the rarest sites of involvement with only 23 cases reported in the medical literature. It is usually seen in the second and fifth decades, but sex or racial predilection has not been noted. Clinical features of this tumor are dependent on the involved anatomical site, nerve of origin, and compression of adjacent structures. The differential diagnosis of masses in pterygopalatine fossa includes angiofibroma, fibrous histiocytoma, malignant melanoma, lymphoma, and low-grade rhabdomyosarcoma. The treatment of choice is that the tumor is completely removed with careful preservation of its nerve. Recently, the authors experienced a case of schwannoma arising in pterygopalatine fossa, which was removed with transantral approach. Hence, we report a rare case with a review of literature.

The Effect of the Amniotic Membrane on Treatment of Tympanic Membrane Perforation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tympanic membrane perforations are usually caused by trauma, infection, surgical procedures such as tympanoplasty or myringoplasty. Because perforations interfere with the transmission and perception of sound, whatever the cause of the perforation, repair of the membrane is desirable. The purpose of this study is to investigate the clinical application and usefulness of allograft amniotic membrane, instead of autograft materials, in the management of tympanic membrane perforation. SUBJECTS AND METHOD: A retrospective study was performed on 14 patients who underwent myringoplasty with allograft amniotic membrane for tympanic membrane perforation from October 2006 to September 2007. Information was collected on sex, age, the cause of perforation, the perforation size, postoperative hearing result, the success rate. RESULTS: Of 14 patients, 13 patients were successfully treated by myringoplasty with allograft amniotic membrane and one patient failed due to infection. So the overall success rate was 93%. The mean air-bone gap was improved from 13.3 dB to 7.1 dB. CONCLUSION: The myringoplasty with allograft amniotic membrane is a successful procedure for the healing of tympanic membrane perforations.

Sudden Hearing Loss Caused by Acute Pontine Infarction: Reports of Two Cases / 대한이비인후과학회지

In most cases, sudden deafness results from viral infection, vascular occlusion or cochlear membrane rupture, but occasionally, its central origin can not be excluded. Although a number of signs are theoretically plausible in patients with pontine infarction such as facial weakness, lateral gaze palsy, Horner syndrome, limb dysmetria, crossed sensory loss or vertigo, isolated sudden deafness is a very rare manifestation. When pontine infarction occurs, it is usually identified on T2-weighted and diffusion-weighted magnetic resonance imaging (MRI). Early treatment with anticoagulant and antiplatelet agents leads to a more rapid resolution of symptoms and preservation of existing brain function. Recently, the authors have experienced two cases of sudden hearing loss caused by acute pontine infarction. Hence, we report two cases with a review of literature.