Evaluation of the Obstructive Site in Patients with Obstructive Sleep Apnea Using Sleep Endoscopy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sleep endoscopy is a valuable modality for an anatomical assessment in patients with snoring and obstructive apnea. The aims of this study is to observe the anatomical obstructive site using sleep endoscopy and to compare the sleep endoscopic findings and the results of the Mueller maneuver in clinical setting. SUBJECTS AND METHOD: Thirty patients with obstructive sleep apnea syndrome underwent sleep endoscopy. After intravenous administration of midazolam, obstructive events were observed. The levels of obstruction were classified as palatal, palatal with tonsil and palatal with tongue base. Obstruction was defined when the site was collapsed more than 50% compared with normal respiration during the apneic episode. RESULTS: On sleep endoscopy, retropalatal obstruction was observed in 14 patients (47%). Obstruction in the retropalatal area combined with the tonsillar area was found in 9 patients (30%). Obstruction in the retropalatal area combined with the tongue base area was found in 7 patients (23%). However, the results of Mueller maneuver showed retropalatal obstruction in 19 patients (63%), obstruction in the retropalatal with tonsillar area in 9 patients (30%) and obstruction in the retropalatal with tongue base area in 2 patients (7%). CONCLUSION: Sleep endoscopy is a useful modality to assess the accurate anatomical site of obstruction during sleep state and provide information useful in planning of further treatment.

Bilateral Simultaneous Bell's Palsy-Two Case Studies / 대한이비인후과학회지

Bilateral simultaneous Bell's palsy is extremely rare and occurs in about 0.3-2.0% of the facial palsy cases. In contrast to the unilateral form of facial palsy, which often has an unknown cause, bilateral facial palsy is increasingly recognized as secondary to a variety of other disorders, including neurological, infectious, traumatic, metabolic, vascular, neoplastic, and degenerative disorders. Yet, bilateral simultaneous Bell's palsy is by definition, not associated with any demonstrable disease along the course of the facial nerve or elsewhere in the body. So, as usual, it is important to make an early diagnosis for the best treatment. We report our experience with two cases of bilateral simultaneous Bell's palsy recently seen in our practice.

Anterior Inferior Cerebellar Artery Infarction Misdiagnosed as Labyrinthitis: A Case Report / 대한이비인후과학회지

Anterior inferior cerebellar artery infarction is the second most common cause of brainstem stroke, and usually accompanied by vertigo, unilateral deafness, ipsilateral facial weakness and ataxia. These symptoms can be confused with other peripheral causes of sudden hearing loss accompanying dizziness including acute labyrinthitis, idiopathic sudden hearing loss, perilymphatic fistula and acoustic neuroma. This case report presents a man who first visited our clinic for sudden hearing loss with vertigo, and whom we treated for acute labyrinthitis. However, 3 days later, left facial numbness was observed and the magnetic resonance imaging (MRI) showed an anterior inferior cerebellar infarction. The patient was then transferred to the neurology department and treated with anticoagulant and antiplatelet agents. After 7 days of treatment, the hearing loss and dizziness were improved and the facial numbness resolved.

Morphological Changes of Endolymphatic Sac after Gentamicin Injection to Chick Embryo / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Gentamicin, which is known to have potential toxic effect to the inner ear, causes functional disturbance by destroying the inner ear at a concentration above a certain level. The purpose of this study was to identify morphological changes in the endolymphatic sac after gentamicin injection using chick embryo and the degree of changes according to different concentration of gentamicin. MATERIALS AND METHOD: The same breed of chicken (Gallus domesticus) was chosen and artificial growth incubator was used to germinate the eggs. Increasing the concentration of gentamicin at the same rate (10, 20, 30, 40 mg/ml), we injected it into the yolk sac of chicken and observed the morphological changes in the embryonic sac by light microscope. RESULTS: As the concentration of gentamicin increased, the size of the endolymphatic sac increased and the thickness and contour of sac wall changed. Especially, the inner membrane thinned down greatly. CONCLUSION: In this research, we confirmed that endolymphatic sac is affected by gentamicin in proportion to its concentration. Especially, considering that inner membrane epithelial cells play an important role in the absorption of endolymph, we suggest that the ototoxicity of gentamicin causes the disturbance in the absorption of endolymph, which may cause endolymphatic hydrops.

Three Cases of Traumatized Auricular Reconstruction / 대한이비인후과학회지

The external ear is frequently injured because of its position. Fortunately, the injuries are usually minor or the ear remains attached by a small pedicle, which results in complete survival. There are, however, rare occasions when the entire ear is completely amputated. The ear has an abundant blood supply, and nowadays it is possible to reconstruct it perfectly using micro-anastomosis and flap surgery. In these cases, we apply the following three methods ; fish-mouth technique, modified pocket method, Dieffenbach's technique. Auricular reconstruction is one of the most challenging areas in reconstructive surgery. The best results are obtained if the surgeon has a broad range of techniques at his disposal. Authors report three cases of traumatized auricular reconstruction with a review of literatures.

Chicken Embryo as a Model of Inner Ear Study

BACKGROUND AND OBJECTIVES:Nowdays, numbers of patient who suffers from inner ear disease are increased and we need to completely understand about inner ear anatomy and embryology. But we have many problems to use human itself as a model, so it is difficult for us to study. Instead of using human as a model, recent days, many doctors use mammalians and birds. In this study, we used chicken embryo as a model whose inner ear was thought to be similar with human's inner ear and we made effort to get inner ear images by light microscope. MATERIALS AND METHOD:We incubated Gallus domesticus in auto-incubator for 12days. In each embryonic day (4th to 12th days), we got the chicken embryo and made paraffin block. Next, with micro-tomb, we made slice section and fixed to slide. Using micro-digital camera system, we took the picture of the inner ear of chicken embryo. RESULTS:We observed the structures of inner ear of chicken embryo from 4th embryonic day to 12th embryonic day. In 4th day and 5th day, we could not get the definite clear image. But from 6th to 12th day, we got the clear images of utricle, saccule, semicircular canals, etc. In several micro-section methods, making oblique coronal section was showed the best images of inner ear. CONCLUSION:This study was the start point of chicken inner ear embryology and anatomy. Hereafter, we should make the deeper study about chicken inner ear with these results and investigate the genetic and extrinsic factors which influence to inner ear disease. So we should solve the fundamental problem of inner ear disease based on this study