Microbiological Results From Middle Ear Effusion in Pediatric Patients Receiving Ventilation Tube Insertion: Multicenter Registry Study on the Effectiveness of Ventilation Tube Insertion in Pediatric Patients With Chronic Otitis Media With Effusion: Part

OBJECTIVES: The aim of this multicenter registry study was to investigate the effectiveness of ventilation tube insertion and the microbiology of otitis media with effusion (OME) in children. This part I study was conducted to evaluate the microbiological profile of children with OME who needed ventilation tube insertion. METHODS: Patients < 15 years old who were diagnosed as having OME and received ventilation tube insertion were prospectively enrolled in 16 tertiary hospitals from June 2014 to December 2016. After excluding patients with missing data, the data of 397 patients were analyzed among a total of 433 enrolled patients. The clinical symptoms, findings of the tympanic membrane, hearing level, and microbiological findings were collected. RESULTS: In 103 patients (25.9%), antibiotics were used within 3 weeks before surgery. Ventilation tube insertion was performed in a total of 710 ears (626 in both ears in 313 patients, 55 in the left ear only, and 29 in the right ear only). Culture of middle ear effusion was done in at least one ear in 221 patients (55.7%), and in a total of 346 ears. Only 46 ears (13.3%) showed positive results in middle ear effusion culture. Haemophilus influenzae (17.3%, followed by coagulase-negative Staphylococcus and Staphylococcus auricularis) was the most common bacteria detected. CONCLUSION: H. influenzae was the most commonly found bacteria in middle ear effusion. Relatively low rates of culture positivity were noted in middle ear effusion of patients with OME in Korea.

An Uncommon Presentation of Human Otoacariasis by Haemaphysalis longicornis

Ticks are obligate parasites on animals and sometimes humans. They usually suck the blood of the hosts and can carry various infectious diseases as a vector. Otoacariasis is the presence of ticks and mites within the ear canal and relatively common in domestic and wild animals. However, tick infestations of human ear canals are rarely reported in the scientific literature and hardly occur in developed countries. Herein, we report a rare case of otoaracariasis involving Haemaphysalis longicornis . A 9-year-old girl living in a suburb presented with otalgia of left ear for 1 day. Otoscopic examination revealed a huge insect occluding the tympanic membrane. Tick removal and washing of external auditory canal was done successfully. The causative tick was identified as the H. longicornis. To our knowledge, this is the first reported case of human otoacariasis by a H. longicornis in Korea.

Clinical Feasibility of Suppression Head Impulse Test in Vestibulopathy Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The suppression head impulse (SHIMP) test has emerged as one of the new vestibular function tests. The SHIMP test is an analysis of anti-compensatory saccadic movements in gazing moving targets as the head moves. In this study, we investigated the accuracy and sensitivity of the test. SUBJECTS AND METHOD: We analyzed the results of SHIMP test (gain, amplitude, and latency) in 24 cases, which included normal, vestibular neuritis, benign paroxysmal positional vertigo (BPPV), Meniere's disease, bilateral vestibular function loss, temporal bone fracture, tuberculosis meningitis and acoustic schwannoma patients. We also carried out a physical exam, audiologic study, video electronystagmography (vENG) and a conventional video head impulse test to evaluate the feasibility of SHIMP test in cases of vesitibulopathy. RESULTS: In patients with vestibulopathy, the analysis of SHIMP test indicated high sensitivity and accuracy, which were supported by accompanying audio-vestibular studies. Patients suspected with BPPV, vestibular neuronitis and Meniere's disease showed low vestibulo ocular reflex (VOR) gain and delayed anticompensatory saccade with smaller and more scattered amplitudes than the control. Patients with bilateral vestibular function loss, temporal bone fracture, tuberculosis meningitis, and acoustic schwannoma showed delayed latency, and small amplitude or few anticompensatory saccades. Finally, changes in the SHIMP test values might be a hint that patients had recovered from vestibular neuronitis and tuberculosis meningitis. CONCLUSION: We found the feasibility of SHIMP test in detecting the pathologic condition of VOR in vestibulopathy patients. We argue that the usefulness of SHIMP test might be extended to evaluating the effectiveness of rehabilitation.

Clinical Feasibility of Suppression Head Impulse Test in Vestibulopathy Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#The suppression head impulse (SHIMP) test has emerged as one of the new vestibular function tests. The SHIMP test is an analysis of anti-compensatory saccadic movements in gazing moving targets as the head moves. In this study, we investigated the accuracy and sensitivity of the test.SUBJECTS AND METHOD: We analyzed the results of SHIMP test (gain, amplitude, and latency) in 24 cases, which included normal, vestibular neuritis, benign paroxysmal positional vertigo (BPPV), Meniere's disease, bilateral vestibular function loss, temporal bone fracture, tuberculosis meningitis and acoustic schwannoma patients. We also carried out a physical exam, audiologic study, video electronystagmography (vENG) and a conventional video head impulse test to evaluate the feasibility of SHIMP test in cases of vesitibulopathy.@*RESULTS@#In patients with vestibulopathy, the analysis of SHIMP test indicated high sensitivity and accuracy, which were supported by accompanying audio-vestibular studies. Patients suspected with BPPV, vestibular neuronitis and Meniere's disease showed low vestibulo ocular reflex (VOR) gain and delayed anticompensatory saccade with smaller and more scattered amplitudes than the control. Patients with bilateral vestibular function loss, temporal bone fracture, tuberculosis meningitis, and acoustic schwannoma showed delayed latency, and small amplitude or few anticompensatory saccades. Finally, changes in the SHIMP test values might be a hint that patients had recovered from vestibular neuronitis and tuberculosis meningitis.@*CONCLUSION@#We found the feasibility of SHIMP test in detecting the pathologic condition of VOR in vestibulopathy patients. We argue that the usefulness of SHIMP test might be extended to evaluating the effectiveness of rehabilitation.

Cochlear Implantation after Subtotal Petrosectomy in Patients with Chronic Otitis Media / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study investigated the surgical and rehabilitative results of cochlear implantation combined with subtotal petrosectomy in patients with chronic otitis media. SUBJECTS AND METHOD: We retrospectively reviewed the medical records of nine adult patients (7 men and 2 woman; mean age 58.9 years), who were operated between 2004 and 2014. Out of the nine, seven patients received simultaneous cochlear implantation and subtotal petrosectomy and two patients were operated by stage depending on the condition of the middle ear. All cases underwent closure of the external auditory canal and Eustachian tube, and the obliteration of mastoid cavity using abdominal fat. Surgical outcomes and performance of the patients after cochlear implantation were analyzed. RESULTS: Middle ear inflammation was completely managed with this surgical technique. No patients showed postoperative symptoms related to otitis media after the surgery. Cochlear implant was successfully replaced and active electrodes were fully inserted in all of the cases. There were no immediate complications including abscess, infection, meningitis, cerebrospinal fluid leakage and ear canal problem. One patient was observed with delayed extrusion of the ball electrode, which was replaced with cartilage reinforcement under local anesthesia. Patient performance, measured in terms of speech evaluation and quality of life during the medical interview, were successful and satisfactory. CONCLUSION: Cochlear implantation with subtotal petrosectomy seems to be very safe and effective for patients deafened by chronic otitis media. Long term follow-ups for possible extrusion of the electrode or other complications are still necessary.

Malignant Melanoma of the Temporal Bone Initially Presenting with Dizziness / 대한이비인후과학회지

Malignant melanoma of the temporal bone is a very rare disease. We report here a case of malignant melanoma of the temporal bone initially presenting as dizziness. The patient was a 48-year-old man presenting with dizziness. Physical examination showed horizontal nystagmus toward the left on the left lateral gaze and an intact tympanic membrane. Caloric tests demonstrated right-sided unilateral weakness. Vestibular neuritis was suspected, and conservative treatment was thus carried out. On follow-up, other symptoms were noted and the tumor of the temporal bone was diagnosed by computed tomography and magnetic resonance imaging of the temporal bone. This case shows that if the dizziness symptom is not improved after conservative management in patients who present with vestibular neuritis, an imaging evaluation could be necessary, taking into consideration the possibility of a tumor in the temporal bone.

Toxoplasmic Lymphadenitis of the Head and Neck Region / 대한이비인후과학회지

Toxoplasmosis is a ubiquitous protozoan infection caused by coccidian Toxoplasma gondii. In an immunocompetent host, the primary infection is generally oligosymptomatic and self-limiting. Fewer than 10% of infected subjects are symptomatic, with lymphadenopathy as the most frequent clinical finding. Here, two cases of Toxoplasmic lymphadenitis are reported for otolaryngologists to consider the clinical findings and natural history aspects of this infection.

A Case of Malignant Small Round Cell Tumor of Temporal Bone with Facial Paralysis

Malignant small round cell tumor is very rare, especially in the head and neck area. It is also difficult to make a differential diagnosis due to their undifferentiated or primitive character. Immunohistochemical staining and chromosomal study is useful to categorize these tumors. Since these are rare tumors, treatment protocols are is not well established. While combined treatments (surgery, chemotherapy, radiotherapy) is currently being applied, the tumor still has a poor prognosis. We present a rare case of a rapidly growing temporal bone malignant small round cell tumor which initially showed facial paralysis.

A Case of Malignant Small Round Cell Tumor of Temporal Bone with Facial Paralysis

Malignant small round cell tumor is very rare, especially in the head and neck area. It is also difficult to make a differential diagnosis due to their undifferentiated or primitive character. Immunohistochemical staining and chromosomal study is useful to categorize these tumors. Since these are rare tumors, treatment protocols are is not well established. While combined treatments (surgery, chemotherapy, radiotherapy) is currently being applied, the tumor still has a poor prognosis. We present a rare case of a rapidly growing temporal bone malignant small round cell tumor which initially showed facial paralysis.

Frequency-Specific Hearing Results After Surgery for Chronic Ear Diseases

OBJECTIVES: To analyze frequency-specific hearing results after surgery for chronic ear diseases while considering pathological findings and various surgical factors. METHODS: Patients who underwent surgical management of chronic otitis media were reviewed retrospectively (n=559). Using pure tone audiometry, air conduction (AC), bone conduction (BC), and air bone gap (ABG) change between pre- and post-operative tests were calculated for the frequencies of 250, 500, 1,000, 2,000, 3,000, 4,000 (AC and BC), and 6,000 Hz (AC). Frequency-specific results were investigated, considering various surgical factors, such as type of surgery, type of ossiculoplasty and pathological findings. RESULTS: AC results in the intact canal wall mastoidectomy showed improvement at each frequency except 4,000, 6,000 Hz. AC results in the tympanoplasty showed improvement at each frequency except 6,000 Hz. AC and ABG results in the open cavity mastoidectomy showed improvement only at the frequencies of 250, 500, 2,000 Hz. AC and ABG improved at low and mid frequencies but not in high frequencies above 3,000 Hz when ossicular reconstruction was conducted. AC and ABG results also improved at low and mid frequencies in the cholesteatoma, and ABG results improved at all frequencies except 3,000 Hz in the non-cholesteatoma. CONCLUSION: After chronic ear surgery, AC and ABG changes improved, primarily in the low and mid frequencies. Further evaluation and studies for post-operative hearing loss at high frequencies are recommended for rehabilitation of hearing ability after surgery.

CT Evaluation of Vocal Cord Paralysis due to Thoracic Diseases: A 10-Year Retrospective Study

PURPOSE: To discuss computed tomography (CT) evaluation of the etiology of vocal cord paralysis (VCP) due to thoracic diseases. MATERIALS AND METHODS: From records from the past 10 years at our hospital, we retrospectively reviewed 115 cases of VCP that were evaluated with CT. Of these 115 cases, 36 patients (23 M, 13 F) had VCP due to a condition within the thoracic cavity. From these cases, we collected the following information: sex, age distribution, side of paralysis, symptom onset date, date of diagnosis, imaging, and primary disease. The etiology of VCP was determined using both historical information and diagnostic imaging. Imaging procedures included chest radiograph, CT of neck or chest, and esophagography or esophagoscopy. RESULTS: Thirty-three of the 36 patients with thoracic disease had unilateral VCP (21 left, 12 right). Of the primary thoracic diseases, malignancy was the most common (19, 52.8%), with 18 of the 19 malignancies presenting with unilateral VCP. The detected malignant tumors in the chest consisted of thirteen lung cancers, three esophageal cancers, two metastatic tumors, and one mediastinal tumor. We also found other underlying etiologies of VCP, including one aortic arch aneurysm, five iatrogenic, six tuberculosis, one neurofibromatosis, three benign nodes, and one lung collapse. A chest radiograph failed to detect eight of the 19 primary malignancies detected on the CT. Nine patients with lung cancer developed VCP between follow-ups and four of them were diagnosed with a progression of malignancy upon CT evaluation of VCP. CONCLUSION: CT is helpful for the early detection of primary malignancy or progression of malignancy between follow-ups. Moreover, it can reveal various non-malignant causes of VCP.

A Case of Cystic Lymph Node Metastasis from Thyroid Papillary Microcarcinoma / 대한갑상선학회지

Papillary carcinoma is the most common type of thyroid cancer, usually presenting as a thyroid mass. Presentation in cervical nodes alone, with no clinical suspicion of thyroid tumor, also occurs. Lymph node metastasis from papillary carcinoma of the thyroid may undergo cystic transformation. This occurrence is seldom encountered in clinical practice and in cases of microcarcinomas the diagnosis may be difficult, resulting in a delay of the correct diagnosis and of therapy for the primary tumor. We present a rare case of solitary cystic lymph node metastasis of papillary microcarcinoma of the thyroid.

Electrical Cellular Physiology in Cochlear Nucleus Using Patch-Clamp Techniques / 대한이비인후과학회지

No abstract available.

Temporal Bone Myeloid Sarcoma

Myeloid sarcoma is a rare condition that's caused by the aggregation of immature myeloid cells in leukemic patients. Myeloid sarcoma occurring in the temporal bone more frequently involves the mastoid bone than is the case for metastatic lesions arising from non-systemic malignancies. The disease is difficult to diagnose when it presents with symptoms that mimic otomastoiditis. However, an early diagnosis is important in order to achieve complete remission of the disease. Magnetic resonance imaging of the temporal bone is useful for making the diagnosis of myeloid sarcoma, and especially to evaluate the extent of disease. High-dose radio- or chemotherapies are the first-line approaches and possibly the only approaches to achieve complete remission and to cure the disease. With the aim of improving our understanding of myeloid sarcoma in the temporal bone, the present report describes our experience with 5 such cases and we compare the clinical features of these 5 patients with those clinical features of patients who have metastatic lesions.

A Case of Image-Guided Acoustic Neuroma Surgery via Middle Cranial Fossa Approach / 대한이비인후과학회지

Acoustic tumor which originates from the vestibular nerve is the most common neoplasm to be found at the cerebellopontine angle. The surgical approaches currently used for the acoustic tumor are the middle cranial fossa, the translabyrinthine, the suboccipital, and the combined approaches depending on the size, location, and growth rate of the tumor and the hearing level, age, and general health condition of the patient. The complex and variable anatomy and the proximity of important structures encountered during acoustic tumor surgery especially when using the middle cranial fossa approach, may make it a tough job even for the experienced surgeon. Recently, developed image-guided system may be an important step in reducing the incidence of the complication. In the present research, authors used image-guided system during acoustic tumor surgery via middle cranial fossa approach, and with good result.

Clinical Analysis of Hearing Loss after Mild Head Trauma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We evaluated the clinical characteristics of hearing impairment in patients who suffered a blunt head trauma without any organic problems, including temporal bone fracture or intracranial hemorrhage. SUBJECTS AND METHOD: This retrospective study examined 42 patients presenting with hearing impairment after blunt head trauma within five recent years. This study included only patients without temporal bone fracture or intracranial hemorrhage. RESULTS: Most patients (90.5%) complained of associated auditory symptoms including tinnitus, dizziness, earfullness and otalgia as well as headache. In 38 patients (90.5%), the symptom was developed on the injured day. Fifteen ears of 13 patients showed sensorineural hearing loss, 2 ears of 2 patients conductive hearing loss, and 10 ears of 8 patients mixed hearing loss. Twenty-four ears of 22 patients showed sensorineural hearing loss only above 4 kHz, 8 ears of 7 patients mild hearing loss, 10 ears of 8 patients moderate hearing loss, 3 ears of 3 patients had a moderately-severe hearing loss, and 6 ears of 6 patients had a profound hearing loss. All cases (24 ears of 22 patients) who had a normal four-tone average complained many otologic symptoms other than a hearing loss. CONCLUSION: Blunt head injury is one of the most common causes of the neurologic disorders. It is important to perform thorough assessment of auditory symptoms as soon as possible. Otologic consultation should be sought in all cases for appropriate management.

A Case of Enchondral Pseudocyst of the Auricle / 대한이비인후과학회지

Endochondral pseudocyst of the ear is considered to be a benign, asymptomatic condition seen infrequently in clinical practice. It is an intracartilaginous cyst devoid of epithelial lining and filled with a sterile, viscous, straw-colored fluid. It is important to remove the pseudocyst to prevent recurrence and good esthetic outcome. We experienced a case of a 59-years-old man with an endochondral pseudocyst of his right auricle. To our knowledge, this is the first report in Korea, so we report this case with a review of the literature.

Clinical Analysis of Delayed Improvement in Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of the study was to evaluate the time-dependent progress and the delayed improvement in patients who were already treated by combination therapy including oral steroid for idiopathic sudden sensorineural hearing loss. SUBJECTS AND METHOD: This study examined patients presenting with idiopathic sudden sensorineural hearing loss at a secondary referral and a university-based center over 10 years. This retrospective study included only those patients who could be followed up for at least 3 months. RESULTS: Of 121 patients who recovered over the 3 months of follow-up period, 9.9% showed a delayed recovery of later than 1 month after discharge. Of 55 patients who did not recover until the discharge but recovered thereafter, 78.2% recovered within 1 month, 5.5% recovered between 1 to 2 months, 12.7% recovered between 2 to 3 months, and 3.6% recovered 3 months later after the discharge. The delayed recovery was found frequently in partial or slightly recovery groups by Siegel's criteria. CONCLUSION: This study demonstrated the presence of delayed recovery in patients who were treated by combination therapy, including oral steroid for idiopathic sudden sensorineural hearing loss, although this result should be further studied by additional research.

Correlation between Anterior Inferior Cerebellar Artery Loop and Otologic Symptoms / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The correlation of anterior inferior cerebellar artery (AICA) vascular loop around cerebellopontine angle (CPA) and otologic symptoms remains controversial. The objective of this study was to evaluate the relationship of the anatomical type of AICA loop and otologic symptoms according to the findings of 3-dimensional Fourier transformation constructive interference in steady state (3DFT-CISS) MRI. SUBJECTS AND METHOD: 316 ears from 165 patients were included in this study. Otologic symptoms and the results of pure tone audiometry, auditory evoked potential, and electronystagmography were checked by retrospective chart review. AICA loops were classified by its configuration on 3DFT-CISS MRI. According to their extension depth in internal auditory canal (IAC), the loops were classified as type I (lying within CPA), type II (from porus acusticus to 50% of the length of IAC), and type III (extending beyond 50% of IAC). In addition, the loops were classified as S (small) and L (large) by comparing the thickness of the loop with adjacent facial nerve. RESULTS: The predominant type of AICA loop was type I (62.0%) and type S (72.8%). Ears with type III loop presented significantly higher rate of hearing impairment than those with type I or II. There were no significant differences in pure tone threshold, hearing loss in 3 consecutive frequencies, canal paresis, and AEP latencies among 3 AICA types classified with the depth of the loop. Ears with type S AICA loop showed significantly higher rate of hearing impairment, elevated threshold, hearing loss in 3 consecutive frequencies, and canal paresis than those with type L loop. CONCLUSION: The small diameter of AICA loop had significant association with hearing impairment and otologic test abnormalities. Impaired blood flow through the vascular loop and resultant hypoperfusion of inner ear may be the pathophysiologic mechanism of vestibulocochlear nerve compression syndrome.

A Case of Fungal Ball of Aspergillus in Chronic Otitis Media / 대한이비인후과학회지

Fungal infections in the ear of immunocompetent patients are mainly observed as otomycosis within the external auditory canal. Benign fungal colonization (fungal ball), though they are common in the paranasal sinuses, has never been reported in the middle ear cavity of a healthy population. We present a case of fungal ball in the middle ear of a 30-year-old, immunocompetent male. He did not have any illness except chronic suppurative otitis media in the right ear. On physical examination, only small central perforation was seen in the right tympanic membrane. Temporal bone computed tomography did not reveal any abnormal finding except thickened tympanic membrane. Intraoperative examination demonstrated a dark gray, cheese-like material in the mesotympanum. After tympanoplasty, mycological staining and histopathologic examination identified the surgical sample to be Aspergillus. So we reported, with a review of literature, the first case of Aspergilloma occurring in the middle ear of a healthy patient.