Swing-Door Overlay Tympanoplasty: Surgical Technique and Outcomes

OBJECTIVES: The classical overlay tympanoplasty is technically difficult with some disadvantages and thus less popular. However, it is particularly useful for large, anterior perforations. In this study, we describe the technique of a modified overlay graft in the tympanoplasty coined as the swing-door overlay tympanoplasty and report its outcomes. METHODS: Retrospective review of patients undergoing the swing-door overlay tympanoplasty at a tertiary referral center between 2003 and 2016 was performed. Patient who had ossicular abnormality, previous tympanoplasty, and profound hearing loss were excluded. The surgical technique is described in detail. The outcomes were evaluated by the graft success rate, complication rate, and hearing results. The hearing level was determined by four pure-tone average at 0.5, 1, 2, and 4 kHz. Air-bone gap closure was mainly assessed. RESULTS: A total of 306 patients (110 males and 196 females) were included. The mean age was 49.1±16.6 years. Follow-up periods ranged from 6 to 108 months with an average of 18.4 months. The overall graft success rate reached 98.4%. Five graft failures occurred with reperforation in three cases and lateralization in two cases. Postoperative complications occurred in 12 cases (3.9%). Air-bone gap changes (closures) were 7.8±12.8, 5.2±12.2, 5.7±10.2, and 6.0± 12.8 dB at 0.5, 1, 2, and 4 kHz, respectively (all P < 0.001) with an average improvement of 6.2 dB. Postoperative airbone gap was closed to ≤20 dB in 86.9%. CONCLUSION: The swing-door overlay tympanoplasty is a highly successful surgical technique suitable for all types of tympanic membrane perforations. This approach is technically easier than classical overlay tympanoplasty and affords an excellent graft success rate with satisfying hearing results.

Three Dimensional Analysis of Caloric, Spontaneous, Positional, Positioning and Post Head Shaking Nystagmus in Bilateral Vestibulotoxic Cats / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Vestibular toxicity can be usually monitored by a caloric test, but measuring eye movements including nystagmus is also helpful in the evaluation of vestibulotoxic process. To understand the vestibular signs during bilateral vestibulotoxic process, we observed three dimensional serial changes of eye movements and the results of caloric test in cats using a magnetic search coil system. MATERIALS AND METHODS: Three-dimensional (3-D) eye movement responses to ice water caloric stimulus and spontaneous, positional, positioning, and post head shaking nystagmus in five cats were serially evaluated at 3, 7, 10, 14, 21, 28 days, 2, 3, 4, 5, 6 months after inducing bilateral vesitibulotoxicity by subcutaneous injection of streptomycin. Histologic changes of vestibular system were also observed. RESULTS: Bilateral vestibulotixicity which showed no response to ice water caloric stimulus was induced within 2 weeks with streptomycin injection. Positional, positioning and post head shaking nystagmus were present during vestibulotoxic process. Caloric nystagmus did not reappear within 6 months and histologic finding in crista ampullaris of lateral semicircular canal showed marked degeneration of the hair cells and nerves. CONCLUSION: Observation of positional, positioning and post head shaking nystagmus as well as ice water caloric test will be helpful to monitor vestibulotoxic process.

Hyperacusis in Patients with Tinnitus-Audiometrical Evaluation & Clinical Characterization / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Hyperacusis, defined as increased sound sensitivity or decreased sound tolerence, has been reported to be related to tinnitus. The purposes of this study are to investigate the audiometrical characterization of hyperacusis and to evaluate the possible effect of hyperacusis on clinical presentation in tinnitus patients. MATERIALS AND METHOD: A total of 128 tinnitus patients, who visited the Tinnitus Clinic, Kangnam St. Mary's Hospital from May, 1999 to September, 2000, were included in this study. Their audiometrical study results were analyzed, and their hearing impairment was compared with those of normal controls. RESULTS: The prevalence of hyperacusis in the patients with tinnitus were as high as 37.8% according to the questionnare. Uncomfortable loudness levels to pure tone stimuli was significantly low in hyperacusis patients. In the tinnitus patients with normal hearing, the tinnitus handicap scores between hyperacusis and non-hyperacusis patients were significantly different, though the results of tinnitogram showed no difference. CONCLUSION: The hyperacusis test using pure tone stimuli may screen hyperacusic patients. It is necessary to consider the presence of hyperacusis in tinnitus patients so as to understand patient discomfort and to seek appropriate treatment modality.

Clinical Implication and Therapeutic Efficacy of Tinnitus Retraining Therapy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tinnitus retraining therapy (TRT) has been presented as a new approach to tiniutus management. The aim of this paper is to show the clinical implication method of TRT in our clinic and to evaluate the therapeutic efficacy of TRT based on questionnaires and tinnitograms. MATERIALS AND METHODS: Using the clinical implication method of TRT, 60 patients with tinnitus, who visited Tinnitus Clinic, Kangnam St. Mary's Hospital from May, 1999 to July, 2001, and who had received TRT for their tinnitus, were included for the evaluation of therapeutic efficacy of TRT. Their psychoacoustic characteristics of tinnitus and changes of subjective tinnitus were analyzed. RESULTS: Loudness, awareness, annoyance and effect on life of tinnitus decreased after TRT. Tinnitus handicap score also significantly decreased (p<0.05). Forty-eight patients among the sixty patients (80%) showed relief of their tinnitus in more than 2 of 4 subjective parameters (loudness, awareness, annoyance and effect on life of tinnitus). CONCLUSION: TRT has been shown to be effective in the treatment of subjective tinnitus. Modification of TRT may be necessary for easy application of this therapy in Korea.

A Case of Osteoma Originated from the Squama of Temporal Bone / 대한이비인후과학회지

Osteoma is a benign bone-forming tumor which is most frequently found in the fronto-ethmoidal area. Although commonly discovered in the external auditory canal of the temporal bone, few cases have been reported in the mastoid or squamous portion of the temporal bone. The authors experienced a case of large osteoma that originated from the squama of temporal bone. We report this rare case and its successful management with a review of the literatures.

Influence of HLA in the Pathogenesis of Meniere's Disease in Korean Population / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study was designed to investigate the influence of human leukocyte antigen (HLA) on genetic susceptibility to Meniere's disease and to evaluate the correlation between HLA genotypes and results of examination for various clinical factors of Meniere's disease. MATERIALS AND METHOD: The distribution of HLA class I was examined in 39 patients with MD and 199 healthy controls. For HLA-A and B, the serologic typing was performed according to a standard microlymphocytotoxicity technique. The HLA-C typing was performed by the ARMS-PCR method at DNA level. RESULTS: The frequencies of HLA-CwX0303 (RR=, p<0.02), and CwX0602 (RR=, p<0.03) were significantly increased in patients with Menieres disease, when compared to the controls. However, HLA-B44 (RR=, p<0.004) and CwX0102 (RR=, p<0.03) were significantly decreased in the patients compared to the controls. When an association between hearing level and the presence of HLA alleles was evaluated, the frequencies of HLA-B13 (RR=, p<0.004), CwX0303 (RR=5, p<0.02) and CwX0602 (RR=5, p<0.02) were significantly increased and the frequencies of B44 (RR=1, p*lt;0.02) and CwX0102 (RR=1, p<0.03) were significantly decreased in patients with the state of mild to profound hearing losses, compared to the controls. HLA-B13 showed a different distribution pattern between patients with and without hearing losses. CONCLUSION: These results suggest that some HLA alleles may be useful genetic markers in conferring the susceptibility to Meniere's disease and in implying a prognosis in Korean patients.

A Case of Patent Foramen of Huschke Confirmed during Tympanoplasty / 대한이비인후과학회지

Herniation of the temporomandibular joint (TMJ) into the external auditory canal (EAC) has been reported to occur spontaneously or as a result of trauma, neoplasia, infection, or inflammatory processes. It was postulated that spontaneous herniations were attributable to a patent foramen of Huschke, which represents a non-ossified portion of the tympanic plate. Eight cases of spontaneous herniation of the TMJ into the EAC were reported internationally. Recently, we experienced a case of a patent foramen of Huschke confirmed during a tympanoplasty. We reviewed the intimate relation of the TMJ to the temporal bone as well as the characteristic location, clinical and radiographic findings of a patent foramen of Huschke.

Distribution and Expression of Superoxide Dismutase in Pediatric Tonsils and Adenoid / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: B-lymphocytes and other phagocytes which infiltrate into inflammatory sites in pathologic condition are able to make reactive oxygen species such as superoxide free radicals (SFRs) which have toxic effects on foreign bodies including bacteria as well as normal eukaryotic cells. To prevent harmful effects of SFRs, eukaryotic cells can produce antioxidant enzymes such as superoxide dismutase (SOD) and catalase. The purpose of this study is to investigate the protective system of pediatric palatine tonsils and adenoids against the SFRs and to evaluate the clinical factors including otitis media with effusion that are related to the expressions and activities of copper zinc superoxide dismutases (CuZnSODs) in these tissues. MATERIALS AND METHOD: Twenty-one children who were operated for enlarged tonsils and adenoid with or without otitis media with effusion (OME) from December 1999 to Feburary 2000 were studied. Physcial fidings were evaluated and history-taking was carried out. RT-PCR and immunohistochemistry stain against CuZnSOD were conducted. RESULTS: Immunohistochemistry showed that CuZnSODs were found in the crypt epithelium, mucous membrane, mantle zone and in the extrafollicular area of pediatric adenoids as well as palatine tonsils. There were significant correlations between the presence of OME, paranasal sinusitis and the expression of CuZnSOD of adenoid (p<0.05), the frequency of tonsillitis, recent tonsillitis and the expression of CuZnSOD of tonsils (p <0.05). CONCLUSION: In pediatric tonsils and adenoids, the mechanism of tissue protection against infection and frequent inflammatory reactions may be closely related to the CuZnSODs expression.

Three dimensional analysis of caloric nystagmus and effect of visual suppression in cats / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The caloric test is considered to be one of the most sensitive parameters in the diagnosis of peripheral vestibular disorders, although it can test only the function of the lateral semicircular canals. In this study, the authors measured the eye movements and visual suppression of caloric nystagmus in cats three dimensionally using a magnetic search coil system. MATERIALS AND METHOD: Three-dimensional (3-D) eye movement responses to an ice water caloric stimulus were studied with the six normal cats positioned in an upright position (lateral semicircular canal vertical). Visual suppression of caloric nystagmus was also investigated. RESULTS: All animals showed eye movements in the horizontal, torsional and vertical planes. Of the three nystagmus components, the horizontal component showed the fastest eye velocity during caloric stimulation. In light, a slight, but certain degree of visual suppression in was recognized in cats. CONCLUSION: The caloric nystagmus response involves a complex eye movement response comprising the horizontal, vertical and torsional nystagmus components. The 3-D analysis system with a magnetic search coil is useful to investigate the eye movement during caloric stimulation when the cat is awake.

Normal variation of subjective visual vertical and horizontal in human / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Otolithic system which senses the head position and linear movement according to gravity acceleration force, plays an important role in maintaining the position of eyeball by otolith-ocular reflex. Measurement of subjective visual vertical and horizontal in darkness with the head upright is one of the static function test of the otolithic system and is simple to perform in man. Several papers reported that perceptual visual vertical and horizontal stays within small range in normal person but numbers of test subjects were limited. Furthermore the effect of age and sex are unknown. MATERIAL AND METHODS: One hundred forty normal subjects(male:70, female:70 ; age 5-70) were selected on the basis of medical history and neurologic examination. The subject was seated upright 100 cm from LED bar(1 mm width , 80 cm length)in the dark. The supporting frame of LED bar was motor driven with minimum rotating angle of 0.01 degree in both directions. After several practice, each subject set the LED bar from random position to subjective vertical or horizontal twice in one session with a motor control switch. Five sessions were repeated with a minimum interval of 5 minutes. RESULTS: The calibrated mean values were 1.06+/-0.45 degree in vertical and 1.00+/-0.52 degree in horizontal and did not demonstrate any difference in plane and direction of adjustment. Age under 10 and over 60 had a significant higher mean value compared with the mean of all subjects but the difference between over 10 and below 60 was not noted. Female had higher mean values than male. Five repeated tests showed high reproducibility. The direction of adjustment did not show any significant difference. CONCLUSION: These results would be a useful clinical data for evaluating the static otolith-ocular reflex.

Effect of Antioxidants and Dexamethasone on inducible Nitric Oxide Synthase Expression and Nitric Oxide Production in Murine Macrophage Cells / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nitric oxide(NO) plays a role in a number of physiologic functions and may be cytotoxic in high concentrations. Some kinds of cells including macrophage are known to produce large quantities of NO in response to inflammatory stimuli such as cytokines and lipopolysaccharide(LPS). Reactive oxygen species are also known to be important in the pathogenesis of cell and tissue injury such as otitis media with effusions. Using the macrophage RAW 264.7 cell, we have examined the ability of oxidant hydrogen peroxide (H2O2) to stimulate NO production and inducible nitric oxide synthase(iNOS) mRNA expression. Also, we have examined the effects of Dexamethasone(DEX) and antioxi- dants on H2O2 induced NO production. MATERIALS AND METHOD: Macrop- hages were cultured with LPS and H2O2 in the presence or absence of DEX or antioxidants for 24 hr. The effect of DEX and antioxidants on NO production and iNOS mRNA expression was examined by assaying the culture supernatant for oxidation product nitrite(NO-2) and nitrate (NO-3) content and Northern blot analysis. The effect of DEX on NO production when added at different stages of activation was determined. RESULTS: DEX significantly inhibited the formation of NO2- and NO3- and iNOS mRNA expression in cells stimulated with LPS and H2O2. Antioxid- ants significantly inhibited the H2O2-induced augmentation of LPS induced NO2- and NO3- formation and iNOS mRNA expression. CONCLUSION: H2O2 contributes to inflammatory process by augmenting the iNOS mRNA expression and NO synthesis induced by LPS, and DEX and anti- oxidants inhibits NO synthesis by inhibition of iNOS mRNA expression.

Immune-mediated Sensorineural Hearing Loss in a Patient with Ankylosing Spondylitis / 대한이비인후과학회지

Sporadic reports of inner ear dysfunction associated with autoimmune disorders such as polyarteritis nodosa, systemic lupus erythematosus, Cogan's disease, rheumatoid arthritis and ankylosing spondylitis have appeared over the years, although the basis of such events was unknown. In recent years, presumable pathogenesis of immune-mediated sensorineural deafness and vestibular dysfunction has been reported and immunosuppressive therapy in patients with suspected autoimmune inner ear disease is highly suggested. We report a case of immune-mediated sensorineural hearing loss with ankylosing spondylitis, which responded to steroid therapy.

Angiogenesis and p53 Mutation in Oral and Oropharyngeal Squamous Cell Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is well known that microvessel density (MVD) and p53 gene mutation are significantly correlated with tumor behaviors in some types of cancer: however, some studies have reported a lack of relationship among MVD, p53 gene mutation and tumor behavior in oral cancers. The objective of this study was to identify putative association between p53 gene mutation and microvessel density (MVD) and to evaluate the usefulness of this association in deciding the therapeutic plan. MATERIALS AND METHODS: In 25 tumor specimens of oral squarnous cell carcinoma, microvessel density (MVD) was analysed by immunohistorhemical staining with CD-31 monoclonal antibody, and p53 mutation was examined in exon 5 through 8 by PCR-SSCP and sequencing analysis. RESULTS: Seven of the 25 patients had mutation in exon 5 to 8 and all the mutations were missense mutation. The mean of MVD in the mutant group was 13.3+/-2.80 and that of MVD in the wild type group was 18.6+/-1.16. An inverse relationship was seen between MVD and p53 mutation (p=0.047). The p53 gene mutation was frequently found in exon 5. CONCLUSION: MVD and p53 gene mutation were not associated with respect to stage, cervical metastasis and recurrence of' the oral and oropharyngeal cancer. Angiogenesis of oral squamous cell carcinoma might not be regulated by p53, but might be regulated by other factors.

Association between HLA Class II Alleles and Response to Steroid Therapy in Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This research investigated the association between HLA (human leukocyte antigen) class II alleles and the susceptibility to sudden sensorineural hearing loss, and between HLA class Il alleles and the results of treatment with steroid in the Korean population. MATERIALS AND METHOD: We carried out HLA-DRR1, -DQA1, -DQR1 and -DPRl genotyping in 41 patients with sudden sensorineural hearing loss and in 206 healthy controls. We examined the initial hearing levels at the onset of hearing loss and the final hearing levels after the treatment, and then evaluated for the association with HLA class II alleles. HLA-DRB1, DQA1, BQB1 and DPB1 genotypings were performed by employing the sequence specific oligonucleotide probes (SSOP) method. RESULTS: The frequencies of HLA-DRB1, DQA1, DQB1, and DP31 alleles were not significantly different between the patients and controls. When the association between the results of treatment and HLA alleles was increased, the frequencies of HLA-DRB1X14 (RR= 3.5, p<0.02), -DQA1X03 (RR=4.2, p<0.02) and -DQA1X05 (RR=3.1, p(0.03) significantly increased, but the frequencies of HIA-DQA1X01 (RR=0.2, p<0.004) and -DQB1X06 (RR =0.2, p<0.009) significantly decreased in patients who did not respond to the steroid treatment, compared with the controls. The frequencies of HLA-DQA1X01 (p<0.04) and -DQB1X06 (p<0.02) significantly increased while the frequency of HLA- DQA1X03 (p<0.003) significantly decreased in patients who responded well to steroid, compared with patients who did not. CONCLUSION: These results suggest that the presence of HLA-DRB1X14, DQA1X03 and DQA1X05 might be an useful marker that implys poor prognoses whereas the presence of HLA-DQA101 and DQB1X06 might be a marker implying good prognoses in Korean patients with sudden sensorineural hearing loss.

The Effect of Middle Ear Effusion on Otoacoustic Emissions / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The transmission properties of the middle ear directly influence otoacoustic emissions (OAEs) which are transmitted from the cochlea to the ear canal via middle ear. The purpose of this study is to evaluate the effects of middle ear effusion (MEE) on detectability of various OAEs and to assess the potential applicability of DPOAE measurements in monitoring the middle ear status. MATERIALS AND METHOD: Spontaneous otoacoustic emissions (SOAEs), transiently evoked otoacoustic emissions (TEOAEs) and distortion product otoacoustic emissions (DPOAEs) were recorded for 44 normal ears and 32 ears with MEE. DPOAEs were collected in two basic forms consisting of distortion product audiograms(DPgrams) and input-output (I-O) functions, elicited by two primary tones fl and f2 with varying geometric mean frequencies between 1-6 kHz. RESULTS: SOAEs were absent in 21 ears of 32 ears with MEE, TEOAEs were diminished in 28 ears with MEE, and DPgrams were eliminated in 17 ears with MEE. I-O function curves at 3 kHz and 4 kHz were significantly diminished by equal levels of fl and f2 primary tones of 45 & 55 dB SPL under the condition of MEE (p<0.05). CONCLUSION: The results suggest that MEE affects the detectability of various OAEs and that the DP I-O function curve measurement at 3 and 4 kHz may be valuable to monitor the middle ear status in pediatric patients.

Detection of Human Papillomavirus and Epstein-Barr Virus in Sinonasal Inverted Papillomas and Its Correlation with p53 and Proliferating Cell Nuclear Antigen Expression / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sinonasal inverted papillomas are benign but topographically aggressive neoplasms that have a high recurrence rate and seem to be associated with malignancy. The etiology of inverted papilloma remains unknown, but some hypotheses suggest that nasal polyps proliferation and chronic inflammation are due to allergy or various infectious lesions. This study was to elucidate the biological characteristics and the role of human papillomavirus (HPV) and Ebstein -Barr virus (EBV) and the expression of p53 protein and proliferating cell nuclear antigen (PCNA) in sinonasal inverted papillomas. MATERIALS AND METHODS: We examined 26 specimens from 26 individuals with normal nasal mucosae (n=10) and inverted papillomas (n=16) to determine the occurance of HPV and EBV infection and the expression of p53 protein and PCNA. RESULTS: Of the 16 Inverted papillomas, HPV DNA was detected in eight cases, HPV 18 was detected in two cases (18%), HPV 16 and HPV 33 were both found in every case (6%), HPV 6 and HPV 16 were coinfected in one case (6%), and other types were found in 3 cases. HPV DNA was not detected in the normal nasal mucosae. EBV DNA was detected in 10 cases (62%) out of 16 inverted papillomas ancl in two cases (20%) of 10 normal nasal mocosae. The altered p53 protein expression was observed in four cases (25%), and positive PCNA staining was detected in four cases (25%) out of 16 inverted papillomas. One positive PCNA staining was detected among 10 normal mucosae. The mean PC10 index was 16.0% in the inverted papillomas group and 4.1% in normal nasal mucosae group. CONCLUSION: An inverse correlation may exist between oncogenic HPV infection and p53 alteration in sinonasa1 inverted papillomas.

A Case of Lateral Semicircular Canal Dysplasia with Normal Cochlea / 대한이비인후과학회지

Congenital anomalies of the inner ear in comparison with anomalies of the external and middle ear present a clinical problem for diagnosis, because the inner ear structures can not be observed directly. Ontolaryngologists can diagnose these anomalies by radiological study alone. In recent years, high-resolution computed tomographs permits more reliable and definitive diagnosis of these anomalies. Although the incidence of anomalies of the vestibular canals have been less well studied than those of cochlear anomalies, congenital malformation of the semicircular canals are rare. We present one case with computed tomographic findings of lateral semicircular canal dysplasia with normal cochlea development. Initial air and bone conductions were within normal limits, although he mainly complained dizziness. Bithermal caloric responses were absent on the involved side. Computed tomogram showed isolated lateral semicircular canal dysplasia. To our knowledge, this case is the first report of labyrinthine dysplasia with normal cochlear development in Korea.

Expression of Inducible Nitric Oxide Synthase in the Experimental Otitis Media with Effusion / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Ntric oxide (NO) is a short-lived biological mediator produced by diverse cell types, including inflammatory cells and epithelial cells. It may be cytotoxic to cells in high concentrations. Inducible nitric oxide synthase (iNOS) expressed in macrophages produce large quantities of NO in response to inflammatory stimuli such as cytokines and lipopolysaccharide. NO is now considered to be a mediator of endotoxin induced middle ear effusion (MEE). The author attempted to identify the expression of iNOS in immune mediated otitis media with effusion (OME). MATERIALS AND METHOD: Immune mediated OME was induced in rats, which were sensitized twice subcutaneously with KLH (keyhole lympet hemocyanine) and challenged with KLH into the middle ear 1 week later. We observed the development of MEE after 1, 3, 7 and 14 days following the challenge and measured nitrite (NO-2) and nitrate (NO - 3) in MEE which are oxidative product of NO. We utilized the RTPCR (reverse transcription polymerase chain reaction) technique to evaluate the presence of iNOS mRNA in MEE. The immunohistochemical method was used to identify the expression of iNOS and infiltration of macrophage in middle ear mucosa. RESULTS: Serous MEE was developed at 3 days, and with time passed, it was changed to the mucoid type. Nitrite and nitrate were detected in MEE and iNOS mRNA was expressed in MEE. iNOS was expressed extensively with time and macrophages were diffusely infiltrated in middle ear mucosa. CONCLUSION: NO produced by the expressed iNOS may contribute to the development of OME, and we will be able to apply the role of iNOS and macrophage to research on pathogenesis and treatment of OME.

Congenital Middle Ear Cholesteatoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Congenital middle ear cholesteatoma (CMEC) is a keratinous mass behind an intact tympanic membrane. CMEC does not have a history of instrumentation and is less common than acquired one. Many theories have been put forward to explain the pathophysiology of CMEC, however, none of these so far have been convincingly proven. This clinical study was performed to investigate the characteristic features of CMEC and to evaluate the correlation between pathophysiology and CMEC by retrospectivly reviewing the cases. MATERIALS AND METHOD: The medical records of patients who underwent otologic procedures at the hospitals of the Catholic university from January 1993 to September 1998 have been reviewed. They were ten males and four females, ranging in age from 4 to 59 (mean age 18). RESULTS: Three of the 14 patients had the lesions isolated to the anterosuperior quadrant of the mesotympanum which were cystic, easily removed and did not affect hearing. The others had more serious condition with extension into the posterior mesotympanum, which were large, often too extensive to indicate a formative site, and causing ossicular damage. CONCLUSION: CMEC presents in two distinctive forms according to the site of formation: the anterosuperior and posterior mesotympanum. The review suggest that the pathophysiology of posterior lesions may be different from anterior ones. For early diagnosis of CMEC, screening program should be carried out in children to prevent the more extensive diseases.

Histopathologic Changes in Nasal Mucosa of Rat with Benzalkonium Chloride / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Benzalkonium Chloride (BZC) is one of the most often used preservatives that has strong germicidal effect. Not only is it used for nasal drops, but also for eye drops and cosmetics. However, there have been many reports that lesions such as dermatitis and conjunctivitis are considered the results of irritation induced by BZC. We evaluated the histological changes after long-term administration of BZC on rat nasal respiratory mucosa. MATERIAL AND METHODS: We divided 40 BZC treated animals into 4 groups. First group received low-concentrated BZC solution which is commonly used for nasal sprays. Second group received high-concentrated BZC solution which is reported to induce dermatitis in human. Third and Fourth group received steroid mixed in the BZC solutions of low and high concentrations, respectively. Control group was administrated with normal saline. After 1, 2, and 4 weeks of topical administration in each group, the symptomatic and histological changes with H&E stain were observed. RESULTS: Sneezing and nose rubbing with forelegs were observed in all subgroups on the 5th day of treatment. The BZC induced lesions, including glandular formation, inflammatory cell infiltration, and edematous changes. The symptomatic and histological changes were pronounced when the duration of BZC administration was increased. Similar results were observed in groups that received steroid mixed in the BZC solution. CONCLUSION: We found that even low concentration of BZC preservative can cause nasal lesions. Thus, there is a strong need to develope a preservative that can be used safely.