Videofluoroscopic Evaluation of Swallowing in Patients with Amyotrophic Lateral Sclerosis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Dysphagia in patient with amyotrophic lateral sclerosis (ALS) is a critical symptom for prognosis. Proper evaluation and follow-up of their dysphagia is also important in management. Videofluoroscope is the gold standard method for evaluation of swallowing in ALS patients. The object of this study is to evaluate their dysphagia using videofluoroscope, on the basis of which we can plan the optimal rehabilitation method. SUBJECTS AND METHOD: The clinical records and videofluoroscopes of 7 ALS patients were reviewed. All patients were classified according to Hillel's ALS swallowing score. We analysed their videofluoroscopes and implied proper treatment strategies on the basis of those findings. RESULTS: All patients had dysfunction of tongue. In the early stage, dysphagia was solely attributable to oral phase dysfunction. In the advanced stage, pharyngeal phase was also affected. In some patients, cricopharyngeal dysphagia and aspiration were observed. After various form of treatment such as tongue exercise, position change, swallowing maneuver, tube feeding, and botulinum toxin injection to cricopharyngeal muscle, we could observe improvement in swallowing function. CONCLUSION: Videofluoroscope is a good method for evaluating patients with ALS. By applying tailored treatment strategies on the basis of videofluoroscopic finding, we can properly manage patients with ALS and eventually improve their quality of life.

A Case of Pulsatile Tinnitus with High Jugular Bulb Treated by Ligation of Internal Jugular Vein / 대한이비인후과학회지

Objective tinnitus due to high jugular bulb is a rare presenting symptom. Annoying pulsatile tinnitus caused by high jugular bulb which may cause sleep disturbance or hearing impairment can be treated by surgical therapy of ligation of internal jugular vein. We present a case of pulsatile tinnitus with high jugular bulb which has been treated by surgical therapy. Otologic examination demonstrated bluish mass in hypotympanic portion behind intact tympanic membrane and temporal bone CT showed the high jugular bulb. Audiological characteristics and the nature of tinnitus was also described. After the angiographic examination, the site for venous ligation was confirmed by compression of internal jugular vein with the probe of doppler sonogram. The patient's pulsatile tinnitus has completely disappeared two weeks after surgery.

Recurrent Vestibulopathy: Clinical Characteristics and Efficacy of Combination Therapy

BACKGROUND AND OBJECTIVES: Recurrent vestibulopathy is defined a disease characterized by more than a single episode of vertigo of duration characteristic of endolymphatic hydrops but without auditory or clinical neurological symptoms or signs. To investigate the clinical characteristics and the efficacy of combination therapy, we analyzed the clinical records of the patients diagnosed as recurrent vestibulopathy. MATERIALS AND METHOD: Clinical records of sixty four patients diagnosed as recurrent vestibulopathy were retrospectively reviewed. The data on age, sex distribution, natural history, family history of recurrent vestibulopathy, concurrent headache, caloric response was analyzed. The efficacy of combination therapy for vertigo control in the patients with a minimum 24-month follow-up was also evaluated. RESULTS: Mean onset age of recurrent vestibulopathy was 43 years and there was a female preponderance. Concurrent headache and elevated SP/AP ratio in electrocochleogram was frequently observed in these patients. After the combination medical therapy, patients with severe recurrent vestibulopathy showed significant decrease in the number of vertigo spells with 37.5% of complete control of vertigo. CONCLUSION: As a distinctive clinical disorder with unknown cause, recurrent vestibulopathy should be always considered to the patients complaining recurrent episodic vertigo. Combination therapy individualized to the symptoms and signs of the patients with recurrent vestibulopathy might be effective in reducing the frequency of vertigo attacks. Further case-control studies with large population should be necessary.