Clinical Application of 3D-FIESTA Image in Patients with Unilateral Inner Ear Symptom

BACKGROUND AND OBJECTIVES: Unilateral auditory dysfunction such as tinnitus and hearing loss could be a warning sign of a retrocochlear lesion. Auditory brainstem response (ABR) and internal auditory canal magnetic resonance image (MRI) are suggested as novel diagnostic tools for retrocochlear lesions. However, the high cost of MRI and the low sensitivity of the ABR test could be an obstacle when assessing patients with unilateral ear symptoms. The purpose of this study was to introduce the clinical usefulness of three-dimensional fast imaging employing steady-state acquisition (3D-FIESTA) MRI in patients with unilateral ear symptoms. SUBJECTS AND METHODS: Two hundred and fifty-three patients with unilateral tinnitus or unilateral hearing loss who underwent 3D-FIESTA temporal bone MRI as a screening test were enrolled. We reviewed the abnormal findings in the 3D-FIESTA images and ear symptoms using the medical records. RESULTS: In patients with unilateral ear symptoms, 51.0% of the patients had tinnitus and 32.8% patients were assessed to have sudden sensory neural hearing loss. With 3D-FIESTA imaging, twelve patients were diagnosed with acoustic neuroma, four with enlarged vestibular aqueduct syndrome, and two with posterior inferior cerebellar artery aneurysm. Inner ear anomalies and vestibulocochlear nerve aplasia could be diagnosed with 3D-FIESTA imaging. CONCLUSIONS: 3D-FIESTA imaging is a highly sensitive method for the diagnosis of cochlear or retrocochlear lesions. 3D-FIESTA imaging is a useful screening tool for patients with unilateral ear symptoms.

A Case of Auditory Neuropathy with Recovery of Normal Hearing

Newborn hearing screening test is very important in the early diagnosis of childhood hearing loss because it affects language development. Auditory neuropathy is a spectrum disorder characterized by abnormal auditory brainstem response but preserved otoacoustic emission and cochlear microphonics. In general, auditory neuropathy patients have poor word discrimination and variable patterns of pure tone audiometry. We report on a patient with auditory neuropathy diagnosed at 16 months of age and started wearing hearing aids, but showed normal pure tone and speech audiometric findings 3 years later. Close follow-up for patients with auditory neuropathy is recommended.

Audiologic Characteristics of Unilateral Tinnitus Patients without Subjective Hearing Disturbance / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tinnitus is an audiologic sensation without external sound stimuli. The aim of this study is to assess characterisistics in unilateral tinnitus patients without subjective hearing loss by analyzing their audiologic test results. SUBJECTS AND METHOD: We used results of audiologic tests including pure tone audiogram (PTA), tinnitogram and distortion products of otoacoustic emissions (DPOAE) from 96 unilateral tinnitus patients without subjective hearing loss. We compared the results of tinnitus ear with non-tinnitus ear individually, and also analyzed these data according to their age, symptom and duration. RESULTS: The hearing level of PTA of tinnitus ears compared to non-tinnitus ears was statistically significant at 4000 Hz and 8000 Hz, and it was more prominent at age over forty. DPOAE results were significantly low at 4000 Hz level in tinnitus ears compared to non-tinnitus ears. Loudness and duration of symptoms were louder and longer when hearing loss was accompanied. CONCLUSION: In unilateral tinnitus patients without subjective hearing disturbance, a pattern of high frequency hearing loss was found in PTA and DPOAE. The patients with hearing loss above 25 dB HL at any frequency are older and have longer duration with high pitch-louder tinnitus. Therefore, even though tinnitus patient has no subjective hearing loss, it is important to make treatment plan by sufficient audiologic evaluation.

Comparative Analysis of the Expression of Involucrin, Filaggrin and Cytokeratin 4, 10, 16 in Cholesteatoma

BACKGROUND AND OBJECTIVES: The aim of this study is to determine whether the hyperproliferative and hyperkeratotic characters of cholesteatoma are associated with differentiation of keratinocytes in cholesteatoma by examining the localization of marker proteins, such as involucrin, filaggrin, and cytokeratins. MATERIALS AND METHODS: Immunohistochemical study was carried out in 30 cholesteatoma tissues and 10 retroauricular skins to examine the expression of involucrin, filaggrin, cytokeratin 4, 10 and 16. The staining results were graded as negative, weakly positive (70%). RESULTS: Involucrin was strongly expressed in upper spinous, granular, and corneal layer of cholesteatoma. Filaggrin was strongly expressed in granular and corneal layer of cholesteatoma. Cytokeratin 4 was expressed in basal layer of retroauricular skin, but occasionally expressed in suprabasal layer of cholesteatoma. Cytokeratin 10 was homogenously expressed in all suprabasal layer of retroauricular skin, whereas pattern of shift to surface layer was showed in cholesteatoma. Cytokeratin 16 was moderately expressed at suprabasal layer in cholesteatoma. CONCLUSIONS: It can be suggested that early differentiation of suprabasal layer may lead to hyperdifferentiation and hyperkeratosis. Different expression of cytokeratins possibly indicates the altered differentiation of cholesteatoma.

Comparative Analysis of the Expression of Involucrin, Filaggrin and Cytokeratin 4, 10, 16 in Cholesteatoma

BACKGROUND AND OBJECTIVES: The aim of this study is to determine whether the hyperproliferative and hyperkeratotic characters of cholesteatoma are associated with differentiation of keratinocytes in cholesteatoma by examining the localization of marker proteins, such as involucrin, filaggrin, and cytokeratins. MATERIALS AND METHODS: Immunohistochemical study was carried out in 30 cholesteatoma tissues and 10 retroauricular skins to examine the expression of involucrin, filaggrin, cytokeratin 4, 10 and 16. The staining results were graded as negative, weakly positive (70%). RESULTS: Involucrin was strongly expressed in upper spinous, granular, and corneal layer of cholesteatoma. Filaggrin was strongly expressed in granular and corneal layer of cholesteatoma. Cytokeratin 4 was expressed in basal layer of retroauricular skin, but occasionally expressed in suprabasal layer of cholesteatoma. Cytokeratin 10 was homogenously expressed in all suprabasal layer of retroauricular skin, whereas pattern of shift to surface layer was showed in cholesteatoma. Cytokeratin 16 was moderately expressed at suprabasal layer in cholesteatoma. CONCLUSIONS: It can be suggested that early differentiation of suprabasal layer may lead to hyperdifferentiation and hyperkeratosis. Different expression of cytokeratins possibly indicates the altered differentiation of cholesteatoma.

Helicobacter pylori in middle ear of children with otitis media with effusion / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Otitis media with effusion (OME) is a common pediatric disease, but its pathogenesis remains uncertain. The relationship between OME and Helicobacter pylori (HP) is currently being studied, and a relationship has not yet been confirmed. The purpose of this study was to show that a relationship does exist between HP and OME.</p><p><b>METHODS</b>The study consisted of 60 patients who were diagnosed with OME and had ventilation tube insertions with or without an adenoidectomy. This study included an additional 30 patients who had only received an adenoidectomy without being diagnosed with OME. The effusion samples were analyzed with polymerase chain reaction (PCR) and the campylobacter-like organism (CLO) test. The adenoid tissue samples were analyzed with the CLO test.</p><p><b>RESULTS</b>Eighteen patients among the 60 patients (30%) tested positive for HP. In the cases with adenoids, 15.6% of the OME patients and 13.3% of the adenoidectomy only patients were positive for HP. There were no differences between the prevalence of HP in the adenoids of OME patients and the patients without OME.</p><p><b>CONCLUSION</b>HP can be considered one of the causes of OME.</p>

Enhancement of Allergen-induced Airway Inflammation by NOX2 Deficiency

BACKGROUND: NADPH oxidase (NOX) modulates cell proliferation, differentiation and immune response through generation of reactive oxygen species. Particularly, NOX2 is recently reported to be important for regulating Treg cell differentiation of CD4+ T cells. METHODS: We employed ovalbumin-induced airway inflammation in wild-type and NOX2-deficient mice and analyzed tissue histopathology and cytokine profiles. RESULTS: We investigated whether NOX2-deficiency affects T cell-mediated airway inflammation. Ovalbumin injection which activates T cell-mediated allergic response increased airway inflammation in wild-type mice, as evidenced by increased immune cell infiltration, allergic cytokine expression, and goblet cell hyperplasia in the lung. Interestingly, NOX2 knockout (KO) mice were more susceptible to allergen-induced lung inflammation compared to wild-type mice. Immune cells including neutrophils, lymphocytes, macrophages, and eosinophils were drastically infiltrated into the lung of NOX2 KO mice and mucus secretion was substantially increased in deficiency of NOX2. Furthermore, inflammatory allergic cytokines and eotaxin were significantly elevated in NOX2 KO mice, in accordance with enhanced generation of inflammatory cytokines interleukin-17 and interferon-gamma by CD4+ T cells. CONCLUSION: These results indicate that NOX2 deficiency favorably produces inflammatory cytokines by T cells and thus increases the susceptibility to severe airway inflammation.

Clinical Review of Dizziness Patients Who Visited Emergency Room / 대한평형의학회지

BACKGROUND AND OBJECTIVES: As most dizziness symptoms are vaigue, and misdiagnosis of central dizziness can be life threatening, diagnosis of the dizziness is difficult. Especially, in the emergency room with a restricted environment, it must be more difficult. The aim of this study is to find out and correct the aspects requiring a modification for diagnosis in patients of dizziness who visited emergency room. MATERIALS AND METHODS: The authors retrospectively have reviewed the charts of 458 patients with dizziness who visited the emergency room at Hanyang University Guri Hospital from April 2008 to March 2009 and researched the various informations such as diagnosis, clinical feature, physical findings, present illness, past history, consulted department, and visiting season, etc. RESULTS: The average age of patients was 61 years old. Even though there was a difference at the diagnosis distribution between age groups, non specific dizziness and benign paroxysmal positional vertigo was the most frequent diagnosis. Checking the dizziness characters like whirling sense, autonomic symptoms and progressing features was important. And vestibular function tests such as nystagmus test and rotatory test like post head shaking or head thrust test were helpful for differential diagnosis of dizziness in emergency room. Patients with central vertigo were older (71.2 year) and had more past medical histories. But there was no seasonal frequency difference of dizziness. CONCLUSION: As at emergency room, the differential diagnosis of dizziness is important but difficult, integrated medical knowledge of several departments associated with dizziness is required.

XRCC1 Polymorphisms and Risk of Papillary Thyroid Carcinoma in a Korean Sample

Polymorphisms of DNA repair genes, X-ray repair cross-complementing group 1 (XRCC1) might contribute to individual susceptibility to different types of cancers. We analyzed the relationship between XRCC1 polymorphisms and the risk of papillary thyroid carcinoma in a Korean sample. A hospital-based case-control study was performed in 111 papillary thyroid carcinoma patients and 100 normal control subjects. XRCC1 Arg194Trp and Arg399Gln single nucleotide polymorphisms (SNPs) were genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The XRCC1 Arg194Trp Arg/Trp genotype was significantly associated with a decreased risk of papillary thyroid carcinoma compared to that of Arg/Arg genotype (odds ratio [95% confidence intervals]; 0.550 [0.308-0.983]). There was no significant association between XRCC1 Arg399Gln genotypes and risk of papillary thyroid carcinoma. Based on these results, the XRCC1 Arg194Trp Arg/Trp genotype could be used as a useful molecular biomarker to predict genetic susceptibility for papillary thyroid carcinoma in Koreans.

Epitympanic Development and Mastoid Pneumatization in Chronic Otitis Media with and without Cholesteatoma

BACKGROUND AND OBJECTIVES: Chronic otitis media (COM) is strongly related to the degree of aeration of the middle ear and mastoid. The developmental pattern of these air cell systems can affect those of COM, especially cholesteatoma, or vice versa. We investigated several anatomical indexes representing the middle ear and mastoid air cell system to research their relationship with different types of COM. SUBJECTS AND METHODS: Temporal bone computed tomography were performed on 51 patients with cholesteatoma, 50 with COM, and 50 normal subjects. Height of epitympanum, degree of mastoid pneumatization and anterior epitympanic space (AES) development were measured. AES development was classified into three categories: undeveloped, single cell and multiple cells. Anatomical index measurements were compared according to the types of COM. RESULTS: The mean height of epitympanum was 5.12mm in cholesteatoma, 6.04 mm in COM, and 7.40 mm in normal group (p<0.05). The degree of pneumatization was 20.9%, 17.2%, and 42.2% respectively. AES was undeveloped in 65%, single cell in 33%, and multiple cells in only 2% of cholesteatoma patients. In COM and normal groups, the proportions of AES were 60%, 30%, 10% and 7%, 48%, 45% respectively (p<0.05). Comparing between attic and pars tensa types of cholesteatoma, all indexes failed to show any difference. However, there was a significant difference in height of epitympanum between affected ear (5.12 mm) and contralateral ear (5.62 mm) in cholesteatoma group. CONCLUSIONS: In patients with COM, the degree of development of epitympanum and AES are significantly lower than control group. We believe epitympanic underdevelopment may be related to the pathogenesis of COM, especially with cholesteatoma.

Expression of EGFR and Microvessel Density in Middle Ear Cholesteatoma

OBJECTIVES: Cholesteatoma destructs bony tissue by the interactions between hyperproliferative epithelial cells and subepithelial inflammatory cells. The aim of this study was to evaluate the expression of epidermal growth factor receptor (EGFR) and microvessel density (MVD) in middle ear cholesteatoma tissue in an effort to determine the relationship between expression of EGFR and neovascularization. METHODS: We evaluated the expression of EGFR and MVD by immunohistochemical staining for CD31 and Factor VIII in 32 cholesteatoma tissue samples and 7 normal postauricular skin samples. We also analyzed the correlation between EGFR expression and MVD. RESULTS: The expression of EGFR was higher in cholesteatoma than in postauricular skin, but the difference was not statistically significant. EGFR was more highly expressed in the suprabasal layer than in the basal layer. Using CD31 and Factor VIII, we analyzed the MVD and found that it was significantly higher in cholesteatoma than in postauricular skin, and significantly correlated with the expression of EGFR. CONCLUSION: Our results suggest that overexpression of EGFR and neovascularization are correlated with the growth of cholesteatoma.

The Association of Anterior Inferior Cerebellar Artery in Internal Auditory Canal with Tinnitus and Hearing Loss

BACKGROUND AND OBJECTIVES: Tinnitus is a common disorder, but the etiology of this disorder remains unknown. The objective of this study was to assess the correlation between anatomical type and the thickness of the anterior inferior cerebellar artery (AICA) loop with tinnitus, using 3D-fast imaging employing steady state acquisition magnetic resonance image (MRI). MATERIALS AND METHODS: 74 patients with tinnitus and 82 asymptomatic controls were included in this study. Otologic symptoms, which was measured based on the results of a pure tone audiometry, were reviewed. We evaluated the position and thickness of the AICA vascular loop in 3D-FIESTA MRI using two scoring systems. The first system was Chavda classification based on the anatomical location of the AICA loop. The second scoring system was used to measure the thickness of the AICA loop. The AICA loops were classified into two groups based on thickness, thinner than adjacent facial nerve and thicker than the facial nerve. RESULTS: Ears with type I, II AICA loops showed significantly higher rates of tinnitus than those with type III. There was no association between the type of AICA loop and subtype of tinnitus (pulsatile, nonpulsatile). There was no association between the type of tinnitus and hearing loss. Ears with thinner AICA loop had a higher rate of tinnitus than those with thicker AICA loop. CONCLUSIONS: The type I, II and thinner AICA loop was significantly correlated with tinnitus. Compression of VIIIth cranial nerve by AICA loops at a cerebellopontine angle and impaired blood flow through the vessel may be the pathophysiology of tinnitus.

The Association of Anterior Inferior Cerebellar Artery in Internal Auditory Canal with Tinnitus and Hearing Loss

BACKGROUND AND OBJECTIVES: Tinnitus is a common disorder, but the etiology of this disorder remains unknown. The objective of this study was to assess the correlation between anatomical type and the thickness of the anterior inferior cerebellar artery (AICA) loop with tinnitus, using 3D-fast imaging employing steady state acquisition magnetic resonance image (MRI). MATERIALS AND METHODS: 74 patients with tinnitus and 82 asymptomatic controls were included in this study. Otologic symptoms, which was measured based on the results of a pure tone audiometry, were reviewed. We evaluated the position and thickness of the AICA vascular loop in 3D-FIESTA MRI using two scoring systems. The first system was Chavda classification based on the anatomical location of the AICA loop. The second scoring system was used to measure the thickness of the AICA loop. The AICA loops were classified into two groups based on thickness, thinner than adjacent facial nerve and thicker than the facial nerve. RESULTS: Ears with type I, II AICA loops showed significantly higher rates of tinnitus than those with type III. There was no association between the type of AICA loop and subtype of tinnitus (pulsatile, nonpulsatile). There was no association between the type of tinnitus and hearing loss. Ears with thinner AICA loop had a higher rate of tinnitus than those with thicker AICA loop. CONCLUSIONS: The type I, II and thinner AICA loop was significantly correlated with tinnitus. Compression of VIIIth cranial nerve by AICA loops at a cerebellopontine angle and impaired blood flow through the vessel may be the pathophysiology of tinnitus.

The Combination Effects of Early Intratympanic Dexamethasone Injection for the Patients with Sudden Sensorineural Hearing Loss

BACKGROUND AND OBJECTIVES: Intratympanic dexamethasone injection (ITDI) offers the potential for directed delivery of high concentrations of steroids to the inner ear while mitigating the risks involved with high doses of systemic steroids. We investigated the effectiveness of combination therapy, sequential early ITDI accompanied with systemic therapy on sudden sensorineural hearing loss (SSNHL). MATERIALS AND METHODS: We gathered 151 SSNHL patient's data, who were refractory to systemic treatment for 5 days. Injection group (n=47) were administered systemic therapy and 4 times of ITDI within 2 weeks after break of SSNHL. Control group (n= 104) only received traditional treatment. We compared last concreted hearing level and recovery rate according to initial hearing level and frequency. RESULTS: Overall hearing improvement was observed in 47 of 104 (45.2%) control patients and in 30 of 47 (63.8%) ITDI patients (p= 0.034). Depending on the degree of initial hearing loss, the patients with severe hearing loss who treated with ITDI showed significant higher recovery rate than control group (83.8% vs. 50.0%)(p=0.049). When we analyzed hearing improvements according to the frequency, clinically significant hearing improvements were observed at lower and mid-frequencies (250, 500 and 1,000 Hz) in the ITDI group than in the control group. CONCLUSIONS: Early combination the-rapy of intratympanic dexamethasone injection within 2 weeks accompanied with initial systemic treatment is effective for patients with refractory SSNHL, especially for patients with severe hearing loss.

Evaluation of Vestibular Function in Idiopathic Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is very important to evaluate vestibular function in patients with sudden sensorineural hearing loss (SNHL) because vertigo combined with sudden SNHL is well known as an important prognostic factor. However, the vestibular function test is not usually performed in sudden SNHL patients without vertigo. We investigated whether different vestibular function tests such as the results of vestibular evoked myogenic potential (VEMP) testing or caloric testing were correlated to prognosis in not only sudden SNHL patients with vertigo but also in sudden SNHL patients without vertigo. SUBJECTS AND METHOD: We enrolled in our study 47 patients with idiopathic sudden SNHL with vertigo or without vertigo. The degree of initial hearing loss was categorized as mild, moderate, moderate-severe, severe, and profound group. Types of initial audiograms were categorized as high tone loss, low tone loss, flat and scale out type. We analyzed the association of the VEMP and caloric test with degree of hearing loss, type of audiogram, and hearing recovery in two month. RESULTS: The more sever the hearing loss was, the more increased was the rate of abnormal VEMP response (p=0.003). The rate VEMP and caloric abnormality was higher in hearing loss types with high tone loss than in the types with only low tone loss. The rate of accompanying vertigo was high (p=0.017), when the hearing loss was more severe. There was significant correlation between the hearing recovery and vestibular dysfunction (p=0.000, r=0.563). CONCLUSION: VEMP and caloric test are useful in evaluating vestibular function and prognosis of sudden SNHL patients.

Isolation of Voltage Dependent Calcium Current in Chick Inner Hair Cell / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Voltage dependent calcium channel (VDCC) mediates calcium ion influx and controls neurotransmitter release in excitable cells. Hair cells in vertebrates cochlea are known to express L-type VDCC. The purpose of this study was to measure calcium current from hair cells to investigate basic activity and characteristics of VDCC. MATERIALS AND METHOD: We measured calcium current in hair cells of the chicken's auditory organ, the basilar papilla analogous to the mammalian cochlea, in whose L-type, dihydropyridinesensitive calcium channels predominate and in vestibular hair cells from cristae. Calcium currentthrough VDCC was isolated in voltage-clamp recording using Cesium, Tetraethylammonium, 4- aminopyridine and apamin to block the much larger potassium currents. Various concentrations of internal calcium buffer, ethylene glycol tetraacetic acid (EGTA) or 1,2-bis (o-aminophenoxy) ethane-N,N,N',N'-tetraacetic acid (BAPTA) were used. RESULTS: The higher the buffer concentration, the larger the current size were ; they were significantly larger in 10 mM of calcium buffer concentration (ANOVA, p< 0.05). There was no difference in calcium current between cochlear and vestibular hair cells. CONCLUSION: We could successfully isolate stable inward calcium current from chick hair cells. This experiment can be used as a basic method to understand neurotransmission process between hair cells and afferent neurons.

Downregulation of the RUNX3 Gene by Promoter Hypermethylation and Hemizygous Deletion in Breast Cancer

The RUNX3 gene is regarded as a tumor suppressor gene in many human solid tumors, and its inactivation is believed to be related with solid tumor carcinogenesis. As little information is available about the role of the RUNX3 gene in breast cancer, we investigated the relationship between the RUNX3 gene and breast cancer. We performed reverse transcriptase-polymerases chain reaction (RT-PCR), methylation specific PCR, and bicolor fluorescent in situ hybridization analysis in an effort to reveal related mechanisms. Forty breast tissue samples and 13 cell lines were used in this study. Eighty-five percent of breast cancer tissues showed downregulated RUNX3 gene expression, whereas it was downregulated in only 25% of normal breast tissues by RT-PCR assay. Sixty-seven percent of breast cancer cell lines showed downregulated RUNX3 expression, but the RUNX3 gene was not expressed in two normal breast cell lines. Hypermethylation was observed in 53% of breast cancer tissues and 57% of breast cancer cell lines. Hemizygous deletion was observed in 43% of breast cancer cell lines. Hypermethylation and/or hemizygous deletion was observed in 5 of 7 breast cancer cell lines, and the four of these five examined showed no RUNX3 gene expression. We suggest that various mechanisms, including methylation and hemizygous deletion, could contribute to RUNX3 gene inactivation.

Comparison of the Rate of Detection of Immunoglobulin Heavy Chain Gene Rearrangement by Fluoresecence In Situ Hybridization Probes in Multiple Myeloma / 대한진단검사의학회지

BACKGROUND: Immunoglobulin heavy chain (IgH) gene rearrangement, which is frequently observed in multiple myeloma, can now be detected easily by using a fluorescence in situ hybridization (FISH) method. The aim of this study was to determine the detection rate and compare the utility of the three most commonly used probes: IGH/CCND1 dual color, dual fusion probe; IGH/BCL2 dual color, dual fusion probe; and IGH dual color break apart rearrangement probe; all from Vysis Products (Downers Grove, IL, USA). METHODS: From October 1994 to July 2003, 99 patients were diagnosed as multiple myeloma at Seoul National University Hospital, Asan Medical Center and Gachon University Gil hospital. We applied the three different probes of IgH FISH on bone marrow specimens from the 99 Korean patients with multiple myeloma to detect IgH gene rearrangement. RESULTS: Forty-one (41.4%) of the 99 patients had IgH gene rearrangement. Of those 41 patients, 23 (56.1%) showed positive to all three probes, but the remaining 18 (43.9%) showed a discrepancy between the three probes: 13 (72.2%) of the 18 patients were only positive to the IGH dual color break apart rearrangement probe and the detection rate was 39.6% on the average. CONCLUSIONS: These results demonstrate that IGH dual color break apart rearrangement probe is superior to the other two probes in qualitative and quantitative ways. Thus, we recommend IGH dual color break apart rearrangement probe for the diagnosis and monitoring of multiple myeloma.

A Case of Meningioma Presenting as a Nasal Polyp: Endoscopic Reconstruction of Skull Base Defect after Removing the Tumor / 대한이비인후과학회지

Olfactory groove meningioma extending into the paranasal sinuses and nasal cavities is unusual. On rare occasions, it presents in the nasal cavity as a polypoid mass with ENT symptoms. We have experienced a case of meningioma presenting as a nasal polyp, in which the only clinical symptom was the sensation of having a foreign body in the left nasal cavity. The patient underwent polypectomy at a local clinic without radiologic evaluation, but because the polyp seemed to have originated from the nasal roof the patient was referred to our hospital. Magnetic resonance imaging (MRI) revealed an extensive intracranial tumor with extracranial extensions into the ethmoid sinuses and nasal cavities, and the tumor was confirmed as meningioma by histological and immunohistochemical examination. The tumor was removed by a transcranial route, and the cranial base defect was repaired with various nasal mucosal flaps and with abdominal fat via an intranasal endoscopic approach. After 8 months of treatment, no evidence of recurrence or of mucosal defect was noted.

A Case of Endoscopic Treatment of Membranous Choanal Atresia with Contralateral Choanal Stenosis Using Powered Instrumentation and Mitomycin C

Congenital Choanal Atresia is a relatively uncommon anomaly. Among various surgical approaches for treating this ailment that have been proposed to date, transpalatal and transnasal endoscopic approaches are the preferred methods for surgical treatments. Because restenosis is the most important post-surgical concern, some authors used topical application of mitomycin C in the choanal atresia and found it to be effective in the prevention and treatment of scar formation. We have experienced a case of right membranous choanal atresia and left membranous choanal stenosis which were treated with a transnasal endoscopic approach using powered instrumentations and topical application of mitomycin C without an application of prolonged stent. Eight months after the treatment, patent neochoanae remains without evidence of restenosis.