Current Treatments for Congenital Aural Atresia

Congenital aural atresia is an ear malformation evident at birth, involving various degrees of failed external ear canal development. A true external ear canal is desirable, as devices that replace the canal are inconvenient and expensive. Therefore, an optimal surgical technique is required. Here, we review useful preoperative and operative techniques. Surgical correction is often not the preferred treatment; the hearing outcome is no better than the outcomes afforded by bone-conduction devices, and surgery may be associated with recurrence or complications such as meatal stenosis. Preoperative evaluation and appropriate management are important. Several means of preventing meatal stenosis are discussed in this review.

Reconstruction of Congenital Aural Malformation / 대한이비인후과학회지

The complexity of the auricle makes its reconstruction technically difficult, owing to the convexities and concavities of the underlying cartilage with its tightly adherent and thin overlying skin. This article gives an overview of the current practice in the field of auricular reconstruction. The majority of surgeons who perform auricular reconstruction continues to employ the well-established techniques developed by Brent and Nagata. Surgery takes between two and four stages, with the initial stage being construction of a framework of autogenous rib cartilage which is implanted into a subcutaneous pocket. Several modifications of these techniques have been reported. Understanding the various treatment options and having sufficient practice to increase the surgeon's skills are crucial to providing the patients with the best outcomes possible.

Factors Affecting the Expansion of Chondrocytes Harvested from Rabbit Auricle and Nasal Septum / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In tissue engineering of the cartilage, cellular expansion is an essential step for creating useful amounts of tissue required. Many variables such as media composition, growth factors and cell seeding density have been utilized to stimulate the ability of cellular proliferation and to reduce the number of expansion in monolayer. The object of this study was to evaluate the effects of human serum (HS) and rabbit serum (RS) on cellular proliferation of auricular and nasal septal chondrocytes of the rabbit. SUBJECTS AND METHOD: Auricular and nasal septal chondrocytes of the New Zealand White Rabbit were expanded in monolayer in medium supplemented with 2% RS, 5% RS, 10% RS, or 10% HS with or without adding of growth factors. The effect of the supplements on the cellular proliferation was compared. RESULTS: The proliferation yield of chondrocytes grown in RS was comparable to that with HS. Both serums results in increased proliferation; however, the amount of cellular proliferation was not correlated with the concentration of the serum. The proliferation rate of nasal septal chondrocytes was higher than that of auricular chondrocytes. CONCLUSION: Both HS and RS resulted in the increased proliferation of rabbit auricular and nasal septal chondrocytes. The results show that the determination of appropriate types and concentrations of serum is required for cell expansion in constructing tissue-engineered cartilage.

A Case of Diffuse Large B-Cell Lymphoma of Sinonasal Tract with Acute Visual Disturbance / 대한이비인후과학회지

Malignant lymphoma of the sinonasal tract is relatively uncommon. In particular, B-cell lymphoma is hardly found in the Asian population although the NK/T-cell type of lymphoma is relatively commonly found. The authors experienced a case of diffuse large B-cell lymphoma originating from the ethmoid sinus, which caused the unexpected visual disturbance without nasal symptoms and/or systemic B symptoms, such as fever, night sweat, and weight loss. Diagnosis of B cell lymphoma is often delayed because it does not always show the specific symptoms of lymphoma. Therefore, starting with careful physical and imaging studies are always important while higly suspecting malignancy. Furthermore, early precise biopsy is of great important for precise diagnosis and proper management for the treatment of malignant lymphoma.

A Case of Auricular Chondroma

Extraskeletal chondroma is a rare benign tumor that develops in the soft tissues, and it manifests as a solitary subcutaneous nodule or a slowly growing tumor. It occurs preferentially in the hand and foot area of adults, and the development in the auricle is very rare. We report a rare case of chondroma that developed in the auricle, which were treated with wedge excision and reconstructed using a Burow's triangle, with a review of the literature.

A Case of Facial Palsy Following Fine Needle Aspiration Cytology of Parotid Lymphangioma / 대한이비인후과학회지

Fine needle aspiration (FNA) is a highly accurate and safe procedure for the evaluation of salivary gland lesions. Although complications are extremely rare, salivary gland FNA may cause hemorrhage, facial nerve injury, or cellulitis at the entry point. The risk of these complications increases in tumors of high vascularity. We report a case of unexpected facial nerve palsy following a fine needle aspiration in a patient with lymphangioma. The patient received a total parotidectomy with preservation of the facial nerve function, and recovered without developing complications after the surgery.

Clinical Characteristics of Auricular Keloids Treated with Surgical Excision

BACKGROUND AND OBJECTIVES: Differences in morphology of auricular keloids possibly contribute to distinct results of treatment. The aim of this study was to evaluate clinical characteristics of the auricular keloids according to the modified Chang-Park classification and to compare the results of treatment including recurrence rate between the subgroups. SUBJECTS AND METHODS: Clinical data of 15 patients of auricular keloids were retrospectively reviewed. The keloids were classified according to modified Chang-Park classification. Clinical characteristics, the presence of recurrence, and the duration required for the recurrence were compared. RESULTS: Eight out of 15 patients (53.3%) were single sessile type (type II), followed by 4 patients of pedunculated type, 1 patient of multiple sessile type, 1 patient of buried type, and 1 patient of mixed type, respectively. Recurrent keloids after previous surgeries were noted in 7 out of 15 patients and most of them (6 of 7, 85.7%) were sessile type. Three patients who underwent surgery at our department showed recurrence. CONCLUSIONS: The classification of auricular keloids according to morphologic patterns can assist surgeons in choosing the appropriate management.

Clinical Characteristics of Auricular Keloids Treated with Surgical Excision

BACKGROUND AND OBJECTIVES: Differences in morphology of auricular keloids possibly contribute to distinct results of treatment. The aim of this study was to evaluate clinical characteristics of the auricular keloids according to the modified Chang-Park classification and to compare the results of treatment including recurrence rate between the subgroups. SUBJECTS AND METHODS: Clinical data of 15 patients of auricular keloids were retrospectively reviewed. The keloids were classified according to modified Chang-Park classification. Clinical characteristics, the presence of recurrence, and the duration required for the recurrence were compared. RESULTS: Eight out of 15 patients (53.3%) were single sessile type (type II), followed by 4 patients of pedunculated type, 1 patient of multiple sessile type, 1 patient of buried type, and 1 patient of mixed type, respectively. Recurrent keloids after previous surgeries were noted in 7 out of 15 patients and most of them (6 of 7, 85.7%) were sessile type. Three patients who underwent surgery at our department showed recurrence. CONCLUSIONS: The classification of auricular keloids according to morphologic patterns can assist surgeons in choosing the appropriate management.

A Case of Nasal Polypoid Mass Originated from Nasal Foreign Body

Intranasal dacryocystorhinostomy(DCR) has been used as a primary treatment of nasolacrimal duct obstruction. Silicon tube or stent(Song's stent in this case) is used in intranasal dacryocystorhinostomy (DCR) for improvement of the lacrimal drainage system. But this material reacting with nasal mucosa induced inflammatory reaction. Consequently, we report a rare case of nasal polypoid mass caused by probably originated from nasal foreign body.

Herpes Zoster Oticus with Cranial Polyneuropathy without Involvement of Facial Nerve

Herpes zoster oticus is caused by herpetic viruses including varicella zoster and most commonly affects cranial nerves (CN) VII and VIII. With a review of literature, we report a case of herpes zoster oticus with selective involvement of CN VIII, IX and X. Interestingly, the motor fibers of CN VII were spared while ipsilateral recurrent laryngeal nerve involvement was evident. The patient was treated with antiviral medication and systemic steroids and symptoms were improved.

Retraction: The Clinical Characteristics and Treatment Results of Bilateral Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

No abstract available.

Retraction: The Effects of Intratympanic Steroid Injection for the Patients with Refractory Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

No abstract available.

Cartilage Tissue Engineering for Auricular Reconstruction / 대한이비인후과학회지

Auricular reconstruction still represents one of the greatest challenges for the ENT surgeon, due to its complex three-dimensional structure. For many years the most suitable substitute for the auricular skeleton has been the autologous costal cartilage although there are some drawbacks. Since the cartilage tissue has a limited capacity for self-renewal and self-repair, cartilage tissue engineering techniques might offer possibilities of restoring missing or damaged cartilage structures. This article reviews implant materials currently being used for auricular reconstruction and also provides a review of possible cell sources, types of scaffold materials and stimulating factors for tissue engineering of cartilage. The recent advances in surgical techniques and biotechnology may promise clinical application of tissue-engineered cartilage as an auricular skeleton in the future.

Comparison of Cochlear Morphology and Apoptosis in Mouse Models of Presbycusis

OBJECTIVES: Morphological studies on presbycusis, or age-related hearing loss, have been performed in several different strains of mice that demonstrate hearing loss with auditory pathology. The C57BL/6 (C57) mouse is a known model of early onset presbycusis, while the CBA mouse is characterized by relatively late onset hearing loss. We performed this study to further understand how early onset hearing loss is related with the aging process of the cochlea. METHODS: We compared C57 cochlear pathology and its accompanying apoptotic processes to those in CBA mice. Hearing thresholds and outer hair cell functions have been evaluated by auditory brainstem response (ABR) recordings and distortion product otoacoustic emission (DPOAE). RESULTS: ABR recordings and DPOAE studies demonstrated high frequency hearing loss in C57 mice at P3mo of age. Cochlear morphologic studies of P1mo C57 and CBA mice did not show differences in the organ of Corti, spiral ganglion, or stria vascularis. However, from P3mo and onwards, a predominant early outer hair cell degeneration at the basal turn of the cochlea in C57 mice without definitive degeneration of spiral ganglion cells and stria vascularis/spiral ligament, compared with CBA mice, was observed. Additionally, apoptotic processes in the C57 mice also demonstrated an earlier progression. CONCLUSION: These data suggest that the C57 mouse could be an excellent animal model for early onset 'sensory' presbycusis in their young age until P6mo. Further studies to investigate the intrinsic or extrinsic etiologic factors that lead to the early degeneration of organ of Corti, especially in the high frequency region, in C57 mice may provide a possible pathological mechanism of early onset hearing loss.

A Case of Warthin's Tumor Associated with Primary Tuberculosis of the Parotid Gland in a Patient with Acquired Immunodeficiency Syndrome / 대한이비인후과학회지

Parotid gland is an uncommon location for tuberculosis, but the incidence in this lesion has increased in human immunodeficiency virus (HIV) infection. Warthin's tumor is a relatively common benign tumor of the salivary glands. However, a coincidence of tuberculosis and Warthin's tumor in the parotid gland is extremely rare. We report a case of a patient with acquired immunodeficiency syndrome (AIDS) who presented parotid swelling. After superficial parotidectomy, the lesion was diagnosed to be tuberculosis associated with Warthin's tumor.

A Case of Congenital Inner Ear Anomaly Combined with Cerebrospinal Leak Using Hydroxyapatite Cement for Treatment / 대한이비인후과학회지

Cerebrospinal fluid otorrhea is a rare disease entity, especially when brought on by spontaneous causes. The site of leakage should be identified to treat the disorder effectively. Various localizing modality was suggested in the literatures. Intrathecal gadolinium-enhanced magnetic resonance imaging identifies the small leakage site easily and correctly. Hydroxyapatite cement is a calcium phosphate-based material that forms dense paste mixed with water or sodium phosphate solution. Hydroxyapatite cement is remarkable for its excellent biocompatability in interacting with the native bone to osseointergrate with the surrounding bone. We report on our experience of successfully treating a patient with the cerebrospinal fluid leak from the congenital inner ear anomaly using the hydroxyapatite cement.

Clinical Analysis of Orbital Complications of Acute Sinusitis according to Age

BACKGROUND AND OBJECTIVES: Acute sinusitis is a mild, self-limiting disease. In children, however, sinusitis may lead to other severe, even life-threatening, conditions. Therefore, appropriate diagnosis and management are needed. Orbital complications from sinusitis are caused by expansion through natural suture lines, foramen, dehiscence of lamina bone and bony erosion due to acute infection and necrosis. The purpose of this study was to analyze the common types of orbital complications and to compare the symptoms, prognoses and treatments of children and of adults, respectively. Materials and Method: Twenty-one children under15 years of age and thirteen adults over 15 were enrolled in the study. Symptoms, durations of treatment, treatment modalities, prognoses, and CT findings were analyzed. RESULTS: Preseptal cellulitis was found in 6 children (28.6%) and 8 adults (61.5%) ; subperiosteal abscess in 9 children (42.9%) and 3 adults (23.1%) ; and orbital cellulitis in 6 children (28.6%) and 2 adults (15.4%). Eye lid swelling was found in all subjects, while diplopia and limitation of eye movement was found in 4 children (19%) and 2 adults (15.4%). Medical treatment was the first line of therapy for both children (76.2%) and adults (61.5%), with the remaining children (23.8%) and adults (38.5%) receiving surgical treatment. CONCLUSION: While generally more severe, orbital complications in children can be treated more conservatively than those arising in adults.

A Clinical Study of Pediatric Tracheotomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: As indications for tracheotomy have evolved over the decades, the trends in the pediatric tracheotomy also have changed. The purpose of this study is to review the clinical courses and outcomes in the current pediatric tracheotomy. MATERIALS AND METHOD: A retrospective study was performed on 42 pediatric patients who underwent tracheotomies at Ajou University Hospital from June, 1994 to May, 2004. Charts were reviewed with respect to indications for tracheotomy, underlying diseases, success rate in decannulation and length of support time until decannulation, complication and mortality rate. RESULTS: There were 34 (81.0%) male patients and 8 (19.0%) female patients. Ventilatory support for neurological impairment (47.6%) was the leading indication for tracheotomy, followed by upper airway obstruction (19.0%), prolonged intubation due to respiratory failure (16.7%), cervical trauma (7.1%), craniofacial abnormalities (4.8%) and vocal cord palsy (4.8%). Convulsive disorder (19.0%) and congenital neurological malformation (14.3%) were the most common underlying diseases. Decannulation was accomplished in 70.0% of children with an average of 254.5 days with tracheotomy. The length of support time until decannulation was significantly greater in the neurological impairment group than in the other group. Complications occurred in 19.0% without tracheotomy-related death. CONCLUSION: Tracheotomy is relatively safe in the pediatric population as conservative therapy and its outcomes are thought to be usually related to the underlying disease and age.

Anatomic Variations of the Paranasal Sinus in Children with Chronic Sinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Endoscopic sinus surgery in children has increased in the recent years. Therefore, we need to know the precise anatomy and anatomic variations of the nose, and we also need to know the relationship between these anatomic variations and sinusitis. SUBJECTS AND METHOD: To assess the extent and distribution of diseases as well as associated anatomic abnormalities in this pediatric population, we retrospectively reviewed 94 OMU CT scans of children who showed continued symptoms of sinusitis after extensive medical therapy had failed. RESULTS: Maxillary sinusitis was the most common sinus infection, followed by ethmoidal, sphenoidal and frontal sinusitis. A agger nasi cell was the most common anatomic variation, followed by septal deviation, Haller's cell, concha bullosa, paradoxical middle turbinate and Onodi's cell. There was no statistical significance between the sinusitis and anatomic variations. CONCLUSION: Anatomic variations in the nose are common in children. However, because there is no definitive relationship between the anatomic variations and sinus disease, local, systemic or environmental factors appear to be more important in pediatric sinusitis than anatomic variations.

The Effects of Intratympanic Steroid Injection for the Patients with Refractory Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: High-dose steroid therapy has been known as the treatment of choice for sudden sensorineural hearing loss (SSNHL). However, about one third of patients do not generally respond to any treatments, and there seem to be no definitive treatment for the patients with refractory SSNHL. We prospectively studied the effect of intratympanic steroid injection (ITSI) for patients with refractory SSNHL. SUBJECTS AND METHOD: Sixty six patients with SSNHL, who were refractory to a course of oral steroid therapy, were included in this study. Thirty three patients (34 ears) were treated with ITSI and the other 33 patients had no further treatments as control. ITSI was performed with dexamethasone in the supine position on 4 separate occasions over the course of 2 weeks. Hearing was assessed immediately before every injection, and at 1 and 4 weeks after therapy. Hearing improvement was defined as more than 10 dB in pure tone average (PTA). RESULTS: Hearing improvement was observed in 13 (39.4%) of 33 patients who underwent ITSI and in 2 (6.1%) of 33 patients in control group. Five of 13 showed hearing improvement over 20 dB in PTA, and 11 of 20 patients showed no improvement in PTA by ITSI, but showed improvement over 10dB in some frequencies. There were no definite prognostic factors between the patients who responded to ITSI and those who didn't. CONCLUSION: ITSI is a simple and effective therapy for patients with refractory SSNHL.