Reconstruction of the Posterior Canal Wall with Mastoid Obliteration after Canal Wall Down Mastoidectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There have been heated controversies over the choice of the canal wall down mastoidectomy (CWD) and canal wall up mastoidectomy (CWU), which are operational methods used to eliminate the lesion of cholesteatoma. Combining the advantages of both methods, we reconstructed the posterior canal wall with conchal cartilage plate and obliterated mastoid cavity with bone chips (group I), or hydroxyapatite mixed with bone chips (group II) since 2001. This study was designed to evaluate the surgical outcomes of posterior canal wall reconstruction with mastoid obliteration in the treatment of cholesteatoma. SUBJECTS AND METHOD: From January of 2001 to March of 2007, the posterior canal wall reconstruction with mastoid obliteration was conducted on 66 patients. There were 30 cases of cholesteatoma and 36 cases of old radical cavity. The postoperative observation period ranged from 5 to 74 months, with the average period of 34.7 months. We analyzed the postoperative complications, and hearing results of the 33 ossicular reconstruction cases. RESULTS: There was 1 case of residual cholesteatoma in the middle ear cavity, but no recurrent cholesteatoma. In most cases, reconstructed canal wall was maintained well, but partial canal wall resorption and postauricular dimpling occurred in 5 cases of group I. On the other hand, the epithelization of posterior canal wall was incomplete in 4 cases of group II. After surgery, no patients complained any cavity problems at all. CONCLUSION: The present study suggests that this procedure can prevent cavity problems and reduce the recurrence of cholesteatoma with destructed canal wall.

Comparison of the Efficacy of Systemic and Intratympanic Steroid Treatment on Sudden Sensorineural Hearing Loss with Diabetes / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: High dose systemic steroid therapy is currently the mainstay of the treatment for sudden sensorineural hearing loss (SSNHL). However, it makes a glycemic control worse in patients with diabetes. Intratympanic steroid injection (ITSI) can result in reduced systemic steroid toxicity and higher perilymph steroid level selectively. The purpose of this study is to compare the efficacy of ITSI (IT group) with that of systemic steroid (IV group) on SSNHL with diabetes. SUBJECTS AND METHOD: Thirty eight SSNHL patients who were diagnosed with diabetes were divided into the IV group (19 patients) and the IT group (19 patients). In the IV group, prednisolone was administrated intravenously for 7 days followed by tapered doses orally for 7 days. In the IT group, dexamethasone was administrated 4 times within a 2 week-period. Hearing outcome was assessed before and after treatment. RESULTS: In the IV group, 10 patients (58.8%) showed an improvement in the pure tone audiogram (PTA), with a mean improvement of 17.6 dB (p=0.023). In the IT group, 16 patients (84.2%) showed improvement in the PTA, with the mean improvement of 25.1 dB (p=0.000). But there was no significant difference in hearing gain and the recovery rate between the two groups. And it is more difficult to control blood sugar in the IV group rather than in the IT group. CONCLUSION: ITSI treatment is as effective as the systemic steroid treatment for SSNHL patients with diabetes and it can avoid a significant side effect of systemic steroids. So it could be considered as an initial treatment for the SSNHL patient with diabetes.

Histopathologic Evaluation of Obliterating Materials in the Temporal Dorsal Bullae of Rat / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mastoid obliteration is the technique to reduce disadvantages of canal wall down procedure. Many materials for mastoid obliteration have been devised. The aim of our study is to evaluate the histopathologic changes according to the different obliterating materials and removal of the mastoid mucosa in the temporal bullae of rat. MATERIALS AND METHOD: We divided rats into two groups. One group underwent removal of mastoid mucosa with 2% TCA (trichloroacetic acid), and the other was left untreated. Both groups had mastoid obliteration by implantation of bone wax, xenograft bone material (Lubboc(R)), or homologous corticocancellous bone. Twelve weeks after implantation, the animals were sacrificed. Histopathology study was performed to evaluate inflammation, foreign body response, new bone formation, implant material resorption, and mucocele formation within the bullae. RESULTS: Histopatholgoic evaluation revealed many instances of inflammation and foreign body response in the groups using the bone wax. In rats implanted with xenograft bone material or homologous corticocancellous bone, by contrast, microscopic examination showed new woven bone ingrowth at the bone implant interface. Especially, homologous corticocancellous bone showed good results. Rats not treated with 2% TCA showed the presence of mucocele. CONCLUSION: We suggest that homologous corticocancellous bone is the better obliterating material than bone wax or xenograft bone material. And also, all mastoid lining mucosa should be removed prior to implantation in mastoid obliteration surgery. Further research will be necessary to determine the sequence of morphologic changes that occur in mastoid bullae mucosa.

Vestibular Evoked Myogenic Potentials Produced by Stimulation with 500 Hz-tone Burst / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Vestibular evoked myogenic potential (VEMP) is muscle reflex caused by surface electrodes following repeated high-intensity auditory stimulation. The current study attempted to determine whether VEMP can be consistently evoked from the sternocleidomastoid muscle (SCM) by the 100 dB air-conducted and 50 dB bone-conducted 500 Hz-tone burst. SUBJECTS AND METHOD: Air-conducted and bone-conducted VEMPs in response to 500 Hz-tone burst were recorded from the SCM of 13 normal volunteers. Subjects were seated on their chairs and made to hold their heads turned up as far as possible towards the side, contralateral to the stimulated ear voluntarily. Two different sound durations (rise/fall time=2 msec, plateau time=2 msec[2/2] and rise/fall time=5 msec, plateau time=5 msec[5/5]) were presented through a insertphone or bone vibrators. Latencies and amplitudes of p13 and n23 responses were measured. RESULTS: All normal volunteers showed p13-n23 responses to 50 dB bone-conducted tone burst as well as to 100 dB air-conducted tone burst. The values of latency of p13 and n23 were the most reliable at 5/5 air-conducted in evaluation by coefficiency of variance. Mean p13 and N23 latencies by airconducted tone burst were significantly longer than those of bone-conducted. Mean p13-n23 amplitudes by air-conducted tone burst were significantly larger than those by bone-conducted at 2/2 sound duration. CONCLUSION: VEMP could be consis-tently evoked by the 100 dB air-conducted and 50 dB bone-conducted 500 Hz-tone burst, especially at 5/5 air-conducted.

Epitympanoplasty with Mastoid Obliteration Technique: 38 Months Follow-Up Results of 283 Cases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There have been heated controversies over the choice of the canal wall down mastoidectomy and canal wall up mastoidectomy, which are operational methods used to eliminate the lesion of chronic otitis media including cholesteatoma. Combining the advantages of both methods, we devised a new operational method in 1994. This study reports the surgical results of the epitympanoplasty employing the mastoid obliteration technique after a follow-up 38 months in 283 cases. SUBJECTS AND METHOD: A retrospective review was made of 283 cases (273 patients) on which this technique was performed by the first author between Dec. of 1994 to Mar. of 2004. The follow-up period varied from 8 to 104 months, with the average period of 38 months. We analyzed postoperative complications including cavity problems, the recurrent cholesteatoma, residual cholesteatoma cases in the mastoid cavity, residual cholesteatoma in the tympanic cavity and postoperative otorrhea and hearing results. RESULTS: The overall incidence of postoperative complications was 21.9%. The results of postoperative complications in the above listed order were 0%, 0%, 1.0%, 4.3% and 5.7%, respectively. Air-bone gap (ABG) closure was 4.73 dB HL and the statistical analysis revealed that the postoperative ABG was significantly lower than the preoperative ABG (p=0.0023). CONCLUSION: The present study suggests that this procedure prevents the cavity problem, helps reduce recurrence and effectively manages the residual cholesteatoma. Also, this procedure achieves good audiologic results.

Epitympanoplasty with Mastoid Obliteration Technique in Only/Better Hearing Ears / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sensorineural hearing loss is one of serious complications caused after the operation of chronic ear disease. In only/better hearing ears, it is important to minimize the chances of developing a severe hearing loss and to stop the progression of disease. We report the results of performing epitympanoplasty with mastoid obliteration in the only/better hearing ear with cholesteatoma. SUBJECTS AND METHOD: From February 11, 1996 to April 16, 2003, epitympanoplasty and mastoid obliteration was performed for 6 patients with the only hearing ear and 2 with a better hearing ear. In the only/better hearing ears, 7 cases had cholesteatoma and 1 case had adhesive otitis media. The other ears of the 5 cases had previously received canal wall down mastoidectomy, 2 cases sensorineural hearing loss and 1 case both epitympanoplasty and mastoid obliteration. The observation period ranged from 7 to 99 months, with the average of 45 months. RESULTS: One-staged operation was performed on all 8 patients. Four cases got total ossicular replacement prosthesis, 3 cases received partial ossicular replacement prosthesis, and 1 case received autologous cartilage short columellization. After each operation, all patients obtained a dry, safe, self-cleansing ear and recurrence did not occur. The hearing results in this series showed that the air conduction thresholds, bone conduction thresholds and air-bone gaps were preserved in 7 cases, but became worse in one patient. Two patients did not need to use hearing aids, five patients used an hearing aid of in-the-canal (ITC) type, one patient used a hearing aid of completely-in the canal (CIC) type. CONCLUSION: Epitympanoplasty with mastoid obliteration in the only/better hearing not only can stop the progression of cholesteatoma, but also can preserve hearing of patients.

The effect of retinoic acid on cell kinetics in bromodeoxyuridine labelled hep G2 cell line / 대한내과학회지

No abstract available.