Laboratory Management Status of Vestibular Function Test in Korea / 대한평형의학회지

OBJECTIVES: This study was conducted to assess the current management status of the vestibular function test laboratories in Korea. METHODS: Questionnaire about the management status of the vestibular function test laboratories was sent by email to the entire members of the Korean Balance Society. The contents of questionnaire included situation of employees who perform the tests, the types of vestibular function tests and equipment, frequency of the test and types of dizziness related questionnaires. RESULTS: Forty-nine hospitals and clinics responded. All the 49 respondents answered that they have videonystagmography. Spontaneous nystagmus analysis by videonystagmogrphy was the most frequently tests for patients with dizziness. Questionnaires for dizziness were used by 27 respondents (55.1%) for initial evaluation of the dizziness patients. The Korean version of dizziness handicap inventory was the most frequently used dizziness related questionnaire. CONCLUSIONS: We analyzed the current management status of vestibular function test laboratories to comprehend the present condition of the vestibular function test. We think that these results will help to provide a standard for laboratory operations and prepare for the education, focusing on high-demand tests.

Single-Center 10-Year Experience in Treating Patients With Vascular Tinnitus: Diagnostic Approaches and Treatment Outcomes

OBJECTIVES: Vascular tinnitus is the most common form of pulsatile tinnitus, particularly when the tinnitus corresponds with the pulse of patients. In this study, we reviewed the 10-year clinical data on vascular tinnitus of our tinnitus clinic to investigate the frequency of the underlying etiologies, to introduce a diagnostic protocol, and to evaluate the treatment outcomes. METHODS: We retrospectively collected the data of 57 patients who were diagnosed as vascular tinnitus between April 2001 and December 2011. Careful history taking, otoscopy, thorough physical examinations, audiometry, laboratory tests, as well as radiologic examinations were performed according to our diagnostic protocol to find the origin of pulsatile tinnitus. Treatment options were individualized based on the specific etiology, and the outcomes were assessed using patient's subjective reports at the follow-up interviews. RESULTS: High jugular bulb was the most common cause (47.4%) of vascular tinnitus, and venous hum was the next (17.5%). Dural arteriovenous fistula, intracranial aneurysm, atherosclerotic carotid artery disease, and hypertension were less common causes. Vascular tinnitus was alleviated in most patients after the appropriate treatment: surgical intervention, tinnitus retraining therapy, reassurance, and medications. CONCLUSION: Vascular tinnitus can be successfully diagnosed by the regular use of the suggested protocol. Many patients with vascular tinnitus have treatable underlying etiologies. Treatment of those etiologies or at least counseling about the tinnitus itself can benefit the patients with troublesome vascular tinnitus.

Small-Group Counseling in a Modified Tinnitus Retraining Therapy for Chronic Tinnitus

OBJECTIVES: The authors have treated chronic tinnitus patients using a combination of a simplified tinnitus retraining therapy (TRT) and medications, which we called modified TRT. In this clinical setting, we have attempted small-group counseling to find a time-effective equivalent of individual counseling. The aim of the present study was to evaluate the effectiveness of small-group counseling by comparing the treatment outcomes between individual and small-group counseling. METHODS: The patients who had distressing chronic tinnitus with normal hearing or mild hearing loss were included. The subjects were placed into the small-group (group 1:4) or the individual (group 1:1) counseling group, and underwent a modified TRT composed of a single session of directive counseling and ambient sound stimulation. In addition, alprazolam (0.25 mg) and ginkgo biloba extract (80 mg) were administered orally to the subjects for 3 months. The 3- and 6- month outcomes were assessed using the follow-up rates and tinnitus severity scores: awareness, tinnitus handicap inventory (THI), loudness, annoyance, and effect on life. The treatment responses were classified as improvement, no changes, and worsening. RESULTS: Of the total 149 patients (77 in group 1:1; 72 in group 1:4), 104 patients completed the protocol at 3 months, and 55 patients at 6 months. The follow-up rates were similar in both groups. Over the period of 6 months, all scores declined significantly except the loudness score at 3 months in both groups. Treatment responses showed no between-group differences. The success rate based on THI was 70% in group 1:1, and 64% in group 1:4 at 6 months. CONCLUSION: The small-group counseling of our modified TRT was comparable to the individual counseling for tinnitus relief. We suggest that this protocol can be implemented effectively in any crowded otolaryngology clinics.

A Case of Cartilaginous Choristoma of External Auditory Canal / 대한이비인후과학회지

Cartilaginous choristoma of bony external auditory canal is very rare. Appearing as a horny sha-ped hard mass, cartilaginous choristoma can be found in the medial portion of anterior wall of external auditory canal. Histologically, it consists of adult-type hyaline cartilage without neoplastic features. If cartilaginous choristoma shows growing tendency or ear symptoms, surgical excision would be the treatment of choice. Here, we report a case of cartilaginous choristoma that occurred in the external auditory canal in an 8-year-old boy.

A Case of Basal Cell Carcinoma of External Auditory Canal

Malignant tumor originated from external auditory canal (EAC) is very rare with an annual incidence of around 1 per million. Pathologically, squamous cell carcinoma is incidentally most common, and adenoid cystic carcinoma, basal cell carcinoma, and melanoma follow in decreasing order. Due to the rarity of malignant tumor of EAC, there is no widely accepted treatment modality yet. But basal cell carcinoma, known to be less aggressive tumor, can be removed with a minimal safety margin and have better treatment results. Recently we experienced a case of basal cell carcinoma in the EAC, confined in the cartilaginous portion of EAC, presenting with intermittent otorrhea for several years. The patient was treated with a sleeve resection of the EAC with a safety margin reconstructed with a split-thickness skin graft. No tumor recurrence or complication was noted in the first postoperative year.

Isolation and Culture of Adult Neural Stem Cells from Guinea Pig Tympanic Membrane / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tympanic membrane perforation is an important clinical problem found in various populations of the world. In large number of cases, acute traumatic perforations heal spontaneously, and in the healing process, stem cells appear to play an important role. However, no studies have been reported regarding somatic stem cells in the tympanic membrane. Herein, we tried to show that guinea pig's tympanic membrane contains cells that display the characteristic features of stem cells. MATERIALS AND METHOD: The tympanic membrane was obtained from the guinea pig. The cells were cultured in a medium with epidermal growth factor (EGF) and fibroblast growth factor (FGF). Proliferating cells were checked with stem cell markers, bromodeoxyuridine (BrdU) and nestin. Differentiated cells from stem cells are checked with betaIII tubulin and S-100. RESULTS: We observed that some of the cultured cells from the tympanic membrane were stained with both stem cell markers, BrdU and nestin. And we observed that these cells differentiated into neuron and gilal cells, which expressed betaIII tubulin and S-100, respectively. CONCLUSION: These results suggest that the tympanic membrane of guinea pigs may have neural stem cells. Further study is needed for finding the origin of stem cells.

Reconstruction of Mid-Facial Defect after Maxillectomy with Free Tissue Transfer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Postoperative defects of nasal cavity cancer are difficult to reconstruct because of its large and complicated defects. Large defects of the head and neck are challenging to reconstruct since there may be a 3-dimensional requirement of both volume and multiple surfaces of oral lining and external skin. SUBJECTS AND METHOD: We conducted a retrospective review of 14 patients who underwent reconstruction between 1999 and 2007. Outcome measures included free flap types, flap success and post-operative functional result. RESULTS: The anterolateral thigh flap method was used in 7 of the 14 patients (50%), the rectus abdominis free flap method in 4 patients (28%), the fibular osteocutanoeus free flap method in 2 patients (14%) and the radial forearm free flap method in 1 patient (7%). The free flap survival rate was 100 percent with partial flap necrosis in one patient. Return to regular diet was seen in 9 patients (64%), a soft diet in 3 (21%), and a liquid diet in one (7%). Speech was accessed as normal in 8 patients (57%), near normal in 5 (36%), intelligible in one patient (7%). CONCLUSION: Free tissue transfer provides the most effective and reliable form of immediate reconstruction for mid-facial defect after maxillectomy.

Clinical Consideration of Vestibular Evoked Myogenic Potential in Dizzy Patients

BACKGROUND AND OBJECTIVES: Vestibular evoked myogenic potential (VEMP) is a relatively new diagnostic tool that is in the process of being investigated in patients with specific vestibular disorders. In this study, we examed the responses of VEMP in patients who complained of dizzines. MATERIALS AND METHOD: Eighty-six patients with complaint of dizziness and ten normal volunteers are included in this study. Among these patients, forty-six patients were diagnosed as unilateral vestibulopathy (A), five patients were bilateral vestibulopathy (B), nine patients were sudden sensorineural hearing loss with vertigo (C), fifteen patients were benign paroxysmal positional vertigo (D) and eleven patients were Meniere's disease (E). We compared VEMP parameters in each group. RESULTS: In each group, abnormal response in VEMP was 33%(A), 0%(B), 11%(C), 12%(D) and 36%(E) respectively. and there was no absent VEMP formation, and there was no abscent VEMP formation. CONCLUSION: VEMP is a promising method for diagnosing and following patients with many vestibular disorders.

A Case of Intranasal Pleomorphic Adenoma Arising from the Nasal Septum and Clivus

Pleomorphic adenomas arise most commonly in the major salivary glands. It has rarely been described arising in the nasal cavity. A 65-year-old woman presented with a 9-month-history of left sided nasal obstruction. Endoscopic examination and computed tomographic scan revealed a lobulated tumor mass arising from the left bony nasal septum and clivus. It was removed endoscopically with endonasal approach. Histologic examination showed a lobular and duct-like structures consisting of a loose myxoid stoma consistent with characteristics of a pleomorphic adenoma. There was positive immunohistochemical expression of cytokeratin and S-100 protein which confirmed earlier histopathological diagnosis. We report a very rare case of pleomorphic adenoma originating from the nasal septum and clivus with a review of literature.

Antrochoanal Polyp's Variant, the Angiomatous Nasal Polyp: A Case Report / 대한이비인후과학회지

Angiomatous nasal polyps are a rarely reported subtype of inflammatory sinonasal polyps that are characterized by extensive vascular proliferation and ectasia. The blood vessels present in these sinonasal polyps may be subjected to compromise at certain areas within the nasal cavity, leading to venous stasis, thrombosis and infarction. Recently, we experienced a case of angiomatous nasal polyp that caused significant diagnostic difficulty at the time of her presentation in a 12-year-old girl. Although entirely benign, angiomatous nasal polyps may simulate neoplastic process, thus awareness of their existence is of considerable importance. Especially, differential diagnosis between angiomatous polyp and angiofibroma is important for evaluation and treatment. In the present paper, the clinical, radiological and pathological features of angiomatous nasal polyps is also discussed.