The Changes of Olfactory and Trigeminal Pungency Thresholds in n-Aliphatic Alcohols with Different Carbon Chain in Normal Adults / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Using n-aliphatic alcohols whose physical properties change gradually as their length increases, we investigated the changes of olfactory threshold and trigeminal pungency threshold with the increase of carbon chain length. MATERIALS AND METHOD: Olfactory and trigeminal pungency thresholds were measured in ethanol (C2), 1-butanol (C4), 1-hexanol (C6) and 1-octanol (C8) in 40 normal adults using a two-alternative forced-choice modified by the ascending method of limit (CCCRC) test. Plastic bottles with 30 ml of four n-aliphatic alcohols were diluted threefold successively by mineral oil. Plastic bottles containing only mineral oil were used as controls. RESULTS: The olfactory and trigeminal pungency thresholds decreased and the ratio of olfactory threshold/trigeminal pungency threshold increased with the length of carbon chain in n-aliphatic alcohols. The correlation coefficients among olfactory thresholds in each alcohol were higher than those among trigeminal pungency thresholds. CONCLUSION: Alcohol with long carbon chains showed low olfactory and trigeminal pungency thresholds, indicating that high lipid solubility is an important factor in olfaction and trigeminal chemosensitivity.

Fungal Mastoiditis in an Immunocompetent Patient / 대한이비인후과학회지

Aspergillus has been recognized in infections of the paranasal sinuses since 1891, and in invasive external otitis since 1985. Fungal mastoiditis is a very rare entity, which is almost exclusively seen in immunocompromised patients. The authors present a case of fungal mastoiditis in a 43-year-old woman without immunocompromise. The patient showed symptoms of chronic intermittent otorrhea, otalgia and progressive hearing loss. On physical examination, attic destruction and adhesive tympanic membrane was seen in the right side. On temporal bone CT scans, soft tissue density was noted in the right mastoid antrum. After radical mastoidectomy, tissue pathology from mastoid cavity showed fungal ball of aspergillus. Fungal infection of mastoid cavity is very rare, however, it can cause serious complications. So, we report here, with a review of literature, a case of fungal mastoiditis in an immunocompetent patient.

Expression of Tonicity-Responsive Enhancer Binding Protein (TonEBP) in the Rat Cochlea: An Immunohistochemical Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The inner ear is an organ used for hearing and balance. For its normal function, the inner ear fluid homeostasis is required. There has been controversy over the regulatory mechanisms of maintaining inner ear fluid balance, and they have not yet been clearly defined. TonEBP is the protein that binds tonicity-responsive enhancer elements in the osmoprotective gene, which elevates the compatible osmolytes, which in turn induces cell survival in hypertonic condition. The aim of this study was to elucidate if there is an osmoregulatory mechanism in cochlea. Material and Method: The localization of TonEBP in the cochlea of male Sprague-Dawley rats was studied by immunohistochemistry with an anti rabbit polyclonal anti-rat TonEBP antibody. RESULTS: TonEBP was expressed at outer hair cells, Deiter cells, spiral ligaments, sprial limbus connective tissues, and epithelial lining of basilar membrane facing scala tympani. CONCLUSION: TonEBP in cochlea is one of the proteins involved in elucidating cell survival in changed tonicity during inner ear homeostasis.

Use of Natural and Synthetic Odorants in Odor Identification Test / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The odor identification tests use natural and synthetic odorants as stimuli. Synthetic odorants span a smaller qualitative range than natural ones, however, they eliminate the need for preparation, preservation and have improved familiarity owing to the improved development techniques. The aim of this study is whether we can use synthetic odorants in odor identification tests by comparing the results of tests using natural odorants and synthetic ones. MATERIALS AND METHODS: Forty-two natural and 21 synthetic odorants familiar to Koreans were applied to 40 normals and 20 patients with decreased sense of smell without sinonasal diseases. Percent-correctness shown by the controls and patients smelling natural and synthetic odorants were compared with those patients showing over 95% identifiability and in 11 corresponding natural and synthetic odorants. RESULTS: Percent-correctness of odor identification test using synthetic odorants was highly correlated with that using natural ones and there was no problem in discriminating patients from the control. CONCLUSION: Synthetic odorants can be used in odor identification tests for Koreans in a clinical context.

Blepharokymography: A New Tool for Dynamic Eyelid Motion Analysis Using Image Processing / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Evaluation of facial movements, especially eyelid movements, per se, depends largely on subjective judgments of trained clinicians. Recently, however, a few objective methods were reported although they required bothersome markers attached on the eyelids and a special-purpose high-speed video camera. This study aimed to develop a new dynamic and quantitative analysis system for eyelid motion using an image processing method without markers or a high-speed camera, and to evaluate parameters that could properly differentiate normal and abnormal states. MATERIALS AND METHOD: The system was consisted of a personal computer with a general-purpose frame grabber and a specially developed software which was named, Blepharokymography. Displacement of upper eyelids, duration of closing and opening segments, and closing and opening velocity were measured in 12 normal subjects and 5 facial nerve palsy patients of variable causes. Mean values of each parameter and the ratio of a palsy or slower side to a normal or faster side in normal and facial palsy groups were compared. RESULTS: In the normal group, the mean displacement of upper eyelids, mean closing time, mean and peak closing velocity were 8.3mm, 161 msec. 61.6 mm/sec and 146.2 mm/sec respectively. Among parameters, displacement, the closing time, mean closing velocity and peak closing velocity were significantly different between normal and facial palsy groups. CONCLUSION: By using blepharokymography system, it was possible to measure the eyelid motion objectively. Displacement, closing time, average and peak closing velocity were useful in differentiating the normal state as well as the facial nerve palsy state.

Odorant Confusion Matrix Odor Identification Test Using Synthetic Odorants / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The odorant confusion matrix (OCM) odor identification test is a kind of suprathreshold odor identification test using 10 synthetic odorants as stimuli and confusion matrix consisted of closed alternatives. This test is known to have an advantage in qualitative diagnosis of olfactory dysfunction by analyzing mis-identification of odorants at specific nerve dysfunctions. The aim of this study is whether we can use this OCM odor identification test for comparing normals with patients with olfactory disturbance. MATERIALS AND METHODS: The OCM odor identification test using 10 synthetic odorants familiar to Korean was applied to 40 normals and 32 patients who showed decreased sense of smell without sinonasal diseases. Percent-corrects of normals were compared with patients and with olfactory thresholds by a modified ascending method of limits (CCCRC) test using successively diluted 1-butanol. RESULTS: Percent-corrects of normals in the OCM odor identification test was higher than those of patients with statistical significance (p<0.001), and the results of OCM odor identification test was well correlated with those of the CCCRC olfactory threshold test (r=0.77). CONCLUSION: The OCM odor identification test exhibited no problems in discriminating patients from normals and can be used in clinical contexts.

Evaluation of Clinical Validity of Cross-Cultural Smell Identification Test (CC-SIT) in Korean / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The development of a l2-item Cross-Cultural Smell Identification Test (CC-SIT) was based upon items from the University of Pennsylvania Smell Identification Test (UPSIT), The selected CC-SIT items were familiar to most persons from American, European, and Asian cultures. Since there were no reports about its clinical validity for Koreans, we evaluated its identifiability in this study. MATERIALS AND METHODS: The CC-SIT were administered to 30 normal subjects and 32 patients with decreased sense of smell, and compared with those of the Korean K-SIT and buthanol threshold test (BTT), items of which many Koreans are familiar with. RESULTS: In the normal group, the mean percent-correct scores of CC- SIT and K-SIT were 87.5+/-7.8% and 90.5+/-9.7%, respectively. In the patient group, the scores were 48.2+/-14.1 and 49.6+/-10.2%, respectively. The results of CC-SIT showed a high correlation with the K-SIT (gamma=0.822, p < 0.001). CONCLUSION: The CC- SIT can be used as an olfactory identification test for Koreans.

Measurement of Nasal Trigeminal Pungency Threshold: Comparison between Normals and Patients with Decreased Sense of Smell

BACKGROUND AND OBJECTIVES: In order to measure the level of nasal trigeminal pungency threshold and to evaluate the interaction between olfactory and trigeminal nerves, we measured olfactory thresholds and trigeminal pungency thresholds using 1-butanol in 40 normal people and in 46 patients with decreased sense of smell by non-sinonasal origin. MATERIALS AND METHODS: Two-alternative forced-choice modified ascending method of limit (CCCRC test) was used for the measurement of olfactory and pungency thresholds, using 1-butanol plastic squeezable bottles successively threefold diluted by distilled water as stimulus, while distilled water as blank. RESULTS: There was a statistically significant difference in pungency threshold between normals (2.18+/-1.5 dilution step) and patients (1.11+/-1.0 dilution step)(p<0.001). CONCLUSION: The pungency thresholds of hyposmics and anosmics are higher than those of normals, which suggests that a loss or decrease of olfactory sensation is accompanied by a simultaneous decrease of trigeminal chemosensitivity.

Eagle's Syndrome: A Case Report

Eagle's syndrome is a rare condition associated with recurrent throat pain, foreign body sensation and odynophagia. It is caused by elongation of the styloid process or calcification of the stylohyoid process. We present the clinical and radiologic findings of a case of Eagle's syndrome.

Rhinocerebral Mucormycosis with Intracerebral Hemorrhage

No abstract available.

The Effects of Pregnancy Conditions on the Incidence of Nasal Septal Deformities in Neonates

BACKGROUND AND OBJECTIVES: To study the incidence of nasal septal deformities (NSD) in neonates and to identify pregnancy conditions related with NSD occurrence. MATERIALS AND METHODS: Prospective study of 131 women and their newborns. Incidences of neonatal NSD were looked for with a cotton wool test and through direct visual examination of the neonatal nasal cavity with an otoscope. Under study were arbitrary but possibly related factors of neonatal NSD : the mother's age, parity, medical history, the duration of total labor, the duration of second-stage labor, the delivery type, neonatal birth weight and gestational age. The contributions of these factors were analyzed statistically. RESULTS: The incidence of neonatal NSD as identified through otoscopic examination was 11.5%. All studied factors indicated no statistically significant relationship with neonatal NSD. CONCLUSION: Probable nasal trauma during pregnancy and delivery is likely not a factor in the occurrence of NSD in neonates.

Selection of Olfactory Identification Items for Koreans / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The olfactory identification test has been used in clinical assessment of olfactory ability for the following reasons: it is fast, it yields results compatible to a threshold test, and it gives a picture of how well the patient can deal with odors of everyday life. However, items in UPSIT (University of Pennsylvania Smell Identification Test)and CCCRC (Connecticut Chemosensory Clinical Research Center)identification test which are widely used in the world are selected for western people. Accordingly, these items in the tests are not appropriate for Koreans of different cultural background. MATERIALS AND METHODS: For the selection of proper items for the olfactory identification test, 42 natural odors familiar to Koreans were applied to 40 normal subjects and 40 patients with decreased sense of smell without sinonasal diseases. Among 42 items, 16 items with high identifiability and familiarity were chosen according to the results of test-retest in normal subjects. RESULTS: The results of olfactory identification test using 16 selected items showed high correlation with olfactory threshold. CONCLUSION: These 16 items can be used for an olfactory identification test for Koreans.

Evaluation of Olfactory Bulb Size on MR Imaging in Normal Volunteers and Anosmic or Hyposmic Patients withoutNasal Disease

PURPOSE: To evaluate the size of the olfactory bulb using MRI in normal volunteers and anosmic or hyposmicpatients without nasal diseases. MATERIALS AND METHODS: MRI was performed in 20 normal volunteers with a normalsense of smell, and in 15 anosmic or hyposmic patients without nasal disease but with abnormality in the olfactoryfunction test. Coronal T1-weighted MRI was performed, with a section thickness of 3mm. The cross sectional area,width and height of the olfactory bulb were measured in multiple sequential images and the largest values of thesewere analysed. The difference in the size of the olfactory bulb between normal volunteers and anosmic or hyposmicpatients was evaluated and Student's t test was used for statistical analysis. RESULTS: In most cases, theolfactory bulb was demonstrated in three sequential coronal images; in normal volunteers, the largest crosssectional area, width and height were not significantly different between the right and left olfactory bulb. In 40 olfactory bulbs(right, left) in 20 normal volunteers and 30 olfactory bulbs in 15 anosmic or hyposmic patients,the respective means of various measurements were as follows: 7.5mm2 and 6.0mm2; greatest width, 4.6mm and 3.8mm;greatest height, 2.7mm and 2.0mm. For the largest cross-sectional area and greatest height, the difference inolfactory bulb size between normal volunteers and patients was statistically significant (P0.05). CONCLUSION: The size of the olfactory bulb issignificantly less in anosmic or hyposmic patients without nasal disease than in normal volunteers; in suchpatients, olfactory MRI could be a useful evaluative modality.

MR Evaluation of the Olfactory Bulb in Normals and Patients with Decreased Sense of Smell*

To evaluate changes in olfactory bulb size in patients with reduced or no sense of smell, 23 normals and 20 hyposmics or anosmics were examined with nasal endoscopy, olfactory testing and magnetic resonance imaging (MRI) of the olfactory bulb. Olfactory testing consisted of a threshold test by bounded three-alternative forced-choice modified ascending method of limits (CCCRC test) and the step method using threefold dilutions of 1-butanol and an olfactory identification test using 32 natural odors familiar to Koreans. The MR evaluation involved the estimation of olfactory bulb size by using a 13 cm diameter general purpose surface coil with 3 mm T1-weighted MR coronal sections without interval. The cut areas of the olfactory bulb in MR coronal sections were measured with a Hope Graph Planimeter (model No. 9-003) after fivefold enlargement. The olfactory bulb was observed in three cuts of MR imaging in all subjects. In the measured area of the olfactory bulb, the anterior portion of the olfactory bulb was significantly smaller than the middle and posterior areas in normals, but hyposmics or anosmics showed decreased olfactory bulb area, especially in height, when compared with normals. There was good correlation between olfactory bulb area and olfactory threshold as well as olfactory identification in normals and patients. MR imaging can be a useful tool for patients with hyposmia or anosmia.

A Case of Kallmann's Syndrome: MR Imaging and Histopathology

Kallmann's syndrome is a rare genetic disorder defined as a combination of anosmia or hyposmia and hypogonadism due to hypothalamic-pituitary deficiency. The incidence of Kallmann's syndrome is one in 100,000 men and one in 50,000 women. However, the syndrome is found in one in 25 people with hypogonadism. The clinical evaluation of these patients includes historical and physical examinations ; chemosensory testing, which includes olfactory threshold and identification tests ; laboratory testing for hormonal abnormalities ; MR imaging of the olfactory apparatus ; and histopathologic findings through an olfactory epithelial biopsy. We report the case of a 19-year-old male patient who had anosmia since birth and who was diagnosed with Kallmann's syndrome.

Transepidermal Water Loss in Patients of Eczematous External Otitis / 대한이비인후과학회지

The difference of transepidermal water loss(TEWL) between normal persons and patients with eczematous external otitis was identified by statistical analysis. In this study, 20 healthy volunteers without history of atopic dermatitis and 20 patients with eczematous external otitis were participated. Measurements were performed at ear lobes and other various anatomical sites(proximal forearm, mid forearm, distal forearm, palm, upper back, lower back, leg(shin), leg(calf), and sole) by Tewameter TM 210(Courage;Rhazaka, Koln, Germany). Prior to the procedure, subjects stayed still for 30 minutes in the room where the temperature was controlled(18-23degreesC) with a relative humidity of 35-45%. The results are summarized as follows:1) TEWL values at ear lobes were higher in patients with eczematous external otitis than in normal persons(p<0.05). 2) TEWL values at other various anatomical sites except upper back were higher in patients with eczematous external otitis than in normal persons(p<0.05).

A Case of Intranasal Meningoencephalocele / 대한이비인후과학회지

Meningoencephalocele is an ectopic protrusion of the meninges and a portion of the brain that retains connection with the CNS through a defect in the bony covering. It is a rare developmental anomaly that results from faulty closure of the embryonic neural tubes. Meningoencephalocele is usually classified into occipital, sincipital and basal types according to the location and among these, the basal type is less frequently encountered than other types. The authors have experienced a case of basal-type intranasal meningoencephalocele in 4 year-old male patient, which was removed successfully via bifrontal craniotomy and intranasal endoscopic approach, and the defect of skull base was repaired by inner table of the cranium and septal mucosa with good result.

Comparison of Olfactory Threshold Tests:CCCRC Test versus Step Method / 대한이비인후과학회지

There are many variables that can be manipulated in the study of olfactory thresholds. They include the choice of odorant, the way to bring the stimulus to the subject's nose, number of trials, interval between trials, dilution method, environmental conditions, as well as psychophysical method. The focus of this study lay on how much differences were made by the psychophysical method, the sequence of presentations of stimuli that led to calculation of an index of sensitivity and how reliable the result of step method in olfactory threshold testing is. The olfactory threshold tests entailed comparison of procedures: 1) a procedure of two-alternative forced-choice(2AFC) testing by an ascending method of limits(CCCRC test), 2) a two-alternative forced-choice(2AFC) version of step method that used a computerized algorithm to calculate threshold on an ongoing basis throughout testing. As a result, mean concentration difference of 7.6-fold was achieved in the thresholds by the two procedures and inter-test correlation coefficient was 0.46. Estimation of threshold in the step method remained relatively constant after 10 trials to the end of the 30 test-trials without biases, which meant step method showed coherent data. Accordingly step method is suitable for olfactory threshold test despite of relatively long testing time.

Measurement of Olfactory Threshold in Normal Korean Adults with Combined Use of Bounded CCCRC Test and Step Method

The high variability of measured olfactory thresholds in humans reflects very broad range of sensitivity within and among individuals. This can be derived from the strongly compressive nature of olfaction, which makes it relatively hard to compare the size of two stimuli in odor sensation. However, we know that some portion of the variation is the result of extrinsic factors e.g. the method used to measure the olfactory threshold. For this reason, in order to address the bias and reliability of a psycophysical method, we combined the use of the CCCRC (Connecticut Chemosensory Clinical Research Center) test with the step method in 40 normal Korean adults twice a week for the evaluation of threshold. The measured thresholds showed high test-retest reliability and the threshold estimates remained consistent during the testing without trial-biases. Based on the results, we can conclude that a combined test using the CCCRC test and step method can be used in the measurement of olfactory threshold in a clinical context.

Lateral Sinus Thrombophlebitis Caused by Isolated Sphenoid Sinusitis

Lateral sinus thrombophlebitis is a very rare complication of paranasal sinusitis. This disease can result in a fatal outcome if not treated with proper antibiotics or surgical intervention. Recently, the authors came across a case of lateral sinus thrombophlebitis resulting from cavernous sinus thrombophlebitis complicated by isolated sphenoid sinusitis. Because of a severe and persistent headache, the case was initially admitted and managed as though the patient was suffering from Tolosa-Hunt syndrome. Hemifacial hypoesthesia, periorbital swelling and meiosis on the right side developed during tentative treatment. High resolution computed tomography showed isolated sphenoid sinusitis with partial bony dehiscence on the roof of left sphenoid sinus. Magnetic resonance images showed multiple thrombosis in the cavernous sinus, internal carotid artery, sigmoid sinus and lateral sinus on the right side. Antibiotics, thrombolytics and endoscopic surgical intervention of sinusitis prevented a fatal outcome in spite of remaining hemifacial hypoesthesia and ptosis on the right side.