Serous Retinal Detachment Following Laser Peripheral Iridotomy for the Angle Closure Secondary to Posterior Scleritis / 계명의대학술지

This study was aimed to report a case of serous retinal detachment following laser peripheral iridotomy (LPI) for the treatment of angle closure secondary to posterior scleritis. A 55-year-old man with bilateral ocular pain, redness, and headache was referred to Keimyung University Dongsan Medical Center. At the initial examination, his visual acuity was 1.0 in the both eyes. The intraocular pressure (IOP) was 25 mmHg in the right eye and 28 mmHg in the left eye. Slit lamp examination showed a shallow anterior chamber, which was found to be Shaffer grade I by gonioscopy. There were no specific findings in the fundus, except a slightly edematous disc margin in both eyes. LPI was performed on both eyes. Fourth day after LPI, the patient complained of a central scotoma and visual disturbance of the left eye, in which the visual acuity had decreased to 0.06. The optical coherence tomography showed serous retinal detachment at the posterior pole. Fluorescein angiography revealed a focal leakage in the superotemporal area, as well as multiple hyperfluorescence lesions. Posterior scleritis of the left eye was diagnosed. Systemic steroid therapy was initiated and the area with the leakage was treated by focal laser photocoagulation. Two weeks later, the serous retinal detachment of the left eye resolved and visual acuity improved to 0.63. Laser peripheral iridotomy can exacerbate serous retinal detachment in patients with posterior scleritis that presented as acute angle closure.

The Surgical Outcomes of Unilateral Lateral Rectus Recession in Recurrent Intermittent Exotropia after Unilateral Recession-Resection

PURPOSE: To evaluate the surgical outcomes of unilateral lateral rectus (LR) recession on the contralateral eye for recurrent intermittent exotropia after unilateral recession-resection (R & R). METHODS: A retrospective analysis of 43 patients was performed. The patients were classified into 2 groups, 18 patients who underwent unilateral LR recession for intermittent exotropia of 18 to 20 prism diopters (PD) after unilateral R & R (reoperation group) and 25 patients who had primary unilateral LR recession (primary operation group). RESULTS: Significant differences in age, gender, refractive error, preoperative deviation, and near stereoacuity were not observed between the 2 groups (p > 0.05). The mean follow-up duration was 14.28 +/- 14.98 months in the reoperation group and 14.68 +/- 12.15 months in the primary operation group. Postoperative deviations were 1.11 +/- 3.89 PD at near distance and 2.00 +/- 4.70 PD at far distance in the reoperation group and 6.44 +/- 5.26 PD at near distance and 7.00 +/- 5.77 PD at far distance in the primary operation group on the final follow-up (p = 0.000, p = 0.004). The final surgical successful rates were 94.4% in the reoperation group and 64.0% in the primary group (p = 0.021). CONCLUSIONS: The long-term surgical results of unilateral LR recession on the contralateral eye was better in patients with recurrent intermittent exotropia of 18 to 20 PD after unilateral R & R than patients who had primary unilateral LR recession.

Phacovitrectomy versus Phacoemulsification after Vitrectomy for Rhegmatogenous Retinal Detachment Repair

PURPOSE: To compare the outcomes of phacovitrectomy and phacoemulsification after vitrectomy for treatment of rhegmatogenous retinal detachment (RRD). METHODS: We performed a retrospective comparative analysis of 39 consecutive eyes with phakic primary RRD followed up for more than 6 months. The patients were divided into phacoemulsifcation after vitrectomy and phacovitrectomy groups. The main outcome measures were the best corrected visual acuity (BCVA), anatomical success rate and postoperative complications. RESULTS: The mean age was 54.17 years in the phacoemulsifcation after vitrectomy group (n = 23) and 56.69 years in the phacovitrectomy group (n = 16; p = 0.031). The log MAR BCVA improved in both groups with no statistically significant difference between the 2 groups (p = 0.592). The anatomical success rate after initial surgical intervention was 100% in both groups. Retinal detachment recurred in 3 eyes in the phacoemulsifcation after vitrectomy group; caused by new retinal tear. CONCLUSIONS: The new RRD rate in phacoemulsification after vitrectomy group was higher than in the phacovitrectomy group. Due to the retrospective and limited data in this study, whether simultaneous combined cataract surgery with retinal detachment surgery should be recommended to reduce RRD risk is inconclusive and further larger, prospectively designed studies are necessary to confirm the present findings.

Intracavernous Sinus Arachnoid Cyst Confused with the Complication of Mycotic Sphenoidal Sinusitis / 대한이비인후과학회지

The arachnoid cyst is a rare disease that accounts for about 1% of the intracranial mass. The etiology of arachnoid cyst is due to either congenital compromise of arachnoidal development or acquired inflammatory reaction or trauma in the subarachnoid space. Computed tomography of arachnoid cyst demonstrates well-marginated low density lesions, whereas magnetic resonance image shows identical signal intensities of cerebrospinal fluid on T1 and T2 weighted image and low signal intensity on diffuse weight imaging without contrast-enhancement. The treatment of intracavernous sinus arachnoid cyst must be tailored to each patient according to the location of the lesion within cavernous sinus and the patient's symptoms. We experienced a case of arachnoid cyst of the cavernous sinus accompanying mycotic sphenoidal sinusitis. There are no previously reported cases of patients with an intracavernous sinus arachnoid cyst accompanying mycotic sphenoidal sinusitis.

A Case of Schwannoma Arising from the Sphenoid Sinus / 대한이비인후과학회지

Schwannomas are neurogenic tumors that arise from the Schwann cells of the nerve sheath. Although up to 45% of all schwannomas occur in the head and neck region, only 4% involve the nasal cavity and paranasal sinuses. A 56-year-old female presented with an incidentally discovered lesion in the left posterior ethmoid and sphenoid sinuses on the brain magnetic resonance imaging. Magnetic resonance imaging showed a well demarcated mass without bony destruction with isointensity in T1 and hyperintensity in T2 weighted scans. Eighteen months later, repeated computed tomography showed an enlargement of the mass with the erosion of the adjacent sinus wall and left vidian canal. She underwent an endoscopic mass removal, which revealed a pale yellowish, firm mass in the left posterior ethmoid and sphenoid sinuses. Final histopathology confirmed the diagnosis of a schwannoma. There has been no evidence of recurrence during the two-year follow-up.

Is Cognitive Function in Adults with Hearing Impairment Improved by the Use of Hearing Aids?

OBJECTIVES: In the present study, we investigated whether speech-related cognitive function and speech recognition ability under background noise in adults with hearing impairment are improved with the use of hearing aids. METHODS: Participants were recruited from the ENT Department of Eulji Hospital from September 2008 to July 2009. The study group comprised 18 participants (mean age, 69.5+/-8.3 years) with sensorineural hearing loss who were fitted with hearing aids, and the control group comprised 11 participants of equivalent age (mean age, 63.1+/-11.8 years) who were not fitted with hearing aids. All participants were assessed using the computerized Korean visual verbal learning test (VVLT) and words-in-noise (WIN) test prior to fitting of hearing aids for the study group and initially for the control group. Both groups were reassessed in both tests after 6 months. For each group, differences in the results between the two assessments were compared using the Friedman test. RESULTS: There was no difference in mean age between the study group and control group. In the study group, total VVLT score (reflecting short-term memory) was significantly improved from before hearing aid use to 6 months after hearing aid use (P0.05). CONCLUSION: The speech-related cognitive function of individuals with hearing impairment improved after using hearing aids. This finding indicates that hearing aids may induce acclimatization of the central auditory system.

Baicalein protects HT22 murine hippocampal neuronal cells against endoplasmic reticulum stress-induced apoptosis through inhibition of reactive oxygen species production and CHOP induction

Baicalein is one of the major flavonoids in Scutellaria baicalensis Georgi and possesses various effects, including cytoprotection and anti-inflammation. Because endoplasmic reticulum (ER) stress has been implicated in neurodegenerative diseases, such as Alzheimer's disease, Parkinson's disease, and cerebral ischemia, we investigated the effects of baicalein on apoptotic death of HT22 mouse hippocampal neuronal cells induced by thapsigargin (TG) and brefeldin A (BFA), two representative ER stress inducers. Apoptosis, reactive oxygen species (ROS) production, and mitochondrial membrane potential (MMP) were measured by flow cytometry. Expression level and phosphorylation status of ER stress-associated proteins and activation and cleavage of apoptosis-associated proteins were analyzed by Western blot. Baicalein reduced TG- and BFA-induced apoptosis of HT22 cells and activation and cleavage of apoptosis-associated proteins, such as caspase-12 and -3 and poly(ADP-ribose) polymerase. Baicalein also reduced the TG- and BFA-induced expression of ER stress-associated proteins, including C/EBP homologous protein (CHOP) and glucose-regulated protein 78, the cleavage of X-box binding protein-1 and activating transcription factor 6alpha, and the phosphorylation of eukaryotic initiation factor-2alpha and mitogen-activated protein kinases, such as p38, JNK, and ERK. Knock-down of CHOP expression by siRNA transfection and specific inhibitors of p38 (SB203580), JNK (SP600125), and ERK (PD98059) as well as anti-oxidant (N-acetylcysteine) reduced TG- or BFA-induced cell death. Baicalein also reduced TG- and BFA-induced ROS accumulation and MMP reduction. Taken together, these results suggest that baicalein could protect HT22 neuronal cells against ER stress-induced apoptosis by reducing CHOP induction as well as ROS accumulation and mitochondrial damage.

The Value of Measuring Eustachian Tube Aeration on Temporal Bone CT in Patients with Chronic Otitis Media

OBJECTIVES: To evaluate that the cross-sectional area of the air space in the Eustachian tube (ET) on computed tomography (CT) images could be useful for predicting the postoperative aeration of the middle ear. METHODS: The patient group consisted of 80 patients (80 ears) with chronic otitis media and who underwent middle ear surgery from 2006-2007 and who were followed up for more than 1 yr. The control group consisted of 100 ears of 50 individuals with normal tympanic membranes and who underwent CT for other causes (such as tinnitus or hearing loss). The largest cross-sectional areas of the aerated ET were measured on the coronal images of the temporal bone CT by a single otologist using the computer-based "Region of Interest" picture archiving and communications system. The patient group was divided into two subgroups, 1) those with good postoperative aeration and 2) those with poor postoperative aeration. The largest cross-sectional areas of the aerated ETs were compared between the patients and the controls, and between the patients with good aeration and the patients with poor aeration. RESULTS: The mean cross-sectional areas significantly differed between the patient group and the control group, and between the good and poor aeration subgroups (P<0.05 each). The mean area of the poor aeration subgroup was smaller than that of the control group (P<0.05), but the mean area of the good aeration subgroup did not significantly differ from that of the controls. CONCLUSION: The cross-sectional area of the aerated ET, as measured on the preoperative coronal images of temporal bone CT scans, may be useful for predicting the postoperative condition of the tympanic cavity.

A Case of Bilateral Congenital Middle Ear Cholesteatoma / 대한이비인후과학회지

The incidence of congenital middle ear cholesteatoma in children has increased recently for the following reasons: developed diagnostic instruments and increased awareness of congenital middle ear cholesteatoma. But bilateral congenital middle ear cholesteatoma is still a rare disease entity. The patient was a 3-year-old male with delayed language development. A whitish bulging mass was presented behind the anterior superior quadrant of right tympanic membrane and the left side lesion was detected on CT scan. Bilateral explotympanotomy were performed simultaneously and cholesteatomas were removed from both middle ear cavities. In the left side case, the cholesteatoma matrix was spreading diffusely and the ossiculoplasty with total ossicular replacement prosthesis was needed. There has been no evidence of recurrence up to 6 months following the surgery. We report this case with a review of literature.