Analysis of Risk Factors for Recurrence of Benign Paroxysmal Positional Vertigo: An 11-Year Nationwide Population-Based Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of dizziness with a high recurrence rate. This study aimed to analyze the recurrence rate and the risk factors for recurrence using the Korean National Health Insurance Service National Sample Cohort (NHIS-NSC 2002–2013) data. SUBJECTS AND METHOD: Patients aged 20 years or older who were diagnosed with BPPV in the period of 2002–2012 and had at least 1 year of monitoring period were included in this study. The diagnosis of BPPV was made when the code for BPPV (KCD-6 code H811) was used or when canalith reposition therapy (EDI code MX035) was entered even in cases with different diagnoses. The risk factors of BPPV recurrence were analyzed. RESULTS: Of the total of 21355 patients diagnosed with BPPV, 5876 patients (28%) demonstrated recurrence. Multiple recurrences were common. When using the univariate regression analysis, age, sex, vestibular disease, headache, osteoporosis, and ischemic heart disease were found significant. When the patients were classified into 4 groups according to age and sex, vestibular diseases were found as a common risk factor for recurrence in all groups, while headache, osteoporosis, hypertension, and ischemic heart disease were significant in females. CONCLUSION: The recurrence rate of BPPV in the Korean adult population was approximately 28% and recurrences were more common in patients aged over 65 and in females. Patients with vestibular diseases were at a higher risk of recurrence regardless of age or sex, while headache, osteoporosis, hypertension and ischemic heart disease increased the risk of recurrence in females.

The Prevalence and Risk Factors of Tinnitus in Korean Adolescents / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tinnitus is the perception of sound in the absence of any outside acoustic stimulus with high prevalence. Multiple risk factors for tinnitus have been identified. So far, most of studies have concentrated on prevalence and associated chronic disease of tinnitus in adults. In the present study, we focused on tinnitus in adolescents which has not been adequately evaluated. The main goal of this study was to assess the prevalence and associated risk factors of tinnitus in adolescents. SUBJECTS AND METHOD: This study was a retrospectively designed analysis of data from the 5th Korea National Health and Nutrition Examination Survey conducted in 2011-2012. We used tinnitus related interview data, the results of physical and audiological evaluation by ENT specialists, the results of daily intake of vitamin using a 24-hour dietary recall method, and blood samples in 1370 subjects. RESULTS: The prevalence of tinnitus was 22.2% in the age range of 12 and 19 years old. Logistic regression is a statistical method used to assess the association between tinnitus and independent variables. The following factors were independently and positively associated with tinnitus; sex (adjusted OR=1.531, CI=1.097-2.137), excessive earphone use (adjusted OR=1.422, CI=1.026-1.970), Non-occupational noise (adjusted OR=4.096, CI=1.702-9.859), explosive noise (adjusted OR=4.100, CI=1.703-9.872), niacin intake (adjusted OR=0.966, CI=0.940-0.993), vitamin (vit.). D serum concentration (adjusted OR=0.959, CI=0.925-0.994). CONCLUSION: This study showed an association between tinnitus prevalence in adolescents and gender, noise exposure, and vit. D supplement. Tinnitic patients are recommended to reduce excessive noise and use hearing protection devices such as earplugs or earmuffs; they are also recommended to obtain a supply vit. D from adequate sun exposure and outside activities.

Study about Economic Adequacy of Tonsillectomy and Adenoidectomy Based on Medical Prime Costs / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The Korean National Health Insurance is based on 'fee for service' system, but recently 7 groups of diseases were forcibly applied to diagnosis related groups (DRG) system. In these 7 group of diseases, tonsillectomy and adenoidectomy were included in the otorhinolaryngology field. The objective of this research is to estimate the invested medical costs, profit and loss, and improvement points for the disease groups according to DRG and 'fee for service' system. SUBJECTS AND METHOD: We investigated 1,377 subjects who underwent tonsillectomy and adenoidectomy based on DRG between January 2011 to December 2013 at our hospital. The profit and loss of medical costs were calculated according to medical record data, medical service fee, and activity based costing (ABC). RESULTS: The total of 1,377 subject comprised of 905 patients younger than 17 years-old and 472 patients older than 18 years-old. A main moderate complication that was not one of the DRG diseases, postoperative bleeding, was only found in 19 patients (1.38%). Profit related to tonsillectomy and adenoidectomy studied for a 3 year-period was higher in the DRG system than in the 'fee for service' system; however, profit was reported as 62.9-67.5% of the actual prime costs. CONCLUSION: DRG system for tonsillectomy and adenoidectomy seems to have higher compensation rate than the 'fee for service' system does. However, the system is still insufficient to compare profit with the input medical cost. Furthermore, the present system of disease grouping needs to be improved to reflect actual medical prime costs.

Change of Voice Quality before and after Treatment of Short-Term Therapy with Proton Pump Inhibitor in Laryngopharyngeal Reflux / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to verify that voice analysis could be an alternate tool for the evaluation of proton pump inhibitor treatment of laryngopharyngeal reflux (LPR). SUBJECTS AND METHOD: Twenty-two patients with LPR symptoms underwent laryngoscopy, stroboscopy and their reflux finding index (RFI) were evaluated. Subjective reflux symptom scores (RSS) and voice handicap index (VHI) were completed at the baseline. All patients underwent voice analysis. Thereafter, patients had short-term proton pump inhibitor therapy for 6 weeks. The RFI, RSS, VHI and voice analysis were repeated during the last week of the treatment. RESULTS: RFI was improved and both RSS and VHI were improved after the treatment. RSS and VHI were significantly correlated. In voice analysis, shimmer significantly improved and harmony to noise ratio (HNR) also improved. CONCLUSION: Voice analysis can be indicators of treatment results of laryngopharyngeal reflux disease.

Review of Medical Curriculum in Post-graduate Course of Korea / 한국의학교육

Medical curriculum of post-graduate course was reviewed to identify current problems and to seek the alternatives for better education for 23 universities. The major findings are as follows: The avera ge number of post-graduate students is 120 in the master's course and 94 in the doctor's course. In only four out of 23 universities, the educational aims and objectives of post-graduate course in medicine are clearly defined in written form. Classroom teaching was given to the students in forms of formal lecture, conference, seminar, discussion and so on. Only eight universities give a lecture regularly according to the lecture schedule. Some universities offer lectures in the evening or in the weekend for the students' convenience. In about 50% of universities, students were evaluated through a set of written exam, oral test, report, presentation and discussion. Obligation of thesis presentation was prescribed in 20 universities of the master's course and in 22 universities of the doctor's course. The students of all 23 universities of master's course and 22 of doctor's course have to pass comprehensive exam for the graduation of the course. For completing doctor's course, the students of 22 universities (97%) still have to pass the secondary foreign language test. In more than 70% of universities, associate professors and assistant professors with doctor's degree are allowed to supervise and examine the thesis. Based on the above results, establishment of educational aims and objectives, reinforcement of teaching and learning activities, modification of foreign language test for entrance and graduation the course, and increase in faculty members and research funds should be needed for the improvement of post-graduate program in medicine.