Change of the Pure Tone Threshold as a Function of Frequency and Clinical Characteristics in Definite Meniere's Disease / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#One of the characteristics of Meniere’s disease is pure tone threshold shift at low frequencies in the lesion; although, in some patients, more pure tone threshold shifts were also shown at mid or high frequencies. Authors speculated that the most varied pure tone frequency may be related with diversity of clinical symptoms and other characteristics.SUBJECTS AND METHOD: We reviewed medical records of 85 patients who met the criteria of definite Meniere’s disease (1995 American Academy of Otolaryngology-Head and Neck Surgery). Patients were classified into 3 groups (high frequency, mid frequency, low frequency) depending on the frequency at which pure tone threshold changes encountered the most. The vestibular function tests and clinical characteristics were compared between the groups.@*RESULTS@#Thirty-six patients (42.0%) showed pure tone threshold changes at 0.25 or 0.5 kHz (low frequency group). Twenty-five patients (30.0%) showed greatest pure tone threshold change at 1 or 2 kHz (mid frequency group). Twenty-four patients (28.0%) belonged to the high frequency group with most changes taking place not lower than 4 kHz. Frequency of vertigo attack, and duration of vertigo attack did not differ between the groups. Low frequency group showed more chance of tinnitus with statistical significance. Vestibular evoked myogenic potentials (VEMP) abnormality was more frequently encountered in the low frequency group.@*CONCLUSION@#This study shows that changes in the pure tone threshold is not confined to low frequencies in definite Meniere’s disease. Patients with pure tone threshold changes at low frequencies have more chance of tinnitus and abnormal cVEMP.

Change of the Pure Tone Threshold as a Function of Frequency and Clinical Characteristics in Definite Meniere's Disease / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: One of the characteristics of Meniere’s disease is pure tone threshold shift at low frequencies in the lesion; although, in some patients, more pure tone threshold shifts were also shown at mid or high frequencies. Authors speculated that the most varied pure tone frequency may be related with diversity of clinical symptoms and other characteristics. SUBJECTS AND METHOD: We reviewed medical records of 85 patients who met the criteria of definite Meniere’s disease (1995 American Academy of Otolaryngology-Head and Neck Surgery). Patients were classified into 3 groups (high frequency, mid frequency, low frequency) depending on the frequency at which pure tone threshold changes encountered the most. The vestibular function tests and clinical characteristics were compared between the groups. RESULTS: Thirty-six patients (42.0%) showed pure tone threshold changes at 0.25 or 0.5 kHz (low frequency group). Twenty-five patients (30.0%) showed greatest pure tone threshold change at 1 or 2 kHz (mid frequency group). Twenty-four patients (28.0%) belonged to the high frequency group with most changes taking place not lower than 4 kHz. Frequency of vertigo attack, and duration of vertigo attack did not differ between the groups. Low frequency group showed more chance of tinnitus with statistical significance. Vestibular evoked myogenic potentials (VEMP) abnormality was more frequently encountered in the low frequency group. CONCLUSION: This study shows that changes in the pure tone threshold is not confined to low frequencies in definite Meniere’s disease. Patients with pure tone threshold changes at low frequencies have more chance of tinnitus and abnormal cVEMP.

Characteristics and Outcomes of Septoplasty in Patients with Paradoxical Nasal Obstruction / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate clinical characteristics and outcome of septoplasty in patients complaining of paradoxical nasal obstruction. SUBJECTS AND METHOD: Medical records of 637 patients who underwent septoplasty from 2011 to 2016 were reviewed retrospectively. One hundred sixty-nine patients whose follow up periods were longer than 3 months were included. These patients were categorized into two groups, the experimental group (paradoxical nasal obstruction) and the control group. We analyzed the degree of nasal obstruction, the sino-nasal outcome test (SNOT)-22 score, which is the sino-nasal outcome, and the minimal cross-sectional area in acoustic rhinometry. The effect of concurrent turbinoplasty was also evaluated. RESULTS: Paradoxical nasal obstruction was found in 19 patients (11.2%). Compared to the control group, the degree of mucosal change (both concave and convex side) had no statistical significance. Although the degree of nasal obstruction and SNOT-22 scores were significantly improved after surgery in both groups (p<0.05), the values for the experimental group were slightly increased at 3 months of surgery after having been improved at one month of surgery. In contrast, those values improved steadily over time in the control group. The tendency of psychologic domain scores was significantly different between the two groups (p=0.021). The results of volume reductive turbinoplasty showed that it maintained the improved symptoms better when performed along with septoplasty. CONCLUSION: Although septoplasty showed beneficial effects in patients with paradoxical nasal obstruction, the effect of septoplasty decreased over time. Concurrent volume reductive turbinate surgery maintained the effect of septoplasty in paradoxical nasal obstruction.

Characteristics and Outcomes of Septoplasty in Patients with Paradoxical Nasal Obstruction / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#The aim of this study was to evaluate clinical characteristics and outcome of septoplasty in patients complaining of paradoxical nasal obstruction.SUBJECTS AND METHOD: Medical records of 637 patients who underwent septoplasty from 2011 to 2016 were reviewed retrospectively. One hundred sixty-nine patients whose follow up periods were longer than 3 months were included. These patients were categorized into two groups, the experimental group (paradoxical nasal obstruction) and the control group. We analyzed the degree of nasal obstruction, the sino-nasal outcome test (SNOT)-22 score, which is the sino-nasal outcome, and the minimal cross-sectional area in acoustic rhinometry. The effect of concurrent turbinoplasty was also evaluated.@*RESULTS@#Paradoxical nasal obstruction was found in 19 patients (11.2%). Compared to the control group, the degree of mucosal change (both concave and convex side) had no statistical significance. Although the degree of nasal obstruction and SNOT-22 scores were significantly improved after surgery in both groups (p<0.05), the values for the experimental group were slightly increased at 3 months of surgery after having been improved at one month of surgery. In contrast, those values improved steadily over time in the control group. The tendency of psychologic domain scores was significantly different between the two groups (p=0.021). The results of volume reductive turbinoplasty showed that it maintained the improved symptoms better when performed along with septoplasty.@*CONCLUSION@#Although septoplasty showed beneficial effects in patients with paradoxical nasal obstruction, the effect of septoplasty decreased over time. Concurrent volume reductive turbinate surgery maintained the effect of septoplasty in paradoxical nasal obstruction.

Two Cases of Recurrent Nasolacrimal Duct Obstruction by Remaining Silicone Tube

Endoscopic dacryocystorhinostomy (DCR) is a widely used procedure for nasolacrimal duct obstruction. Because endoscopic DCR has shown higher success rate, fewer complications, and better cosmetic outcome compared to the conventional external approach, it has replaced the external approach. However, since the openings of the nasal cavity formed during surgery are small, recurrence often occurs due to stenosis caused by granuloma formation or the silicone tube. Hence, it is important to remove the silicone tube before granuloma formation around the openings of the nasal cavity after surgery. Failure to remove the silicone tube at the appropriate time can cause inflammation, resulting in granuloma formation. We recently experienced two cases of recurrent nasolacrimal duct obstruction caused by a remaining silicone tube. Here, we present these cases with a brief review of the literature.

Endoscopic Removal of Retained a Wooden Foreign Body Causing Persistent Intraorbital Inflammation

An intraorbital foreign body can cause a variety of signs and symptoms depending on size, location, and composition and can be classified as metal, inorganic, or organic depending on composition. An intraorbital organic foreign body, such as wood, can cause severe inflammation. An intraorbital foreign body is not only difficult to detect, but also can cause severe complications such as orbital cellulitis, orbital abscess, optic nerve injury, and extraocular muscle injury. A wooden foreign body can be very difficult to detect, even if computed tomography (CT) or magnetic resonance imaging (MRI) is used. Therefore, clinical suspicion based on history taking, physical examination, and radiological examination is essential for diagnosis of intraorbital wooden foreign body. We report a case of repeated intraorbital inflammation due to a retained wooden foreign body in a healthy 56-year-old male patient, who was treated with a combination of intravenous antibiotics and transnasal endoscopic foreign body removal.

Conditions of Cervical Vestibular Evoked Myogenic Potentials Test to Minimize Interaural Variation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cervical vestibular evoked myogenic potentials (cVEMP) test has been widely used to assess the function of the saccule and inferior vestibular nerve. Electrode location and stimulating sound are important factors which might affect the test results. Today those parameters are usually selected to maximize the waveform response. In this study, we tried to find the optimal condition to minimize the range of normal value of cVEMP. SUBJECTS AND METHOD: Thirteen normal subjects (26 ears) were included. We placed electrodes at five different locations over the sternocleidomastoid muscle (SCM) and used four different stimulation sounds. Variances of parameters, including interpeak amplitude, interaural difference (IAD) and normal value were analyzed and compared. RESULTS: When using the classical condition (mid point of SCM and 500 Hz) without rectification, IAD ratio was 20.8+/-14.2% and the range of normal value was 39%. When we used 2000 Hz tone burst sound at the classical electrodes site, IAD ratio and normal value were minimized, resulting in 18.7+/-14.3% and 31% respectively. After the rectification, when using the classical condition, IAD ratio was 26.4+/-22.3% and the range of normal value was 49%. The minimum IAD ratio was measured as 17.4+/-13.7% when we used click sound at SCM at the level of mandibular angle. And the minimum normal value of 32% was measured when we used 1000 Hz tone burst sound at SCM at the level of mandibular angle. CONCLUSION: Although the condition was not optimal for maximizing the interpeak amplitude, we could alternatively use the condition to minimize the normal value.