Cochlear Fistula in Chronic Otitis Media without Cholesteatoma

Cochlear fistula in the chronic otitis media (COM) without cholesteatoma is an extremely rare with only a few cases reported in the literature to this date. We describe a case of cochlear fistula observed in a female with COM without cholesteatoma. This report presents the first clinical case of a transtympanic iatrogenic trauma by habitual cotton swabs probably causing cochlear fistula.

Contralateral Suppression of Transient Evoked Otoacoustic Emission in Vestibular Neuritis / 대한평형의학회지

BACKGROUND AND OBJECTIVES: The etiology of vestibular neuritis is unknown. Many investigators have suggested that this condition spares the inferior vestibular nerve system. However, others have reported that the lesion sometimes affects the inferior vestibular nerve system based on vestibular evoked myogenic potential. The function of the inferior vestibular nerve was studied in acute vestibular neuritis by monitoring medial olivocochlear bundle (MOCB) function. Under normal conditions, contralateral acoustic stimulation has inhibitory effects on ipsilateral otoacoustic emissions through the MOCB. MATERIALS AND METHODS: Twenty patients that presented with dizziness and spontaneous nystagmus, and were confirmed to have acute vestibular neuritis by rotatory chair and caloric testing were enrolled in this study. We evaluated the evoked otoacoustic emissions with and without contralateral acoustic stimulation in both ears in all patients. The percent loss of normal inhibitory action on otoacoustic emissions was determined in the normal and affected ears. RESULTS: All patients showed inhibitory effects in response to contralateral acoustic stimulation on evoked otoacoustic emissions in normal ears. Fifteen patients (75%) had an absence of contralateral suppression of otoacoustic emissions on the affected side. CONCLUSION: The findings of this study suggest the presence of dysfunction of the MOCB in patients with acute vestibular neuritis.

Clinical Features of Cholesteatoma in the Normal Hearing Ear / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cholesteatoma in the normal hearing ear represents a surgical challenge. We aimed to identify the clinical features and surgical results of these patients. SUBJECTS AND METHOD: Sixty-three ears with cholesteatoma had preoperative pure-tone averages of less than 25 dB. Parameters for study were age, location of cholesteatoma, type of tympanoplasty, status of ossicles, and type of mastoidectomy. Postoperative audiogram was evaluated. RESULTS: Hearing was preserved within 30 dB on air conduction audiometry in 60.3% on postoperative 2 months and in 60.5% on postoperative 6 months. The rate of hearing preservation was related to the location of cholesteatoma. Similar hearing outcomes resulted from the comparisions of adult versus children, intact versus reconstructed ossicular chains and open versus closed mastoidectomy. CONCLUSION: Preserving an intact ossicular chain and maintaining an intact canal wall did not have a significant effect on hearing preservation, but the location of cholesteatoma does.

Grommet Cholesteatoma / 대한이비인후과학회지

There are occasional complications after tympanostomy tube insertion due either to the operative procedure itself or to the anato-mical or physiological effects of the tubes. Hearing loss, persisting perforation, tympanosclerosis, atrophy, atelectasis, and the development of cholesteatoma have all been attributed to the tympanostomy tubes. The development of a secondary cholesteatoma at the site of the tube placement Grommet cholesteatoma- is a very uncommon complication. We report one case of cholesteatoma associated with tympanostomy tube insertion.

A Case of Combined Facial and Vestibulocochlear Nerve Paralysis in Brainstem Infarction / 대한이비인후과학회지

Isolated cranial nerve palsy without long tract signs such as contralateral hemiparesis, hemihypoesthesia and ataxia is often reported as brainstem infarction. But most of them are accompanied by oculomotor or abducens nerve palsy. Isolated cranial nerve palsy involving the facial nerve and vestibulocochlear nerve is very rare in brainstem infarction. We report, with a review of literature, a case of right caudal pontine infarct on the dorsolateral portion of the middle cerebellar peduncle with isolated 7th and 8th cranial nerve palsies.

The Effect of Contralateral Acoustic Stimulation on the Latency of Distortion Product Otoacoustic Emissions / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The auditory efferent system -Medial olivocochlear bundle (MOCB)-controls the sensitivity and frequency selectivity of the cochlea and maintains the cochlea for optimal acoustic signaling. Contralateral acoustic sound stimulates the MOCB and has inhibitory effects on the sound evoked amplitude response of the cochlea. There are only a few reports on the latency response of contralateral acoustic stimulation (CAS) on distortion product otoacoustic emission (DPOAE), and it has no consistent conclusion. The purpose of this study was to evaluate whether changing the latency of DPOAE by CAS could be a stable method for monitoring the function of MOCB. SUBJECTS AND METHOD: The change in the latencies of DPOAE after CAS were monitored in 24 normal hearing ears with f2 sweep paradigm. The CAS level was divided into two groups, one was under 65 dB SPL and other was over 65 dB SPL. RESULTS: As f2 frequency changed from 1 kHz to 2 kHz, the latency of DPOAE was shortened from 11.82 +/- 1.87 ms to 7.29 +/- 0.86 ms in low stimulation level (50 dB SPL) and from 10.70 +/- 2.65 ms to 6.16 +/- 1.59 ms in high stimulation level (75 dB SPL) There were no significant shortening on the latency of DPOAE after CAS in low stimulation level group. But in higher stimulation level group (75 dB SPL), DPOAE latency changed from 10.70 +/- 2.65 ms to 10.12 +/- 1.95 ms (CAS level: 35 dB SL) and to 9.76 +/- 2.97 ms (CAS level: 50 dB SL) in 1 kHz, from 6.16 +/- 1.59 ms to 5.96 +/- 1.49 ms (CAS level: 35 dB SL) and to 5.83 +/- 1.28 ms (CAS level: 50 dB SL) in 2 kHz. CONCLUSION: Changes in the latency of DPOAE after CAS is not a stable monitoring tool for the function of MOCB.

Auditory Effects of Microperfused Lidocaine on Guinea Pig Cochlea / 대한이비인후과학회지

OBJECTIVES: Lidocaine is one of the therapeutic trials to treat tinnitus. However, the exact mechanism of the effect of lidocaine remains unclear. The aim of this study was to elucidate the action site of lidocaine in the cochlea by measuring compound action potential (CAP) and transient evoked otoacoustic emission (TEOAE) amplitude in guinea pigs. METHOD: Artificial perilymph was perfused into the scala tympani of the guinea pig cochlea in the control group, and lidocaine diluted with artificial perilymph was perfused into the scala tympani of the experimental groups. Electrocochleogram (ECoG) and TEOAE were measured in each groups both before and after lidocaine perfusion. RESULTS: Artificial perilymph perfused to the scala tympani of the guinea pig cochleae did not affect either the CAP threshold or the TEOAE response. But, lidocaine perfused into the scala tympani of the guinea pig cochleae produced a dose-dependent increase in CAP threshold, but did not affect TEOAE response. CONCLUSION: This study revealed that lidocaine perfused into the scala tympani of the guinea pig cochlea affects the CAPthreshold but not the TEOAE amplitude and reproducibility. It means that the locally perfused lidocaine affects the cochlear nerve greater than the outer hair cells.

Two Cases of the Landau-Kleffner Syndrome / 대한이비인후과학회지

Landau-Kleffner syndrome, or acquired epileptiform aphasia, is an epilepsy syndrome with variable disruption of acquired language and epileptiform discharges on electroencephalograph (EEG). Auditory agnosia can deteriorate into total unresponsiveness and impaired expressive communication. In spite of the presence of this condition, the pure tone audiometry, otoacoustic emission and brainstem evoked auditory potential could be normal. Therefore, in the above hearing tests which are the mainstream methods for pediatric hearing evaluation, otolaryngologists should have suspicion for the presence of this syndrome, although it is rare.

Hyperostosis of the Maxillary Sinus Wall in Aspergillosis: Is it a Characteristic Finding?

PURPOSE: To determine whether the wall thickening of the maxillary sinus is a characteristic finding in aspergillosis. MATERIALS AND METHODS: In 103 patients, including 26 with aspergillosis, 21 with inverted papilloma (IP), and 56 with unilateral chronic sinusitis, the thickness of the maxillary sinus wall was determined by CT scanning. All cases were proven pathologically, and patients with a history of previous surgery or bone destruction were excluded. Two neuroradiologists retrospectively reviewed the CT scans using bone window settings for sinus wall hyperostosis and the presence of intrasinus calcification. Thickening of the maxillary sinus wall was assessed visually in a semiquantitative manner, and graded as 'none'(absence of thickening), 'mild'(thickening of up to 1.5 times), or moderate to severe(over 1.5 times thicker than normal contralateral sinus wall at its thickest point). RESULTS: Moderate to severe wall thickening was found only in patients with aspergillosis (21/26, 80.8%). Mild wall thickening was seen in two patients with aspergillosis (2/26, 7.7%), in 12 of 21 with IP (57.1%), and in 5 of 56 with chronic maxillary sinusitis (8.9%). Most cases of chronic maxillary sinusits (51/56, 91.1%), 9/21 IP cases (42.9%), and 3/26 cases of aspergillosis (11.5%) showed no thickening of the maxillary sinus wall. Calcifications were found in 18 patients with aspergillosis (69.2%), in no patient with IP (0%), and in one with chronic maxillary sinusitis (1.8%). CONCLUSION: We suggest that 'moderate to severe' wall thickening of the maxillary sinus is the characteristic finding of aspergillosis. Although various sinonasal diseases can cause bone change, CT findings of hyperostosis of the maxillary sinus and intrasinus calcification are very helpful in differentiating fungal sinusitis from other types of chronic inflammatory lesions.

The Protective Effect of Free Oxygen Radical Inhibitors on Na-salicylate Induced Cochlear Damage in Guinea Pig / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To elucidate the mechanism of salicylate ototoxicity of free oxygen radicals (FORs), we made an animal model with Na-salicylate cochlear toxicity and evaluated the protective effect of free oxygen radical inhibitors. MATERIALS AND METHODS: Na-salicylate soaked in gelfoam was placed on the round window niche of guinea pigs for 2 hours. After removal of gelfoam, electrocochleography and evoked otoacoustic emission test were performed at regular time intervals. These tests were repeated to see the protective effect of FORs inhibitors after the injection of allopurinol or superoxide dismutase (SOD). RESULTS: Hearing loss was noted after removal of gelfoam which was soaked with Na-salicylate. After 6 hours, these ototoxicity effects disappeared. The OAE test showed similar response. FORs inhibitors showed protective effects and SOD was more effective than allopurinol. CONCLUSION: These results support the idea that FORs activity contributes to ototoxicity of Na-salicylate. This damage can be diminished by treatment with drugs that scavenge and inhibit the formation of FORs.

A Case of the Audiotory Neuropathy / 대한이비인후과학회지

Auditory neuropathy is a recently described hearing disorder in which patients demonstrate hearing loss for pure tones, impaired word discrimination out of proportion to pure tone loss, absent or abnormal auditory brainstem responses (ABR), but normal outer hair cell function as measured by otoacoustic emissions and cochlear microphonics. Auditory neuropathy affects the normal synchronous activity in the auditory nerve, without affecting the amplification function in the inner ear. There is impairment in their temporal processing in the auditory nerve. So patients can hear sounds, but can not understand speech. Auditory neuropathy occurs either in isolation or as a part of a generalized neuropathy. We have identified one pediatric patient who demonstrated hearing defects and developed signs for peripheral neuropathy. We report it with a review of literatures.

Expression of p53, PCNA, EGFR in Rat Submandibular Gland Tumor Induced Experimentally / 대한이비인후과학회지

BACKGROUND AND IBJECTIVES: Animal models of cancer are frequently used in many studies. In this study, we tried to make a model of SMG cancer using rats. We used SMG tissues from rats for the analysis of expression of p53, PCNA and EGFR MATERIALS AND METHODS: Pellets of 4-6 mg DMBA were implanted into the submandibular glands of 47 female Sprague- Dawley rats which were sacrificed at 4, 8, 10, 14, and 18 weeks after DMBA implantation. Thirteen rats were sacrificed at the beginning of experiment and were used as a control group. Histopathological and immunohistochemical staining for p53, PCNA and EGFR were carried out using tissues From rat submandibular glands (SMGs). RESULTS: Histopathological features during carcinogenesis were as follows : 1) Well differentiated squamous cell carcinomas (SCCs) were first developed at the 8th week of the experiment. 2) In 2 out of 12 cases, fibrosarcoma and SCC were induced simultaneously at the 18th week of experiment. P53-positive nuclei were not observed in this experiment. PCNA-positive nuclei were mainly confined to the basal cells of' the morphologically altered ducts at the 4th week of experiment, Squamous metaplastic cells and well differentiated SCCs showed strong reactivity to PCNA. The PCNA index was about 40% in the tumour incduced group. PCNA indices were 28.8%, 48.1%, 44.6% and 37.8% at the 4th, 10th, 14th and 18th week of the experiment, respectively. In the control group, PCNA index was 6.1%. Increase of PCNA index in the experimental groups was statistically significant compared with control group. The staining intensity for EGFR increased along with the duration of exposure to DMBA. CONCLUSION: SCC: model of rat SMGs could be developed successfully by implantation of DMBA. In this model, p53 mutation does not seeem to play any important role during carcinogenesis. PCNA and EGFR seem to be closely related to carcinogenesis of SMGs in this model.

Fat Myringoplasty in Graft Failures / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Fat myringoplasty has been used for closure of small tympanic membrane perforations. It is fast, safe and efficient method on ambulatory basis. The performance of this study is to investigate the results of fat myringoplasty in graft failure patient after conventional tympanoplasty with temporalis muscle fascia. METHOD:Fat myringoplasty were performed on 21 ears in 18 patients. RESULTS: We found that in 21 ear success rate was 71% (15/21), but in patient basis success rate was 83% (15/18). CONCLUSIONS: We believe that due to significant operational advantage, fat myringoplasty can be suggested for reparing perforation in graft failure patient.

Congenital Epiglottic Cysts / 대한이비인후과학회지

Epiglottic cyst are relatively uncommon and account for about five percent of benign laryngeal lesions. The most common location is the epiglottis. We experienced two cases of congenital epiglottic cysts, one in an infant who showed dyspnea at birth and was incubated and the other in a 1-month-old infant with increasing stridor during the first month of life. In both cases, each cysts were completely removed under suspension laryngoscopy under general anesthesia with satisfactory results. We reviewed the clinical characteristics, diagnostic modalities, treatments, and prognosis of the epiglottic cyst.

The Effects of Middle Ear Negative Pressure on the Transiently Evoked (TEOAEs)and Distortion Product (DPOAEs) Otoacoustic Emissions / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The clinical utility of otoacoustic emissions (OAEs) has been well established in childhood hearing screenings. As middle ear negative pressure prevails in normal children, and since all OAEs must be transmitted through the middle ear before they can be measured in the ear canal, OAEs can be affected by middle ear negative pressure. The purpose of this study is to elucidate the effect of middle ear negative pressure on the detectability of OAEs. MATERIAL AND METHODS: TEOAEs were recorded for 36 ears using click before & after tonsillectomy and, or adenoidectomy (T and, or A) operations. Before & after T and or A operations, DPOAEs were generated at six geometric mean frequencies between 1-6 kHz for two different groups, Group I (40 ears) and Group II (36 ears). Group I: 3(f2/f1) ratios (1.21, 1.22 and 1.23) were used at the fixed stimulus level (70-70 dB SPL). Group II:3 stimulus levels were used (70-70 dB SPL, 60-70 dB SPL and 30-40 dB SPL). RESULTS: The negative middle ear pressure attenuated low frequency emission more than high frequency emission. CONCLUSION: Negative middle ear pressure may increase false alarm. So pneumatic otoscopy and aural immittance testing should be utilized to predict the feasibility of applying OAEs in childhood hearing screening test.

Test / Retest Reliability of DPOAE and TEOAE / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Otoacoustic emissions (OAEs) are the objective and noninvasive methods to assess cochlear function. The purpose of the present study is to determine the short-term and long-term test/retest reliability of the distortion-product otoacoustic emissions (DPOAEs) and transient-evoked otoacoustic emissions (TEOAEs). MATHODS: The short-and long-term reliability of DPOAE and TEOAE were examined in 11 normally hearing adults. DPOAE were collected in two basic forms consisting of audiograms and input/output (I/O) functions and reliabilities for TEOAE level, reproducibility index and peak stimulus level were calculated. RESULTS: The result of this study showed that the reliability of DPOAE and TEOAE was generally excellent. CONCLUSIONS: The DPOAE and TEOAE are highly reliable and useful tests to monitor the cochlear function for the purpose of study or clinical use in combination with other standard tests of audiometric function.

Evaluation of Recurrence of Otitis Media with Effusion Using Ultra High Frequency Audiometry / 대한이비인후과학회지

The goal of treatment in OME is normal aerated middle ear space. When the tympanogram convert to type A or C from type B in patients with OME, no further medication would be needed. But 1/3 of these patient had type B tympanogram again after 4 weeks follow up without medication. Many parameters-including age, sex, season, unilaterality, passive smoking, associated rhinitis etc-were concerned about the recurrence of OME. Ultra high frequency audiometry was added as a new parameter in recurrence of OME.

Age-related normal ultra high frequency thresholds / 대한이비인후과학회지

No abstract available.

Sonographic findings of postoperative cheek cyst / 대한이비인후과학회지

No abstract available.

Two cases of sinogenic intracranial complications / 대한이비인후과학회지

No abstract available.