Treatment Response of Modified Tinnitus Retraining Therapy with Medical Therapy in the Patients with Tinnitus / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: According to the neurophysiologic model of tinnitus, emotion and autonomic nervous systems are closely related to generation of tinnitus. We performed this study to evaluate the treatment response of modified tinnitus retraining therapy (TRT) with medication in the patients with sensorineural tinnitus. SUBJECTS AND METHOD: Forty-three tinnitus patients who were diagnosed as sensorineural tinnitus through audiologic evaluation and have normal hearing in speech frequency were included in this study. Tinnitus and psychological status were measured by tinnitus questionnaire, Korean version of Brief Encounter Psychosocial Instrument (BEPSI) scale, Beck Depression Inventory (BDI), Spielberger State Trait Anxiety Inventory (STAI). Patients treated with anxiolytics and microcirculation enhancer were Group 1 and those treated with modified TRT and medications were Group 2. Short-term therapeutic response was analyzed and compared between two groups. RESULTS: Loudness, awareness, annoyance and effect on life of tinnitus and tinnitus handicap score were significantly decreased in Group 2. Relief of tinnitus in more than 2 of 4 subjective parameters was achieved in 4 patients (30.7%) in Group 1 and 15 patients (75%) in Group 2. Stress score was also decreased significantly after treatment in Group 2. CONCLUSION: Tinnitus patients in Group 2 treated with medication and modified TRT showed the higher compliance and the response rate of treatment than the patients in Group 1 treated with medication alone. Modified TRT, in addition to medical therapy, should be considered to increase the therapeutic response in patients with sensorineural tinnitus.

A Case of Adenoid Cystic Carcinoma of the Ectopic Lacrimal Gland

Adenoid cystic carcinoma (ACC) of the lacrimal gland is a rare malignant tumor accounting for 1.6% of all orbital tumors. We report a case of ectopic adenoid cystic carcinoma that developed on the nasal orbital side of the face adjacent to the nasal cavity. A 60-year-old man developed progressive right ocular proptosis and pain for over three years. The orbit MRI and CT revealed a 24x36x17 mm-sized lower signal mass on the medial side of the right medial rectus muscle. It also showed an erosion of the orbital bone in the superior and medial orbital walls. An endoscopic biopsy was performed and a frozen section of the tissue in the operating room showed no evidence of a malignancy. The mass was excised by endoscopic surgery. The final pathology was an adenoid cystic carcinoma. An orbital exenteration was recommended but the patient refused the procedure and, after receiving chemotherapy and radiation therapy, his condition is being followed. Some of the orbital mass remains in the posterior orbital area immediately after the endoscopic excision. The patient underwent his first session of Cyberknife radiosurgery therapy after concurrent chemotherapy and radiotherapy.

Clinical Significance of Serum Eosinophil Cationic Protein(ECP) in Chronic Rhinosinusitis with Nasal Polyposis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Eosinophils play a major role in the pathophysiology of chronic rhinosinusitis with nasal polyposis (CRS/NP). The secreted form of eosinophil cationic protein (ECP) is considered to be the marker of eosinophil activity. The aim of this study is to investigate the relationship between serum ECP and CRS/NP. SUBJECTS AND METHOD: A retrospective review of medical records was carried out on 198 patients who had undergone endoscopic sinus surgery from March, 2001 through July, 2006 at our institution. We reviewed blood eosinophil counts, tissue eosinophil, serum ECP, symptom scores, CT scan scores according to the Lund-Mackay system, recurrence of polyp and revision surgery during follow-up. RESULTS: The serum ECP concentration was significantly higher in the CRS/NP patients than in the normal control subjects. The serum ECP concentration was significantly correlated with the blood eosinophil count, CT score and tissue eosinophil count. The serum ECP concentration was significantly higher in patients with recurrence or revision surgery than in patients without recurrence or revision surgery. CONCLUSION: The results suggest that the level of serum ECP is correlated with the disease severity, and is one of prognostic factors after endoscopic sinus surgery.

Prognostic Value of Electroneurography in Bell's Palsy and Ramsay-Hunt's Syndrome / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study evaluated the usefullness of electroneurography (ENoG) as a prognostic indicator in Bell's palsy and Ramsay-Hunt's syndrome. SUBJECTS AND METHOD: Retrospective case-series review in a university-based hospital. The treatment consisted uniformly of high-dose prednisolone, dextran, vasodilators, carbogen therapy, and stellate ganglion block. Acyclovir was administered in the case of Ramsay-Hunt's syndrome. ENoG was performed 7 to 10 days in Bell's palsy and 10 to 14 days in Ramsay-Hunt's syndrome. The recovery of the facial nerve function was documented using the House-Brackmann grading system. All patients were followed up until they recovered or at least for 3 months. RESULTS: The recovery rates to House-Brackmann grade II or better were 96.3% in Bell's palsy and 84.6% in herpes zoster oticus. There was no significant difference of ENoG value between recovery and non-recovery groups in Bell's pasly and in herpes zoster oticus. The logistic regression model between ENoG values and the chance of recovery was not found in Bell's palsy and in herpes zoster oticus. CONCLUSION: Although ENoG accurately predicts the percentage of remaining motor axons of the facial nerve, it cannot give a precise information on the prognosis or recovery rate of facial paralysis.

Effect of Inhibitor of TNF-alpha and Oxatomide on Experimental Immune Mediated Otitis Media with Effusion / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Local immune response, one of the pathogenesis of middle ear effusion (MEE) is associated with the development and persistence of effusion in the middle ear cavity and inflammatory mediators play a major role in the production of MEE. The purpose of this study was to determine the effects of TNF-alpha antagonist and oxatomide on the outcome of immune mediated otitis media with effusion (OME) in rats. MATERIALS AND METHOD: Otitis media was induced by injecting KLH (Keyhole lympet hemocyanin) transtympanically 7 days after systemic immunization. Phosphate-buffered saline solution was used as control. Other groups were pretreated with TNF-alpha antagonist (soluble TNF receptor type I, sTNF RI) or oxatomide respectively before transtympanic injection of KLH. Seventy-two hours after the transtympanic injection, temporal bones in each group were examined histopathologically and vascular permeability of the middle ear mucosa was measured by the Evans blue vital dye technique. RESULTS: In the KLH, sTNF RI and oxatomide groups, MEE was developed in 83%, 0%, 66% of the ears, respectively. The oxatomide group and sTNF RI group showed significant decrease in inflammation, mucosal thickening and vascular permeability as compared with KLH group and those parameters of sTNF RI group showed lower values than those of oxatomide group. CONCLUSION: Transtympanic administration of sTNF RI and oxatomide appears to suppress the development of immune mediated OME. In terms of inhibiting MEE, sTNF RI was more effective than oxatomide. This study suggests that TNF-alpha antagonist and oxatomide may have a adjunctive role in the treatment and prevention of otitis media with effusion.

Effects of Preincisional Infiltration with Bupivacaine and Oral Dextromethorphan on Postoperative Pain in Uvulopalatopharyngoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Uvulopalatopharyngoplasty is one of the most painful surgical procedures in otolaryngology. Repetitive nociceptive impulses from injured peripheral tissues and activation of N-methyl-D-aspartic acid (NMDA) receptors induce central sensitization and post-injury pain hypersensitivity states. We aimed this study to evaluate whether bupivacaine for preincisional block of nociceptive afferent inputs and dextromethorphan, a clinically available NMDA receptor antagonist could reduce postoperative pain after uvulopalatopharyngoplasty. MATERIALS AND METHOD: Thirty patients scheduled for uvulopalatopharyngoplasty were randomly assigned to one of the three groups : control, bupivacaine, and bupivacaine- dextromethorphan groups. The second and third group had 10 ml of 0.25% bupivacaine hydrochloride infiltrated around tonsils and soft palate before incision. The third group was given oral doses of dextromethorphan before and after surgery. Pain was assessed using numeric rating scale at rest and on swallowing on postoperative day 0, 1, 2, 3, and 5. Daily consumption of supplementary diclofenac sodium was also recorded. RESULTS: Resting pain scores were significantly lower in the groups treated with bupivacaine infiltration with or without dextromethorphan on postoperative days 0, 1, 2, 3, and 5. Swallowing pain scores were significantly lower in the bupivacaine-dextromethorphan group on days 0, 1, and 2. CONCLUSION: Preincisional infiltration with bupivacaine and oral dextromethorphan could decrease the intensity of postoperative pain following uvulupalatopharyngoplasty.