Effects of Particulate Matter Exposure on the Eustachian Tube and Middle Ear Mucosa of Rats

Objectives@#. Particulate matter (PM) is a risk factor for various diseases. Recent studies have established an association between otitis media (OM) and PM exposure. To confirm this relationship, we developed a novel exposure model designed to control the concentration of PM, and we observed the effects of PM exposure on the Eustachian tube (ET) and middle ear mucosa of rats. @*Methods@#. Forty healthy, 10-week-old, male Sprague-Dawley rats were divided into 3-day, 7-day, 14-day exposure, and control groups (each, n=10). The rats were exposed to incense smoke as the PM source for 3 hours per day. After exposure, bilateral ETs and mastoid bullae were harvested, and histopathological findings were compared using microscopy and transmission electron microscopy (TEM). The expression levels of interleukin (IL)-1β, IL-6, tumor necrosis factor-α, and vascular endothelial growth factor (VEGF) in the middle ear mucosa of each group were compared using real-time reverse transcription polymerase chain reaction (RT-PCR). @*Results@#. In the ET mucosa of the exposure group, the goblet cell count significantly increased after PM exposure (P=0.032). In the middle ear mucosa, subepithelial space thickening, increased angio-capillary tissue, and inflammatory cell infiltration were observed. Moreover, the thickness of the middle ear mucosa in the exposure groups increased compared to the control group (P<0.01). The TEM findings showed PM particles on the surface of the ET and middle ear mucosa, and RT-PCR revealed that messenger RNA (mRNA) expression of IL-1β significantly increased in the 3-day and 7-day exposure groups compared to the control group (P=0.035). VEGF expression significantly increased in the 7-day exposure group compared to the control and 3-day exposure groups (P<0.01). @*Conclusion@#. The ET and middle ear mucosa of rats showed histopathologic changes after acute exposure to PM that directly reached the ET and middle ear mucosa. Therefore, acute exposure to PM may play a role in the development of OM.

Comparison of Surgical Outcomes for Treatment of Maxillary Sinus Inverted Papilloma: Endoscopic Prelacrimal Recess Approach versus Caldwell-Luc Approach / 대한이비인후과학회지

Background and Objectives@#Endoscopic prelacrimal recess approach (PLRA) was introduced to treat maxillary sinus inverted papilloma (IP) without sacrificing the inferior turbinate and nasolacrimal duct. This study aimed to compare surgical outcomes of prelacrimal recess approach with the conventional Caldwell-Luc approach (CLA) to remove IP of maxillary sinus and to evaluate the usefulness of the PLRA.Subjects and Method We retrospectively reviewed medical records of 51 patients who were treated in our institution for IP of nasal cavity and sinuses between March 2010 and June 2019. Twenty patients had maxillary sinus IP. Sixteen patients underwent endoscopic sinus surgery combined with either CLA (n=8) or PLRA (n=8). Demographic data, surgical technique, site of IP origin, intra- and postoperative complications, duration of follow-up, recurrence rate and pathologic diagnosis were reviewed. @*Results@#IP was the pathologic diagnosis for all 16 cases. Gross total removal was achieved in all cases. The mean follow-up period was 20.1 months in CLA group and 12.5 months in PLRA group. There was one case of massive bleeding during operation requiring transfusion and postoperative ICU care in CLA group. On postoperative follow-up, two patients from the CLA group had recurrence during the follow-up period. One patient had numbness around the gingival area, another patient had transient wound dehiscence, and another had persistent oro-antral fistula. In PLRA group, one patient had periorbital swelling after blowing nose; otherwise, no other patient from the PLRA group developed subjective complaints after surgery. @*Conclusion@#Endoscopic prelacrimal recess approach showed lower complication rates and recurrence rates compared to CLA. PLRA is a safe and effective method for the excision of primary maxillary sinus IP.

A Case of Squamous Cell Carcinoma in Situ of the Middle Ear / 대한이비인후과학회지

Malignancy of the middle ear is rare and its estimated incidence is 0.18 cases per million people in the US, with its most common type being squamous cell carcinoma. Squamous cell carcinoma in situ is thought to be a precursor to squamous cell carcinoma, which is extremely rare in the middle ear. The pathology reports of squamous cell carcinoma have not been well-characterized as it has not been reported to date in Korea. Here, we report a case of squamous cell carcinoma in situ of the middle ear in a 66-year-old man, who presented with otorrhea and tympanic membrane perforation.

A Case of Squamous Cell Carcinoma in Situ of the Middle Ear / 대한이비인후과학회지

Malignancy of the middle ear is rare and its estimated incidence is 0.18 cases per million people in the US, with its most common type being squamous cell carcinoma. Squamous cell carcinoma in situ is thought to be a precursor to squamous cell carcinoma, which is extremely rare in the middle ear. The pathology reports of squamous cell carcinoma have not been well-characterized as it has not been reported to date in Korea. Here, we report a case of squamous cell carcinoma in situ of the middle ear in a 66-year-old man, who presented with otorrhea and tympanic membrane perforation.

Sensorineural Hearing Loss: Causes and Hearing Rehabilitation / 한양의대학술지

Sensorineural hearing loss is one of the most common chronic clinical disorders that we can easily encounter. The etiology of sensorineural hearing loss is multifactorial: congenital, idiopathic, traumatic, noise-induced, head injury induced, infectious disease, drug induced, degenerative, immune disorder, vestibular schwannoma and Meniere's disease. Many people are living with the discomfort of hearing loss because fundamental treatment is has not yet been found. Also due to the progress of medical science, human life span has been extended. As the result, the number of patients suffering from hearing loss has increased. But the present situation does not measure up to the demand for recovery of hearing loss. Hearing loss has a great influence on the quality of life. To overcome this situation, neural prostheses such as the cochlear implant and auditory brainstem implant are helpful for the rehabilitation of total deaf patients. Recently, due to the advancement of studies related to hair cell regeneration and the field of gene therapy on the inner ear has made big progress during the last few years. The purpose of this study is to describe the latest known causes and rehabilitation of sensorineural hearing loss.

A Case of Cavernous Lymphangioma Originated in the Middle Ear Cavity / 대한이비인후과학회지

Lymphangioma is a rare benign congenital tumor involving both the head and the neck and causing obstructing symptoms in the upper airways as well as aesthetic anomalies. About 90% of the cases occur within 2 years of age, except for a few cases, which occur in adulthood. The lesions can grow rapidly with infection, truma or bleeding, resulting in disfigurement as well as severe impairment of respiraton, swallowing and speech. The middle ear lymphangioma is very extreme. There have been no previously reported cases of middle ear lymphangioma in Korea. The treatment of choice for lymphangioma located in the middle ear is surgical excision. We present and discuss this rare case with a review of the literature.

A Case of Bilateral Sudden Hearing Loss and Tinnitus after Salicylate Intoxication

Salicylate, the active ingredient of aspirin can cause sensorineural hearing loss and tinnitus when plasma concentrations reach a critical level. The ototoxic mechanisms of salicylate remain unclear but hearing and tinnitus usually recovers a few days after intoxication. There have been few reports of salicylate-induced ototoxicity in Korea, and the majority is caused by a low dose of aspirin. Herein, we report a case of sudden hearing loss and tinnitus after acute salicylate intoxication and review recent updates on salicylate ototoxicity.

A Child of Palatal Myoclonus Tinnitus Treated with Intraoral Injection of Botulinum Toxin / 대한이비인후과학회지

Palatal myoclonus (palatal tremor) was reported to be presented with a sole symptom of objective pulsating tinnitus and could be controlled by botulinum toxin injection alone. However, there were 3 cases reported in Korea of palatal myoclonus tinnitus controlled with botulinum toxin injection through the dual administration route of the mouth and nasal cavity. We present an 11-year-old boy of essential palatal myoclonus tinnitus, which was controlled by intraoral botulinum toxin injection to the tensor veli palatini muscle alone. Intraoral injection of botulinum toxin to the anatomical location of tensor veli palatini muscle with the guidance of electromyography was effective and safe for the child of objective tinnitus caused by palatal myoclonus.

Early Effect of Barbecue Rotation and Modified Semont Combination in Apogeotropic Horizontal Canal Benign Paroxysmal Positional Vertigo / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) of horizontal canal shows reversible direction changing positional nystagmus and diverse clinical courses because of the frequent clinical presentation of cupulolithiasis. The aim of this study is to find out the early effect of particle repositioning maneuver (PRM) including the barbecue and the modified Semont in single treatment session for the apogeotropic horizontal canal BPPV. SUBJECTS AND METHOD: Thirty-three episodic vertigo patients with direction-changing apogeotropic horizontal nystagmus were enrolled in this study. The patients were initially treated with barbecue rotation and the second PRM was applied 15 minutes after the first PRM. Barbecue rotation was applied when the positional nystagmus was changed its direction to that of geotropic. The modified Semont maneuver or barbecue rotation was randomly applied when nystagmus was not changed. Patients were followed-up 2 or 3 days after the initial visit and the nystagmus was rechecked to determine the single session treatment result. RESULTS: The combination of PRMs in a single treatment session was effective in 23 out of 33 (69.7%) patients. An initial barbecue rotation was effective in 17 patients (51.5%); geotropic nystagmus was obtained in 12, and no nystagmus in 5. Eleven out of 16 (68.8%) patients with persistent apogeotropic nystagmus after initial treatment were successfully treated with the second PRM. There was no statistical difference between the second PRMs of the modified Semont maneuver and barbecue rotation (p=1.000). CONCLUSION: The combination of PRMs including barbecue rotation and the modified Semont maneuver in a single treatment session showed a comparable success rate as the previously reported studies.

Three Cases of Surgical Excision with Radiation Therapy in Auricular Keloids / 대한이비인후과학회지

Keloids are abnormal wound reactions, which develop from connective tissue as a result of skin trauma such as inflammation, burns, piercing or surgery in predisposed individuals. This fibrous growth extends beyond the boundaries of the original wound and rarely regresses. Keloids have a thick and glassy appearance. These characteristics distinguish keloids from hypertrophic scars, which are confined to the original wound and show spontaneous regression. Despite of various treatment options, there is no consensus on the best way to treat keloids. Surgical excision followed by radiation therapy is considered to be the most effective treatment available for severe recurrent keloids. We present three cases of patients with recurred keloids in the auricle, which were treated with surgical excision and adjuvant radiation therapy.

First Branchial Cleft Anomaly Presenting External Auditory Canal Atresia and Duplication Anomaly / 대한이비인후과학회지

Maldevelopment of the first branchial cleft can produce a broad spectrum of anomalies in its derivative structure, the external auditory canal (EAC). Failure of the cleft to develop normally can result in either the absence of a normally patent EAC (atresia or stenosis) or a duplication anomaly (cyst, sinus, or fistula). Despite their common origins, the coexistence of these anatomical abnormalities is quite unusual. We present a 6-year-old girl with congenital EAC atresia and duplication anomaly of the EAC in addition to the cholesteatoma of EAC.

Autoimmune Sensorineural Hearing Loss: Immunological Review / 대한이비인후과학회지

No abstract available.

A Case of Bilateral Sudden Hearing Loss Caused by Right Anterior Inferior Cerebellar Artery Plus Syndrome and Left Anterior Inferior Cerebellar Artery Infarction / 대한이비인후과학회지

Acute ischemic stroke in the distribution of anterior inferior cerebellar artery (AICA) is known to be associated with vertigo, nystagmus, facial weakness and gait ataxia. A few reports have carefully examined the deafness associated with the AICA infarction. A 55 year old man was presented with right sudden hearing loss, tinnitus and vertigo. The magnetic resonance image of the brain with 4-vessel angiogram showed stenosis in the lower third of the basilar artery due to partial thrombosis and no remarkable lesion in AICA. Although heparin treatment was done, the patient's hearing was not improved. After 3 months of heparin treatment, the patient was presented again with left sudden hearing loss, tinnitus and facial palsy. The magnetic resonance image and angiogram showed increased size of thrombosis and non-visualization of left vertebral artery and basilar artery. Diffusion scan showed focal infarction involving the left AICA territory. Recently, we experienced a case of bilateral sudden hearing loss caused by the right AICA plus syndrome and the left AICA infarction. So authors report this case with a review of literature.

Expression of Angiogenic Growth Factor in Middle Ear Cholesteatoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Angiogenesis is important both in normal and pathologic processes, including wound healing and inflammation. Because proliferating tissues require an enhanced blood supply, angiogenesis appears to be a prerequisite for expansion of cholesteatoma. This study was aimed to investigate mRNA and protein expression of angiogenic growth factors such as vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), transforming growth factor-alpha (TGF-alpha) and platelet derived-endothelial cell growth factor (PD-ECGF) in middle ear cholesteatoma. SUBJECTS AND METHOD: Cholesteatoma tissues and retroauricular skins were obtained from 12 patients during operation. The mRNA expression was detected by semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR), and the degree of expression was measured by comparing density ratio of beta-actin by NIH imaging analysis system. The protein expression was evaluated by immunohistochemistry, and the degrees of expression in epithelial, endothelial, inflammatory cells of cholesteatoma and retroauricular skin were judged by two pathologists and then converted on a 5-grade rating scale according to intensity of expression. RESULTS: The expression rate of mRNA in cholesteatoma and retroauricular skin was 67.7 and 33.3% in VEGF, 75.0 and 50.0% in bFGF, 53.8 and 8.3% in TGF-alpha, 67.7 and 75% in PD-ECGF. There was statistically significant difference only in TGF-alpha (p0.05). The degrees of VEGF, bFGF and PD-ECGF protein expression in cholesteatoma tissue were more intense at the inflammatory (p0.05) than in retroauricular skin. And the degree of TGF-alpha protein expression in cholesteatoma tissue was more intense at all three cells (p<0.05) than in the retroauricular skin. CONCLUSION: These results suggest that angiogenesis processes in cholesteatoma perimatrix and the expression of angiogenic growth factors are upregulated by mRNA. Further studies for evaluating the factors that can affect the expression of mRNA and also for disclosing the roles and control mechanisms of these factors in cholesteatoma angiogenesis must be followed.

A Case of Cerebellopontine Angle Lipoma Presented as Sudden Hearing Loss / 대한이비인후과학회지

Intracranial lipomas are uncommon and rarely symptomatic benign tumors comprising 0.1% of intracranial tumors. Although they can be found in other sites of the brain, the corpus callosum is generally believed to be the most common location of these tumors. And lipomas within the cerebellopontine (C-P) angle and internal auditory canal are extremely rare. In the C-P angle region, lipomas are the most symptomatic compared in other intracranial regions, although symptoms depend on the origin site and involve neural and vascular tissues adjacent to lipomas. And hearing loss, dizziness and tinnitus are the commonly presenting symptoms. Among these symptoms, hearing loss is the most common, but sudden hearing loss, as in this case, has not been reported. Because of the potential for significant morbidity with surgical resection of these lesions, conservative follow-up is the best treatment option for patients with these rare lesion. But surgery is indicated only when significant progressive or disabling symptoms are present. We experienced a case of right side C-P angle lipoma with sudden hearing loss in a 49-year old female who showed complete recovery of hearing by conservative therapy. With a review of literature, authors report a case of right C-P angle lipoma presented as sudden hearing loss.

Prediction of Postoperative Voice by Speech Synthesis in Benign Laryngeal Diseases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Though patients who have undergone surgery due to pathologic voice with benign laryngeal diseases are concerned about postoperative voice quality, there was no way to propose postoperative voice objectively. For this reason, the authors studied to synthesize predictive postoperative voice based on preoperative voice. MATERIALS AND METHOD: The authors evaluated 47 patients who experienced laryngeal microsurgery due to pathologic voice with benign laryngeal diseases. The voice was analysed by Computerized Speech Lab 4300B. Linear Prediction and Pitch Synchronous Overlap and Add methods were used to synthesize the predictive voice. Assessments for the synthetic voice were sound waves, spectrographic patterns with preoperative voice, and an acoustic evaluation of the postoperative voice. RESULTS: Synthetic voice showed improvement of noise component in a high frequency range that was seen in preoperative voice on spectrographic analysis. In the perceptual test, the degree of similarity in both postoperative and synthetic voice was similar and almost the same in 75% of test voice. CONCLUSION: The synthesized voice from this program was not completely identical to the real postoperative voice, but most of the tested synthetic voice was satisfactory in the perceptual test. So we conclude that this study is meaningful as a first trial that showed the possibility of synthesizing a postoperative voices by using its preoperative voice.

Influence of middle ear conditions on measurement of evoked otoacoustic emissions / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Otoacoustic emissions (OAEs) are low level acoustic sounds of cochlear origin. They have several advantages over other methods in auditory testing, particularly in children. However, because of the crucial dependence of emission levels on the healthiness of the middle ear conduction system, some middle ear problems confound the interpretation of evoked OAEs (EOAEs). The purpose of this study is to evaluate the effects of middle ear condition (tympanometry) on DPOAEs and TEOAEs in normal hearers. Materials and Method : Tympanometry, TEOAEs and DPOAEs were measured in 42 subjects (68 ears) who were under 12 years old and have pure tone thresholds within 25 dB HL RESULTS: The OAEs pass rates for the three groups were as follows: 95 % for TEOAEs and 90 % for DPOAEs in the tympanogram type A group; 12 % for TEOAEs and 12 % for DPOAEs in the tympanogram type B group; 27.3 % for TEOAEs and 13.6 % for DPOAEs in the tympanogram type C group. The pass rate and sensitivity of EOAEs were much higher in the type A group than in the type B and C groups. CONCLUSION: OAEs are useful for screening the integrity of outer hair cells in the tympanogram type A group but not in the type B and C groups. Therefore, tympanometry that represents middle ear condition is recommended before the OAE test. In addition, if TEOAEs and DPOAEs are simultaneously performed, sensitivity will be increased.

A Comparative Acoustic Study of Voice Rehabilitation After Total Laryngectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Acoustic parameters of maximal phonation time, sound intensity, fundamental frequency, voice range, jitter and shimmer were analyzed in order to evaluate voice quality and differences among esophageal speech (ES), tracheoesophageal shunt speech (TES), pneumatic aid speech (PA), electrolaryngeal speech (EL) according to phonetic rehabilitation methods in 16 cases of laryngectomees. MATERIALS AND METHODS: We acquired acoustic data on alaryngeal voice by different methods, and analysed each of those using specially designed programs (Laryngeal analyser V1.0 base on Matlab V5.0). RESULTS: Maximal phonation time was significantly longer in TES voice and PA speech than in ES voice (p<0.05). Jitter and shimmer were significantly regular and stable in the EL and PA speech than in the ES and TES voice (p<0.05). Voice range was significantly wider in TES voice and PA speech than in EL and ES voice (p<0.05). In two cases capable of bi-modal speech of ES and TES voice, maximal phonation time was longer with wider voice range in TES voice than in ES voice. Jitter and shimmer were regular and stable in ES voice than in TES voice. CONCLUSION: PA speech displays phonetically more natural laryngeal speech than other rehabilitation methods. But this methods is inconvenient and cosmetically unacceptable, because patients have to bite intraoral vibrator in the patient's mouth. So, we recommend TES voice rather than ES voice, without the use of speech-making device such as EL and PA speech.

The Vocal Tract and Speech Intelligibility of Tracheoesophageal Shunt Patients after Total Laryngectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In this paper, rehabilitation of voice after total laryngectomy has been suggested through the correct estimation and simulation of patients' vocal tract. Material and Methods: The author studied the shape of vocal tract during the phonation of five Korean vowels /u, o, a, e, i/ in tracheoesophageal shunt patients by magnetic resonance images (MRI). The same vocal tract was determined in each vowels from MRI. First, speech data produced by them were analyzed and also checked for speech intelligibility. Then the author tried to synthesize vowels from the vocal tract area of each vowels and from the expanded pharyngeal section of the vocal tract. RESULTS: The obtained results were as follows: 1) The sounds of /a/, /e/, /i/ were similar to natural sounds in actual patients' speech. The sound of /o/ was heard as /sigma/. The sound of /u/ was heard as strained /u/. 2) The synthesized vowels of /a/, /e/ from MRI were heard as natural sounds. The sounds of /u/, /o/, /i/ were heard as other sounds. 3) The synthesized vowel by the expanded pharyngeal section of 3 times in vowel /o/ was more naturally heard than that of 2 times. The synthesized vowel from Formfrek was more naturally heard than that from AreatoFormant. CONCLUSION: In conclusion, some of the synthesized sounds from MRI disagrees with the actual sounds produced by the subjects. This could be best identified by the synthesis from the area data. Future MRI studies should consider this problem for more accurate measurements. Also, pharyngeal areas with varied sizes should be experimented to secure better speech output because the correct shapes of vocal tract ensures correct vowel pronunciation.

Acoustic Parameters for the Early Detection and Differential Diagnosis of Pathologic Voice / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The survival rate of laryngeal cancer has improved in recent day. But in case of advanced cancer, radical destructive surgery is required for survival. So early detection of laryngeal cancer prevent from this disastrous condition. In this point of view, mass screening test for early detection of laryngeal cancer is necessary. Screening tests using voice has many advantages of being simple, non invasive, and requiring less space. In this system, the most important factor is the selection of acoustic parameters to be used in voice analysis. Thus authors studied the acoustic parameters that can differentiate normal, benign, malignant laryngeal diseases by an acoustic analyzing system and we also checked the availability of parameters. MATERIALS AND METHODS: We evaluated the voice analyzed data from 25 laryngeal malignancy patients, 33 benign laryngeal disease patients, 35 normal control who visited PNUH otolaryngology department from October 1996 to May 1998. A computerized speech lab. 4300B (CSL) was used to carry out the analysis of each voice sample and statistical analysis, ANOVA. Canonical analysis and cumulative frequency curve were used. RESULTS: The statistically significant parameters that can differentiate normal and malignant laryngeal disease groups were 15 parameters and can differentiate normal and benign laryngeal disease group were 9 parameters and that can differentiate benign and malignant laryngeal disease group were 7 parameters. CONCLUSION: We consider that these parameters and detection programs may be effective in development of a screening system using voice only. Developing diagnostic tools and programs would need further study of phonetics and voice engineering.