President's address: Research and development on computer-based testing and extension of clinical skill examination to a variety of fields / 보건의료교육평가

No abstract available.

Can a medical regulatory system be implemented in Korea?

The International Association of Medical Regulatory Authorities has suggested three roles for a country's medical regulatory authority: first, it should provide the graduates of medical schools and immigrant physicians licenses to practice in the country; second, it should provide high-quality educational and training programs to promote and maintain the health and safety of the public and ensure professionalism; third, it should resolve public complaints regarding medical practice so as to increase rapport between professionals and the public. In Korea, the first function has been performed by the National Health Personnel Licensing Examination Board. The second function has been executed by the Korean Medical Association as required by medical law since 2012. No authority has been designated to deal with the third function, so this role has been ceded to the legal market. There are three major reasons that the time has come to establish medical regulatory authority in Korea. First, to assure a minimum quality of medical service, more vigorous continuing medical education must be required for licensure. Second, specific and comprehensive preparation should be made available for medical professionals who immigrate, including physicians from North Korea. Third, the establishment of a regulatory authority is the easiest and most reasonable way to establish and promote a level of professionalism that is respected by the public. To establish a medical regulatory authority in Korea, not only physicians but also the government and the public should participate in discussions of this topic. The medical societies should lead the process of discussion, and the societies' agreement with any regulatory outcomes should be obtained.

Retraction: Mechanism of Apoptotic Cell Death in Cholesteatoma Epithelium / 대한이비인후과학회지

No abstract available.

Retraction: Development of the Mucociliary System in the Murine Eustachian Tube and Middle Ears / 대한이비인후과학회지

No abstract available.

Retraction: Development of the Secretory Elements in the Murine Middle Ear and Eustachian Tube / 대한이비인후과학회지

No abstract available.

Retraction: Development of the Murine Tubotympanal Cavity / 대한이비인후과학회지

No abstract available.

The Effect of Early Canalith Repositioning on Benign Paroxysmal Positional Vertigo on Recurrence

OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) can be treated using a simple repositioning maneuver. This study demonstrates the effects of early repositioning therapy in patients with BPPV, especially with regard to recurrence. METHODS: We enrolled 138 consecutive patients who had been diagnosed with BPPV in the emergency rooms and ENT out-patient clinics of Chung-Ang University Hospital and Samyook Medical Center from January to June 2009. All patients immediately underwent appropriate canalith repositioning procedures (CRPs) depending on canalith type and location. The CRPs were performed daily until the patient's symptoms were resolved. The patients were classified into two groups according to the duration between symptom onset and initial treatment: less than 24 hours (early repositioning group, n=66) and greater 24 hours (delayed repositioning group, n=72). We prospectively compared the numbers of treatments received and the recurrence rates between the two groups. RESULTS: Follow-up periods ranged from 8 to 14 months, 77 cases involved posterior canal BPPV, 48 cases were lateral canal BPPV (of which 20 cases were cupulolithiasis), and 13 cases were multiple canal BPPV. BPPV recurrence was found in a total of 46 patients (33.3%). The necessary numbers of CRPs were 2.3 for the early repositioning group and 2.5 for the late repositioning group, a difference that was not statistically significant (P=0.582). The early repositioning group showed a recurrence rate of 19.7%, and the delayed repositioning group showed a recurrence rate of 45.8% (P=0.002). CONCLUSION: Performing repositioning treatments as soon as possible after symptom onset may be an important factor in the prevention of BPVV recurrence.

A Case of Inverted Papilloma Originating from the Middle Ear / 대한이비인후과학회지

Inverted papilloma (Schneiderian-type papilloma) involving the middle ear is extremely rare. Most of cases originate from the mucosa of the lateral nasal wall, extending into the paranasal sinuses and orbits. Inverted papilloma involving the middle ear has a high recurrence rate and a possibility of malignant change. We experienced a case of inverted papilloma of the middle ear secondary to congenital cholesteatoma surgery. A nine-year old male who was diagnosed with congenital cholesteatoma was treated with intact canal wall tympanomastoidectomy. Nine months later, he underwent a second look operation. In the second surgery, a 3 mm round pinkish mass which was located at the tympanic orifice of Eustachian tube was identified as inverted papilloma. There was no recurrence of cholesteatoma or inverted papilloma four months after the 2nd operation.

Surgical Management of Facial Paralysis Following Temporal Bone Fractures / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Controversy persists in regard to the management of traumatic facial paralysis. We reviewed the cases of decompression of traumatic facial nerve according to the type of fracture, injury site of nerve, injured state of nerve, surgical timing, surgical approach and opening of epineurium to determine good prognostic factors and propose in this article a rationale of management. SUBJECTS AND METHOD: The authors reviewed retrospectively 35 cases of the decompression of traumatic facial paralysis at the Department of Otorhinolaryngology, Yonsei University College of Medicine from January 1991 to December 2002. RESULTS: The most common site of the injury was perigeniculate area. The most common fracture type was longitudinal fracture. The results of immediate facial nerve decompression were excellent in functional recovery. The surgical findings of injured facial nerve were, in order, edematous swelling, bony impingement, fibrosis and partial transection, traumatic neuroma. Decompression with nerve sheath slitting appeared to provide better outcomes. The approach for decompression according to the injured sites was sufficiently adequate. CONCLUSION: According to our surgical experiences of traumatic facial paralysis, the important prognostic factors are timing of surgical intervention, injured state of the nerve and the slitting of the nerve sheath.

Early Detection of Childhood Hearing Impairment

Hearing loss in infants and children, despite its relatively high incidence and possible detrimental outcomes, is commonly overlooked. Currently, no program for newborn hearing screening has been established in Korea, although early detection and early intervention of hearing loss in infants will significantly influence the developmental course of speech and language skills. The Joint Committee on Infant Hearing recommends that all children should be screened for hearing impairment before age 3 months of age and medical or audiologic interventions be instituted before 6 months of age when indicated. Generally, a two-staged protocol employing automated auditory brainstem response(AABR) and otoacoustic emission(OAE) is recommended for newborn hearing screening, and its sensitivity reaches nearly 100%. Once hearing loss is diagnosed, further evaluation of the severity, nature, and the cause of hearing loss should follow, and interventions including amplification and rehabilitation should be started as soon as possible.

Auditory Functional MRI Findings in Patients with Unilateral Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Auditory pathway is a unique sensory system in that its ascending pathway has both contralateral and ipsilateral projection to auditory cortex. It has been known that monaural auditory stimulation with auditory functional MRI (fMRI) in normal hearing subject produces bilateral auditory cortical activation, slightly lateralized to opposite side. Our goal was to assess the pattern of auditory cortical activation in patients with unilateral sensory neural hearing loss. SUBJECTS AND METHOD: Auditory fMRI studies using a single-shot gradient-recalled echo-planar imaging (EPI) sequence were performed in eight normal volunteers, thirteen patients with unilateral hearing loss of acute onset (AO, 3 months). A box-car design of 1, 000-Hz sine tone stimuli was given to right or left ear of normal volunteer and to healthy ears of patients. The data were analyzed by BOLD Analysis package. The lateralization index (LI) between contralateral and ipsilateral hemispheric activation were obtained by calculating and comparing the number of activated pixels in each auditory hemisphere. RESULTS: In normal volunteers, the LI was 2.9-5.2 for monaural stimuli suggesting contralateralization of auditory cortex to monaural stimuli. The LI was increased for the AO (8.1-19.2) and decreased for the LD (0.8-1.2). CONCLUSION: The auditory cortical activation in patients with unilateral sensory neural hearing loss showed different pattern according to the duration of hearing loss. The present results might suggest the time course of neuronal plasticity of auditory cortex after deterioration of input function of auditory ascending pathway.

Hearing Results of Ossiculoplasty Using Polycel(R) Prosthesis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: During the last decade, the surgical use of alloplasts has become more and more widespread among otologists. In this study, we evaluated the hearing results of ossiculoplasty using Polycel(R) prosthesis. SUBJECTS AND METHOD: One hundred eighty eight cases who underwent ossicular chain reconstruction using Polycel(R) prosthesis and had been followed up postoperatively for more than 12 months at Severance Eye-ENT Hospital from 1998 to 2002 were reviewed retrospectively. Postoperative hearing results were assessed by measuring the postoperative air-bone gap (ABG) and closure in air-bone gap. Successful postoperative ABG criteria were defined as the following three groups ; ABG of < or =10 dB, ABG of < or =20 dB, and ABG of < or =30 dB. Several prognostic factors such as the condition of middle ear mucosa and ossicles, presence or absence of cholesteatoma, surgical method, staging and revision surgery were analyzed. RESULTS: Of the total of 188 cases, 22 cases (11.7%) were < or =10 dB ABG, 96 (51.1%) cases were < or =20 dB ABG, and 158 (84.0%) cases were < or =30 dB ABG. The hearing results were good for healthy middle ear mucosa and cases which contained stapes superstructure, the hearing results were Good. CONCLUSION: Polycel(R) is a good material to be used in ossiculoplasty as a hydroxyapatite and autologous bone. In ossiculoplasty, good prognostic factors of the middle ear condition were healthy middle ear mucosa and the presence of stapes superstructure.

The Effectiveness of the Directive Counseling in Tinnitus Retraining Therapy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tinnitus retraining therapy (TRT) was introduced as a new method for tinnitus management, and it is currently an efficacious therapy in use. In this article, we would like to show the effectiveness of directive counseling in TRT on tinnitus management. MATERIALS AND METHOD: A total of 1, 100 patients who visited tinnitus clinic at the Severance Hospital from 1999 to 2002 were included in this study. Their characteristics and negative associations of tinnitus were investigated. Forty-six patients who were managed with directive counseling were evaluated with questionnaires about the psychoacoustic characteristics of tinnitus and the subjective changes in tinnitus. RESULTS: Tinnitus was developed after stress (35.6%), fatigue (32.0%) and exposure to noise (21.4%), and it was negatively associated with hearing loss (51.8%), continuation of tinnitus (51.6%) and sleep disorder (17.5%). Factors such as awareness, loudness, annoyance, the effect on life tinnitus had were decreased after directive counseling. And the tinnitus handicap inventory (THI) score was also significantly decreased. CONCLUSION: Directive counseling in TRT which includes explanation of neurophysiology of tinnitus should be tried preferentially before habituation occurs.

A Study on Educational Accountability of Faculty in Medical Schools / 한국의학교육

PURPOSE: A college or university faculty can be regarded as an educator, researcher, and service provider. The purpose of this study is to evaluate the accountability of medical school professors focusing on the educational duties and to propose the solution and strategy for accountability evaluation of medical school faculty. METHODS: The study used questionnaires which was developed in five big categories asking basic information of the faculty, educational activities, subject of the accountability evaluation, and the primary disturbing factor in accomplishing the educational accountability. The questionnaires were asked to 61 faculty members in Yonsei University College of Medicine. RESULTS: The accountability importance of the medical school faculty was research(37.13%), teaching(31.80%), practice medicine(21.97%) and service(9.10%). Much weight was given for research(40.00%) and education(19.42%). The faculty concentrated mostly on delivering learning objectives as their educational activities. The biggest problem affecting the faculty from concentrating on educational accountability was the over workload. Insufficient incentives and lack of interest in education came next. The faculty also showed dissatisfaction with the obscurity of accountability assessment in operation, uniformity of the measurement and the absence of objective assessment standard. CONCLUSION: Medical schools need to create an environment in support of the faculty to focus on the educational activities. And when evaluating their accountability, the assessment standards need to be systematized and differentiated according to their specialities.

A Study on Evaluation of Clinical Clerkship / 한국의학교육

Since 1998, Yonsei University College of Medicine attempted a curriculum reform focusing on clinical clerkship. The reform concentrated on the next three categories; (1) minor clinical courses following major clinical courses, (2) selecting 9 minor clinical courses out of 18, (3) introducing 'Specialized Elective Course' at the first semester of fourth year of medical school. The opinions from students and teachers on such matter were taken into consideration. The study draws its conclusion as follows; first, 'Specialized Elective Course' satisfy students' learning disposition and give guidance in shaping one's career. Second, taking the major clinical course prior to minor clinical courses give students integrated clinical experience and closer connection among the subjects. Third, switching the minor course into elective course provide expanded choice of course selection and reinforce students' motivation to learn. In general, the last two years of the new clinical clerkship showed a satisfactory result. Nevertheless, successive effort of preparing alternative measures should be made regarding the negative opinions in part. In order to do this, a school wide support system must be carried out along with the continuing interest from the students and teachers. The new attempt and study of such curriculum will outgrow the uniform and rigid education, reflecting upon the differences among students and learning goals, which ultimately help medical education to be more successful.

Compositional difference of middle ear effusion according to viscosity of the effusion / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Serous otitis media (SOM) is usually responsive to medical treatment, whereas mucoid otitis media (MOM) is not. This study was undertaken to elucidate the compositional difference between serous and mucoid effusion, and to investigate whether MUC5AC acts as a major mucin in the middle ear mucosa with MOM. MATERIALS AND METHODS: Middle ear effusion (MEE) samples were collected from 29 patients with MOM and 20 patients with SOM. The level of mucin, lysozyme, secretory IgA and interleukin-8 were measured by dot blotting or enzyme-linked immunosorbent assay. Periodic acid-Schiff and immunohistochemical staining with monoclonal anti-MUC5AC antibody were performed on the serial sections of middle ear mucosa with MOM. RESULTS: Mucoid effusions contained higher levels of mucin, lysozyme, secretory IgA and interleukin-8 than serous effusion. Immunohistological study revealed that MUC5AC mucin was expressed in only a small portion of the goblet cells of middle ear mucosa with MOM. CONCLUSION: Our study suggests that both serous secretions and mucin might make the middle ear effusion more viscous, and that mucins other than MUC5AC might have a major role in the viscosity of MEE. Further study is necessary to identify the major mucins in the MEE of otitis media with effusion.

Secretory Differentiation of Serially Passaged Normal Human Middle Ear Epithelial(NHMEE) Cells / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study was to subculture normal human middle ear epithelial (NHMEE) cells, investigate whether the subcultured NHMEE cells could have ability to differentiate into secretory cells, and establish a method to get cultured NHMEE cells for further study of human middle ear epithelial differentiation and secretion. MATERIALS AND METHOD: Freshly isolated epithelial cells from healthy middle ear mucosa were subcultured repeatedly after enzymatic disaggregation in serum-free medium on plastic tissue culture dishes. The subcultured cells were counted after every passage and tested for secretory differentiation in air-liquid interface (ALI) cultures. The apical secretion of cultured NHMEE cells were characterized by immunoblotting and Western blotting. RESULTS: Attachment rate of subcultured NHMEE cells was over 70% through every passage. Cells proliferated by 22 fold from passage-1 to passage-2 (P-2), but passage-4 cells did not proliferate. P-2 NHMEE cells in ALI cultures was stained with mucin antibody (H6C5) but not b-tubulin antibody. Cultured NHMEE cells secreted mucin and lysozyme. CONCLUSION: P-2 NHMEE cell cultures retained many important features of normal epithelium and were suitable for conducting many studies of human middle ear epithelial cell biology including cell differentiation and secretion.

The Study on the Faculty Evaluation System of Teaching Ability in Korea / 한국의학교육

The purpose of this study is to discuss the evaluation system of teaching ability of medical college faculty members. Reviewing of books and journals ha s been carried out by the authors so that the problems and methods of faculty evaluation may be discussed. The practical Korean data on the faculty evaluation system were collected by the department of faculty affairs of each college in March 1998. Faculty evaluation can be divided into two dimensions-dynamic and static dimensions. The methods vary according to evaluators, such as self evaluation, student evaluation, peer evaluation and administrator evaluation. On the bases of the object or the time of evaluation, it can be divided into formative or summative evaluation. According to the methold of data collection, it also can be divided into literature evaluation, observation evaluation and site visiting evaluation as well. The authorities of medical colleges used to give much more weight on the research activities rather than on teaching abilities. This kind of idea has been pushed faculty members to stress on research activities not on teaching abilities. Some inportant problems detected in this study are the narrow evaluation scope of aculty teaching activities, the not well established rationale of the evaluation, the underdevelopment of evaluation items, and the rigidity of the related authority. The introduction of a faculty track system is recommended as a desirable arrangement to develop the evaluation system in Korea.

Mechanism of Apoptotic Cell Death in Cholesteatoma Epithelium / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Accumulation of keratin debris in the middle ear is one of the characteristics of the cholesteatoma. It is related to increased rate of cell death and differentiation of keratinocytes compare to normal skin. This kind of cell death is known as apoptosis. In this study, we plan to investigate the apoptotic cell death and expression of Fas in both normal and cholesteatoma epithelia. MATERIALS AND METHODS: Seven cholesteatomas and retroauricular skins were obtained from patients undergoing middle ear operations. Detection of the fragmented DNA in apoptosis was done by in situ TUNEL methods and agarose gel electrophoresis. For the morphologic confirmation of apoptosis, transmission electron microscopy (TEM) was done. Immunohistochemistry was also performed for detection of Fas expression on the tissue. RESULTS: In TUNEL staining, many positive staining nuclei were observed in upper layers of cholesteatoma epithelium whereas a few positive cells were found on the granular layer of retroauricular skin. Typical "ladder pattern" was seen on the gel electrophoresis of the genomic DNA of cholesteatoma. On TEM study, we observed condensation of chromatin in the keratinocytes of the cholesteatoma epithelium. Immunohistochemical studies revealed that Fas protein was expressed in all layers of cholesteatoma epithelium, while retroauricular skin showed weak reactions only in the granular layer. CONCLUSION: We confirmed that increased apoptosis and up-regulated expression of Fas in cholesteatoma epithelium. Since Fas is known as apoptosis triggering protein, the authors suggest that accumulation of keratin debris is due to increased apoptotic cell death and further investigation should be needed about the mechanism of cell death in cholesteatoma.

A Clinical Study of Tracheotomy in Pediatrics / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tracheotomy, although an inevitable procedure in some situations, is often avoided in pediatrics for its frequent and serious complications. So, authors studied clinical characteristics of tracheotomy as observed in pediatrics. MATERIALS AND METHODS: 138 children who underwent tracheotomy during the past twenty years since 1977 were investigated. We analyzed distribution of age and gender, annual frequency, causative disorders for tracheotomy and complications. RESULTS: 1) Number of tracheotomy performed tended to be decreased with time: 2) Tracheotomy was performed two times more frequently in males than in females, and most frequently below eight years old: 3) Most frequent causative disease was head injury (27.5%): 4) Most frequent indication of tracheotomy was ventilator support (49.3%): 5) The history of endotracheal intubation before tracheotomy was 86.2%: 6) The complications of the tracheotomy developed in 39.9%, with the most frequent complications being granulation formation (18.1%), followed by tracheal stenosis (17.4%). 7) Frequency of late complication was relatively lower in the shorter intubation period group (22.9%) than in the longer intubation period groups (51.5% and 33.3%): 8) Late complications were lower in the group who had not been supported by a ventilator: 9) Late comlications did not occurre in cases who were decannulated before 1 month. CONCLUSION: We found that factors associated with complications were duration of endotracheal intubation before tracheotomy, history of ventilator care and timing of decannulation.