Validation of Korean-Language Version of Chronic Otitis Media Questionnaire-12 to Reflect the Disease Activity of Chronic Otitis Media / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#The Chronic Otitis Media Questionnaire-12 (COMQ-12) was developed in the United Kingdom to assess disease specific Health-Related Quality of Life (HRQoL) of chronic otitis media (COM) patients. We assessed the validity of Korean version of COMQ-12 (K-COMQ-12) and its correlation with the disease activity of COM classified according to the type of surgery.MATERIALS AND METHOD: We translated the original COMQ-12 into Korean and also performed a back-translation of the translated text into English. Enrolled were 106 COM patients and 106 healthy subjects. Cronbach alpha was used to evaluate internal consistency, and factor analysis was performed to prove reliability. We compared K-COMQ-12 scores between normal subjects and COM patients to assess validity. The scores were also compared by dividing groups according to disease activity of COM.@*RESULTS@#Cronbach's alpha showed good internal consistency (0.939). There was a significant difference in K-COMQ-12 scores between healthy subjects (1.99±4.34) and COM patients (22.69±12.41). Also, scores go higher as the disease activity of COM increased. A cut-off score of 6 of K-COMQ-12 sets 0.915 of sensitivity and 0.934 of specificity.@*CONCLUSION@#The K-COMQ-12 is a reliable and valid tool to assess HRQoL in patients with COM. The K-COMQ-12 could be also used as an objective tool that reflects the disease activity of COM.

Validation of Korean-Language Version of Chronic Otitis Media Questionnaire-12 to Reflect the Disease Activity of Chronic Otitis Media / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The Chronic Otitis Media Questionnaire-12 (COMQ-12) was developed in the United Kingdom to assess disease specific Health-Related Quality of Life (HRQoL) of chronic otitis media (COM) patients. We assessed the validity of Korean version of COMQ-12 (K-COMQ-12) and its correlation with the disease activity of COM classified according to the type of surgery. MATERIALS AND METHOD: We translated the original COMQ-12 into Korean and also performed a back-translation of the translated text into English. Enrolled were 106 COM patients and 106 healthy subjects. Cronbach alpha was used to evaluate internal consistency, and factor analysis was performed to prove reliability. We compared K-COMQ-12 scores between normal subjects and COM patients to assess validity. The scores were also compared by dividing groups according to disease activity of COM. RESULTS: Cronbach's alpha showed good internal consistency (0.939). There was a significant difference in K-COMQ-12 scores between healthy subjects (1.99±4.34) and COM patients (22.69±12.41). Also, scores go higher as the disease activity of COM increased. A cut-off score of 6 of K-COMQ-12 sets 0.915 of sensitivity and 0.934 of specificity. CONCLUSION: The K-COMQ-12 is a reliable and valid tool to assess HRQoL in patients with COM. The K-COMQ-12 could be also used as an objective tool that reflects the disease activity of COM.

Pesticide metabolite and oxidative stress in male farmers exposed to pesticide

BACKGROUND: The objective of this study was to measure malondialdehyde (MDA) and isoprostane which has been used as an index of lipid injury, 8-hydroxy-2′-deoxyguanosine (8-OHdG), which has been used as an index of DNA damage, and dialkyl-phosphate (DAP), which has been used to quantify pesticide exposure, and to investigate the relationship between pesticide exposure and oxidative stress. METHODS: This study was a cross-sectional study that evaluated 84 male farmers exposure to pesticide. In this study, 8-OHdG, isoprostane, and MDA were measured as oxidative stress indices, and dialkyl-phosphate (dimethylphosphate(DMP), diethylphosphate(DEP), dimethylthiophosphate(DMTP), and diethylthiophosphate (DETP)) excreted in the urine was also measured to evaluate pesticide exposure. A linear regression analysis was performed to investigate the relationship between pesticide metabolites, and oxidative stress biomarkers. RESULTS: A Correlation analysis was performed for pesticide exposure month (PEI), cumulative exposure index (CEI), and DAP as well as the concentration of the oxidative stress biomarkers. The PEM significantly and positively correlated to the levels of 8-OHdG, isoprostane, CEI, and DMP. CEI showed a correlation to 8-OHdG and PEM. DMP, DEP, and DETP showed a positive correlation to 8-OHdG, isoprostane, and MDA. A correlation analysis was adjusted some demographic characteristics, such as age, smoking, drinking, and exercise to determine the relationship between pesticide exposure and oxidative stress. The 8-OHdG, isoprostane, and MDA levels were significantly related to the DMP (ß = 0.320), DEP (ß = 0.390), and DETP (ß = 0.082); DMP (ß = 0.396), DEP (ß = 0.508), and DETP (ß = 0.504); and DMP (ß = 0.432), DEP (ß = 0.508), and DETP (ß = 0.329) levels, respectively. CONCLUSIONS: The concentration between oxidative stress biomarkers and the pesticide metabolite were a positive correlation. Indicators of oxidative stress was associated with a pesticide metabolite DMP, DEP, and DETP. Therefore, Pesticide exposure and oxidative stress were relevant.

Validation of the Korean Version of the Spatial Hearing Questionnaire for Assessing the Severity and Symmetry of Hearing Impairment

PURPOSE: Spatial hearing refers to the ability to understand speech and identify sounds in various environments. We assessed the validity of the Korean version of the Spatial Hearing Questionnaire (K-SHQ). MATERIALS AND METHODS: We performed forward translation of the original English SHQ to Korean and backward translation from the Korean to English. Forty-eight patients who were able to read and understand Korean and received a score of 24 or higher on the Mini-Mental Status Examination were included in the study. Patients underwent pure tone audiometry (PTA) using a standard protocol and completed the K-SHQ. Internal consistency was evaluated using Cronbach's alpha, and factor analysis was performed to prove reliability. Construct validity was tested by comparing K-SHQ scores from patients with normal hearing to those with hearing impairment. Scores were compared between subjects with unilateral or bilateral hearing loss and between symmetrical and asymmetrical hearing impairment. RESULTS: Cronbach's alpha showed good internal consistency (0.982). Two factors were identified by factor analysis: There was a significant difference in K-SHQ scores for patients with normal hearing compared to those with hearing impairment. Patients with asymmetric hearing impairment had higher K-SHQ scores than those with symmetric hearing impairment. This is related to a lower threshold of PTA in the better ear of subjects. The hearing ability of the better ear is correlated with K-SHQ score. CONCLUSION: The K-SHQ is a reliable and valid tool with which to assess spatial hearing in patients who speak and read Korean. K-SHQ score reflects the severity and symmetry of hearing impairment.

Clinical Features and Prognosis of Sudden Sensorineural Hearing Loss Secondary to Intralabyrinthine Hemorrhage

BACKGROUND AND OBJECTIVES: A number of etiologies of idiopathic sudden sensorineural hearing loss (ISSNHL) have been proposed, including viral infection, vascular disturbance, and immune-mediated mechanisms. Intralabyrinthine hemorrhage (ILH) as a cause of SSNHL is extremely rare, and there have been no studies defining the characteristics of hearing impairment and prognosis in patients with ISSNHL due to ILH. This study aimed to investigate the difference in impaired hearing patterns and prognosis for hearing recovery between patients with ISSNHL due to ILH confirmed by magnetic resonance imaging (MRI) and sex- and age-matched patients with ISSNHL due to causes other than ILH. SUBJECTS AND METHODS: We compared the results of audiometry and MRI in 12 patients who had ILH on MRI (hemorrhage group) and in 23 sex- and age-matched controls without abnormal findings related to their hearing loss on MRI (non-hemorrhage group). Initial hearing impairment, progression, and recovery of hearing loss were compared between the two groups. RESULTS: A majority of patients (92%) in the hemorrhage group complained of dizziness. Initial hearing impairment was more frequent in the hemorrhage group than in the non-hemorrhage group (94.09±35.9 vs. 66.66±30.1, p-value=0.036). The final recovery threshold in the hemorrhage group was worse (78.19±46.26 vs. 37.17±31.96, p-value=0.014) than that in the non-hemorrhage group. In the hemorrhage group, hearing recovery seemed to occur less often at high frequencies (2,000, 4,000, and 8,000 Hz) than at low frequencies (250, 500, and 1,000 Hz). CONCLUSIONS: The presence of ILH was associated with poor hearing prognosis and the occurrence of vertigo. The abrupt onset of hearing loss associated with vertigo and the presence of hyperresonance on fat-suppressed T1-weighted MRI images of labyrinthic fluid strongly suggests acute intralabyrinthine hemorrhage, and is predictive of considerable hearing impairment and poor prognosis.

Obesity as a Risk Factor for Prostatic Enlargement: A Retrospective Cohort Study in Korea / 대한배뇨장애요실금학회지

PURPOSE: We aimed to evaluate obesity, a risk factor of metabolic syndrome, and its association with prostatic enlargement in a retrospective cohort in Korea. METHODS: Baseline data were obtained from the Korean Genome and Epidemiology Study on Atherosclerosis Risk of Rural Areas in the Korean General Population (KoGES-ARIRANG). Between March 2015 and November 2015, 2,127 male participants of KoGES-ARIRANG were invited to the Korean Prostate Health Council Screening Program, and 602 participants underwent urological examination, including serum prostate specific antigen measurement and transrectal ultrasonography, and completed the International Prostate Symptom Score questionnaire. The data for 571 participants were analyzed, after excluding 31 men who had a history of prostatic disease or testosterone replacement, or had undergone a prior prostatic surgery or procedure. RESULTS: Among components of metabolic syndrome, waist circumference had a statistically significant linear correlation with incremental increases in prostate volume (B=0.181, P=0.004). Abdominal obesity as determined by anthropometric measures including body mass index (odds ratio [OR], 1.205; 95% confidence interval [CI], 1.088–1.336), waist circumference (OR, 1.073; 95% CI, 1.032–1.115), body fat (OR, 1.126; 95% CI, 1.056–1.202), and visceral fat composition (OR, 1.667; 95% CI, 1.246–2.232) was significantly associated with the presence of high-volume benign prostatic hyperplasia (BPH) (prostate volume≥ 40 mL). Furthermore, the highest quartile of serum leptin (OR, 3.541; 95% CI, 1.103–11.365) and adiponectin levels (OR, 0.315; 95% CI, 0.102–0.971) were significantly correlated with high-volume BPH compared to the lowest quartile of levels. CONCLUSIONS: Abdominal obesity and serum leptin level are positively associated with prostate growth, whereas serum adiponectin level is inversely associated with the presence of prostatic enlargement.

A Case of Metastatic Renal Cell Carcinoma Invasion in External Auditory Canal / 대한이비인후과학회지

A renal cell carcinoma (RCC) is known for its high propensity for early metastasis. Among the metastatic cancers of the head and neck, RCC is the third most common disease after breast cancer and lung cancer. Head and neck metastasis of RCC occurs mainly in the thyroid gland (36.6%), nose and sinus (9.1%), and lesions in the ear canal and temporal bone are very rare. Although extremely rare, metastatic malignancy in the breast, lung, prostate, kidney to the external auditory canal have been reported in the literature. We report a case of metastatic RCC of the left external auditory canal in a 78-year-old male patient who had experienced multiple organ metastasis after nephrectomy due to renal cell carcinoma.

Herpes Zoster Oticus / 대한이비인후과학회지

Herpes zoster oticus, traditionally known as Ramsay Hunt syndrome, is nowadays described also as acute peripheral facial neuropathy by varicella zoster virus infection. Besides facial palsy, auricular vesicular eruptions accompanied by neuralgic pain, adjacent cranial nerve structures are involved and various audiovestibular symptoms are frequently combined. Early proper treatment strategies are required to get the favorable outcome and reduce the morbidity of neurocranial deficits of this syndrome.

Difference of Diagnostic Rates and Analytical Methods in the Test Positions of Vestibular Evoked Myogenic Potentials

OBJECTIVE: To compare the differences of diagnostic rates, of the two widely used test positions, in measuring vestibular evoked myogenic potentials (VEMP) and selecting the most appropriate analytical method for diagnostic criteria for the patients with vertigo. METHODS: Thirty-two patients with vertigo were tested in two comparative testing positions: turning the head to the opposite side of the evaluating side and bowing while in seated position, and bowing while in supine positions. Abnormalities were determined by prolonged latency of p13 or n23, shortening of the interpeak latency, and absence of VEMP formation. RESULTS: Using the three criteria above for determining abnormalities, both the seated and supine positions showed no significant differences in diagnostic rates, however, the concordance correlation of the two positions was low. When using only the prolonged latency of p13 or n23 in the two positions, diagnostic rates were not significantly different and their concordance correlation was high. On the other hand, using only the shortened interpeak latency in both positions showed no significant difference of diagnostic rates, and the degree of agreement between two positions was low. CONCLUSION: Bowing while in seated position with the head turned in the opposite direction to the area being evaluated is found to be the best VEMP test position due to the consistent level of sternocleidomastoid muscle tension and the high level of compliance. Also, among other diagnostic analysis methods, using prolonged latency of p13 or n23 as the criterion is found to be the most appropriate method of analysis for the VEMP test.

Difference of Diagnostic Rates and Analytical Methods in the Test Positions of Vestibular Evoked Myogenic Potentials

OBJECTIVE: To compare the differences of diagnostic rates, of the two widely used test positions, in measuring vestibular evoked myogenic potentials (VEMP) and selecting the most appropriate analytical method for diagnostic criteria for the patients with vertigo. METHODS: Thirty-two patients with vertigo were tested in two comparative testing positions: turning the head to the opposite side of the evaluating side and bowing while in seated position, and bowing while in supine positions. Abnormalities were determined by prolonged latency of p13 or n23, shortening of the interpeak latency, and absence of VEMP formation. RESULTS: Using the three criteria above for determining abnormalities, both the seated and supine positions showed no significant differences in diagnostic rates, however, the concordance correlation of the two positions was low. When using only the prolonged latency of p13 or n23 in the two positions, diagnostic rates were not significantly different and their concordance correlation was high. On the other hand, using only the shortened interpeak latency in both positions showed no significant difference of diagnostic rates, and the degree of agreement between two positions was low. CONCLUSION: Bowing while in seated position with the head turned in the opposite direction to the area being evaluated is found to be the best VEMP test position due to the consistent level of sternocleidomastoid muscle tension and the high level of compliance. Also, among other diagnostic analysis methods, using prolonged latency of p13 or n23 as the criterion is found to be the most appropriate method of analysis for the VEMP test.

Eccrine Poroma of the Auricle: A Case Report

Eccrine poroma is described as a benign neoplasm originating from the intraepidermal eccrine duct of sweat glands. This tumor is known to arise in bare skin areas, but more rarely appeared in head and neck region. A 54-year-old female presented with a mass on the retroauricular aspect of the left auricle. There was a soft, protruding, and purple-colored, solitary mass of about 1.0x1.0 cm in size. After authors performed an excisional biopsy, eccrine poroma was confirmed histopathologically. Thus, we report a rare case of eccrine poroma of the ear with the review of literature.

Multicenter Study on the Clinician's Diagnostic and Therapeutic Approaches for Benign Paroxysmal Positional Vertigo in Korea / 대한평형의학회지

BACKGROUND AND OBJECTIVES: It is necessary to establish the most efficient diagnostic and therapeutic method for benign paroxysmal positional vertigo (BPPV), which is appropriate for Korean healthcare system. We aimed to evaluate current state of Korean clinician's diagnostic and therapeutic approaches for BPPV. MATERIALS AND METHODS: A 16-item survey was emailed to the members of dizziness department of Otology Research Interest Group in the Korean Otologic Society (n=68). 43 were returned and analyzed. RESULTS: All respondents (100%) used Dix-Hallpike test as a diagnostic tool for vertical canal-BPPV. Supine roll test was used for diagnosing lateral canal BPPV in nearly all the respondents (97.7%). Epley maneuver was chosen as otolith repositioning maneuver (ORM) for posterior canal BPPV in all respondents and barbecue rotation (BBQ) was used for treating lateral canal BPPV with geotropic nystagmus in 95.3% of respondents. Extreme variation was noted for therapeutic approach of lateral canal BPPV with ageotropic nystagmus BBQ, with 4 kinds of ORM and adjunctive measures to liberate otolith from cupula, while BBQ was again the most commonly used ORM (76.7%). CONCLUSION: The development of practical and efficient ORM for lateral canal BPPV with ageotropic nystagmus is necessary.

Tubular Apocrine Adenoma with Syringocystadenoma Papilliferum of the External Auditory Canal / 대한이비인후과학회지

Tumors that develop from external auditory canal (EAC) are very rare. Adenoma that originates from apocrine is also a rare entity found in the EAC. Nevus sebaceous, syringocystadenoma papilliferum (SCAP), tubular apocrine adenoma (TAA), and fibroadenoma are known to originate from apocrine. Among them, SCAP is believed to be a benign tumor that is manifested as papule and plague on the scalp and the face. However, TAA is a rare intradermal eccrine tumor and it mostly manifests as an isolated single nodule within the scalp area. Generally, these tumors are considered as two separate entities. Many articles have reported on the prevalence of TAA or SCAP with nevus sebaceous on the body, extremities, and scalp; but only 2 articles were reported on tumors that developed from EAC. In this article, we report on a patient who presented a mass in EAC, with both SCAP and TAA pathohistologic finding without nevus sebaceous.

A Case of Multiple Osteomas in the External Auditory Canal / 대한이비인후과학회지

Osteoma is a benign neoplasm that can occur and extend beyond the nearest region in the external auditory canal (EAC); however, a multiple growth of the tumor in the ipsilateral ear has never been reported. A 41-year-old male patient having a past history of uncertain chronic otitis media complained of recent otalgia and progressive hearing loss in the same ear. Physical examination showed that two hard masses arising from both anterior and posterior aspect of the right EAC were contacting each other and obstructing most of the lumen. High resolution computed tomography scan revealed not only two growing exophytic bone lesions causing EAC stenosis but also inflammation of the middle ear and sclerotic mastoid cavity. We performed excision and middle ear surgery at the same time. Both specimens were pathologically confirmed as osteomas, so we report this unusual case with a review of literature.

Correlation between VEMP (Vestibular Evoked Myogenic Potentials) and Vestibular Ratio of Posturography in Patients with Vertigo

OBJECTIVE: To find out whether there is correlation between result of VEMP and vestibular ratio of posturography, and also to investigate if VEMP can show diagnostic efficiency in patients with vertigo. METHOD: Thirty-two patients whose BAEP test showed normal latency were included after patients whose somatosensory ratio and visual ratio from posturography showed abnormality were excluded. Ten healthy participants were set up as control group. We made comparison between P13 latency in VEMP and vestibular ratio posturography among these participants. RESULTS: Among the participants 47% showed normal P13 latency, and 53% showed abnormal P13 latency. In normal P13 latency group, 86.7% of patients showed normal vestibular ratio, and in abnormal P13 latency group, 70.6% of patients showed abnormal vestibular ratio. CONCLUSION: VEMP showed high correlation between vestibular ratio of posturography. VEMP can be used in screening test and clinically complementary diagnostic method of vestibular function test for patients with vertigo.

The Role of Inflammatory Mediators in the Pathogenesis of Otitis Media and Sequelae

This review deals with the characteristics of various inflammatory mediators identified in the middle ear during otitis media and in cholesteatoma. The role of each inflammatory mediator in the pathogenesis of otitis media and cholesteatoma has been discussed. Further, the relation of each inflammatory mediator to the pathophysiology of the middle and inner ear along with its mechanisms of pathological change has been described. The mechanisms of hearing loss including sensorineural hearing loss (SNHL) as a sequela of otitis media are also discussed. The passage of inflammatory mediators through the round window membrane into the scala tympani is indicated. In an experimental animal model, an application of cytokines and lipopolysaccharide (LPS), a bacterial toxin, on the round window membrane induced sensorineural hearing loss as identified through auditory brainstem response threshold shifts. An increase in permeability of the blood-labyrinth barrier (BLB) was observed following application of these inflammatory mediators and LPS. The leakage of the blood components into the lateral wall of the cochlea through an increase in BLB permeability appears to be related to the sensorineural hearing loss by hindering K+ recycling through the lateral wall disrupting the ion homeostasis of the endolymph. Further studies on the roles of various inflammatory mediators and bacterial toxins in inducing the sensorineumral hearing loss in otitis media should be pursued.

A Case of Solitary Fibrofolliculoma of the Auricle / 대한이비인후과학회지

Fibrofolliculoma is a relatively uncommon benign neoplasm that develops on the head and neck, upper trunk and arm. Typically, it presents as a multiple lesion, and each has a characteristic histopathologic pattern of centrally dilated follicular infundibulum surrounded by well-circumscribed, thick mantle of fibrotic tissue and numerous thin anastomosing strands of follicular epithelium extending into stroma. We recently confirmed a unique case of solitary nodular form of fibrofolliculoma occurred on the cavum concha of 56-year-old male patient. We report this interesting case with a review of literature.

Clinical Study on the Reliable Temporal Bone Fracture Classification Scheme / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Until now, the temporal bone fracture patient has been classified mostly according to the classic definition of transverse or longitudinal one, but it is often obscure and has problems of discrepancy in correlation with otologic symptoms. So we investigated the practicality of other noticeable reporting schemes for reasonable adoption. SUBJECTS AND METHOD: We thoroughly reviewed the medical records of the temporal bone fracture patients in past two years. And high resolution CT images were also re-evaluated by the senior radiologist using traditional and newer (otic capsule sparing vs. otic capsule violating, petrous vs. nonpetrous) classification schemes. RESULTS: A total of 61 cases were identified as temporal bone fracture. Among various symptoms, only sensorineural hearing loss was significantly higher in the transverse type of traditional scheme and in otic capsule violating fracture. Symptoms such as subjective and verified hearing loss including conductive hearing loss and ear fullness were higher in nonpetrous fracture (p<0.05). CONCLUSION: Traditional and otic capsule scheme correlated poorly with clinical presentation, whereas the petrous classification was better matched with main symptoms. Therefore, the petrous scheme was suggested as the more discriminative classification plan of temporal bone fracture to predict its sequela.

The Significance of a Hypoplastic Bony Canal for the Cochlear Nerve in Patients with Sensorineural Hearing Loss: CT and MRI Findings

PURPOSE: The purpose of this study is to evaluate the significance of the hypoplastic canal for the cochlear nerve in patients with sensorineural hearing loss (SNHL) and the relationship between the hypoplastic bony canal and aplasia or hypoplasia of the cochlear nerve. MATERIALS AND METHODS: A retrospective review of high resolution temporal CT(HRCT) and MRI findings was conducted. The narrow bony canal of the cochlear nerve and the relative size of the internal auditory canal were correlated with the cochlear nerve deficiency on MRI. The comparative size of the component nerves (facial, cochlear, superior vestibular, inferior vestibular nerve), and the relative size of the internal auditory canal and the bony canal of the cochlear nerve were measured. The clinical history and the results of the clinical examination were reviewed for each patient. RESULTS: High resolution MRI showed aplasia of the common vestibulocochlear nerve in one patient and a deficiency of the cochlear nerve in 9 patients. These abnormalities occurred in association with a prominent narrowing of the canal for the cochlear nerve and a stenosis of the internal auditory canal, which was observed on temporal bone CT in 9 patients with congenital SNHL. Three patients had normal IAC, despite the presence of a hypoplastic cochlear nerve on the side on which they had SNHL. In one patient, the narrowing of the canal for the cochlear nerve and internal auditory canal were not found to be associated with acquired SNHL. CONCLUSION: The hypoplastic bony canal for the cochlear nerve might be more highly indicative of congenital cochlear nerve deficiency than that of the narrow internal auditory canal, and the position of the crista falciformis should also be carefully.

A Case of Medullomyoblastoma of Cerebellopontine Angle Mimicking Acoustic Neuroma

Medulloblastoma is a common malignant central nervous system neoplasm found mainly in children. One the contrary, medulloblastoma of the cerebellopontine angle, the location of the tumor is very unusual. This is the the first case of the medullomyoblastoma, a rare form of medulloblastoma, occurring in the cerebellopontine angle. A 15-year-old boy experienced a sudden hearing loss in the left ear. Conservative medical treatment failed, and temporal MR imaging revealed a heterogeneously enhancing mass at the left cerebellopontine angle cistern and in the internal auditory canal; therefore, the lesion was regarded as a typical acoustic neuroma. Few days before surgery, an ipsilateral facial palsy developed, and a follow-up MR imaging showed a rapid growth of the previous lesion. The extended translabyrinthine approach permitted surgical removal. And under pathological diagnosis of malignancy, radiation therapy and series of chemotherapy was performed.