Clinical Usefulness of Viral IgM Antibody Test in Sudden Sensorineural Hearing Loss Patient / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There are many possible causes of sudden deafness such as viral infection, vascular occlusion, immune-mediated mechanism and abnormal cellular stress response in the cochlea. Viral hypothesis is one of the potential mechanisms for explaining sudden deafness. The aims of this study were to investigate the usefulness of viral IgM antibodies to evaluate the clinical findings and prognosis in sudden sensorineural hearing loss and to identify the more useful viral IgM antibodies. SUBJECTS AND METHOD: A retrospective study was carried out for 283 patients with sudden deafness. The results of serologic tests performed for the following were studied: Ebstein barr virus (EBV), Measles, Mumps, Toxoplasma, Rubella, Cytomegalovirus, Varicella zoster virus, Herpes simplex virus, and human immunodeficiency virus. Results of blood tests and audiologic tests taken initially and 2 months after the onset of sudden deaf were studied as well. RESULTS: Positive ratio of Viral IgM antibodies was 4.9% (13/283). Clincial findings and prognosis of viral IgM positive patients were not different from other sudden deafness patients except for the age factor. EBV Viral capsid antigen, EBV Early antigen-diffuse and restrict complex were common positive viral markers in sudden hearing loss patients. One third of the patients (4/13) had viral markers for Measles, Mumps and Toxoplasma. CONCLUSION: In sudden deafness, the positive ratio of serologic tests for viral IgM antibodies was less than 5% and viral IgM positive patients had similar clinical findings and prognosis to viral IgM negative patients. However, viral origins of Measles, toxoplasam and Mumps as well as EBV should be considered in sudden deafness patients with the symptoms and signs of viral infection.

A Study for the Characteristic Frequency of Korean Disyllabic Word List / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Speech audiometry is a useful test for obtaining practical information which could not be gotten from the pure-tone audiometer test. Nowadays, Hahm's Korean disyllabic word lists are the most commonly used word lists for the speech reception threshold test in Korea. The disyllabic word lists should be composed of spondaic words (equally stressed words). The aim of this study is to evaluate the characteristic frequency of Hahm's disyllabic word lists. SUBJECTS AND METHOD: Two of the Hahm's disyllabic word lists were evaluated. The word lists were analyzed using an acoustic analysis program that has the MATLAB function. RESULTS: The percentage of disyllabic words in the Hahm's disyllabic word lists that had the spondaic words pattern were 33%. The characteristic frequencies of these words were equally stressed above 1,000 Hz. Other disyllabic words showed an unequally stressed pattern. The percentage of words that had the first syllable stressed pattern was 31% and the percentage of second syllable stressed pattern was 36%. CONCLUSION: Some words, which are commonly used in the Hahm's disyllabic words lists, had an unequally stressed pattern. A new Korean dissyllabic word list needs to use more balanced words that have the characteristic frequency of each word.

A Study for the Acoustic Characteristics of PB Word List according to Frequency / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The Korean phonetically balanced (PB) word list (Ham's Korean PB Word List) is currently the most commonly used word list for speech discrimination test. The aim of this study was to investigate the frequency characteristics of the Ham's Korean PB word list and to compare frequency characteristics of the Ham's Korean PB word list with that of the 21st Century Sejong words, which represent characteristics of the contemporary spoken Korean language. SUBJECTS AND METHOD: The 300 syllables most commonly used were collected from the words in 21st Century Sejong project. The 21st Century Sejong words were weighted according to the frequency of usage. The 21st Century Sejong words and words from the Ham's Korean PB word list were analyzed using an acoustic analysis program that has the MATLAB function. RESULTS: Syllables with frequencies above 2,000 Hz comprise 34% of the 21st Century Sejong words and 16% of the Ham's Korean PB word list. The Ham's Korean PB word list does not represent the high frequency characteristics of the contemporary spoken Korean language. The 21st Century Sejong words have more 'eu', 'i' and open syllables than the Ham's Korean PB word list. CONCLUSION: The Ham's Korean PB word list does not reflect the high frequency characteristics of the contemporary spoken Korean language included in the 21st Century Sejong words. Therefore, a new PB word list that incorporates a greater number of syllables with high frequency characteristics is required.

A Study for the Assessment of Disability and Compensation in Patients with Hearing Impairment / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Disability in hearing impairment represents not only an increase in hearing threshold level, but also unmeasurable subjective discomfort to patients. Until now, several guidelines for quantitative assessment of disability of hearing impairment have been offered. In Korea, laws for industrial accident compensation insurance (IACI) and disabled persons welfare (DPW), and guidelines proposed by American Medical Association (AMA) were frequently used to assess the degree of disability in hearing impaired patients, but there were some discrepancies in the methods and criterions of assessment among the different guidelines and laws. The purposes of this study were to compare these guidelines and look for the problems and to suggest a plan for the improvement in the objective assessment of disability in hearing impaired patients. MATERIALS AND METHOD: The grades of Korean laws for IACI and DPW were converted into the impairment percentage rates used in the AMA guideline. We compared inter-guideline and inter-grade differences in impairment percentage rates. RESULTS: We found several problematic areas in the grades of IACI and there were some differences in the understanding of the degree of disability in hearing impairment between guideline of the Korean laws and foreign guidelines. CONCLUSION: Some changes are needed to be made in the guidelines for disability assessment in the Korean laws for IACI and DPW. Modification of the current grading system into the percentage rating system that is suited to the Korean sociocultural situation would be beneficial in the objective and balanced assessment of the disability of hearing impaired patients.

Up-regulation of Surfactant Protein-A in Chronic Sialadenitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Surfactant protein-A (SP-A) is a member of the collectin family, and plays an important role in the first-line airway defense. The purpose of study was to examine the expression of SP-A mRNA and protein in human salivary glands, and to investigate its up-regulation during inflammatory conditions of salivary glands. MATERIALS AND METHOD: Reverse transcription-polymerase chain reaction was performed on salivary gland tissues from ten patients with chronic sialadenitis and ten samples of normal salivary gland tissue. The expression levels of SP-A to GAPDH (glyceraldehyde-3-phosphate dehydrogenase) transcripts were semi-quantified by densitometry. We also characterized the cellular localizations of SP-A protein immunohistochemically. RESULTS: SP-A mRNA and protein were detected in normal and chronic sialadenitis glands. The expression levels of SP-A mRNA in salivary glands with chronic sialadenitis was significantly increased as compared with normal salivary glands. Immunohistochemical staining revealed SP-A immunoreactivity in the ductal epithelia of normal salivary glands and chronic sialadenitis, and stronger immunoreactivity was observed in chronic sialadenitis tissues. CONCLUSION: SP-A is present in the human salivary gland epithelium and is up-regulated during chronic sialadenitis. These results suggest that salivary gland SP-A may play an important role in the innate host defense of human salivary glands.

Acoustic Pharyngometry in Normal Adults / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Assessment of the upper airway for possible site of obstruction is one of the keys to a successful management of patients of sleep apnea syndrome. Acoustic pharyngometry has a potential for localizing obstructive sites, so normal standard data was prerequisite for using this equipment. The aim of this study was to measure normal standard data in normal adults with acoustic pharyngometry on sitting, supine, left and right decubitus positions. SUBJECTS AND METHOD: A total number of 120 normal adults were examined by acoustic pharyngometry. RESULTS: Oropharyngeal junctional area was located within 8-11 cm, and glottic area was within 15-18 cm. There was no statistically significant difference in pharyngeal crosssectional area and pharyngeal volumes measured on sitting, supine, left and right decubitus positions (p>0.05). CONCLUSION: Acoustic pharyngometry is easy, rapid and cost-effective and has been shown to be successfully repeatable.

Up-regulation of Cathelicidin in Chronic Sialadenitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Salivary secretions and the secreted IgA in the secretions play a critical role in maintaining oral health via innate host defense mechanism. Cathelicidins are a family of peptides thought to provide an innate defensive barrier against a variety of potential microbial pathogens. LL-37, an antimicrobial peptide, is the only Cathelicidin protein so far identified in humans. The purpose of this study was to examine the expression of Cathelicidin in human salivary glands and to investigate upregulation of Cathelicidin in inflammatory conditions. MATERIALS AND METHOD: Reverse transcriptase-polymerase chain reaction (RT-PCR) and immunohistochemical staining were performed on 20 salivary gland tissues, of which 10 were normal and 10 were chronic sialadenitis. RESULTS: Cathelicidin mRNA transcripts were detected in the normal salivary glands and chronic sialadenitis. The level of Cathelicidin mRNA in chronic sialadenitis was significantly increased compared with that in the normal salivary gland. Cathelicidin protein was expressed in the glandular epithelium of the normal salivary gland and chronic sialadenitis. CONCLUSION: The results indicate that Cathelicidin might play an important role in the innate host defense of human salivary glands.

Clinical Analysis of Orbital Subperiosteal Abscess

BACKGROUND AND OBJECTIVES: Subperiosteal abscess is one of the most common orbital complications of sinusitis. It occurs secondary to the spread of infection through natural dehesience of orbital wall, bony suture line, and vein. One of serious complications of subperiosteal abscess is permanently decreased visual acuity, and its incidence is reported as 15-30%. The purpose of this study is to assess the clinical features, diagnosis, management, and therapeutic results. MATERIALS AND METHODS: We reviewd retrospectively the medical records of 7 patients with subperiosteal abscess for recent 13 years. Patients were 5 males and 2 females, and the age of patients ranged from 4 to 64 years. RESULTS: 3 cases of subperiosteal abscesses developed in medial wall, 3 cases in superior wall and 1 case in inferior wall. We did successful surgical drainage in 5 patients and 2 cases were treated with intravenous antibiotics only. In case of medial and inferior wall, drainage procedure was done safely by endoscopic sinus surgery. However, in case of superior wall, traditional external approach was used. CONCLUSION: Exact ophthalmologic evaluation and CT finding are important in determinig surgical treatment. Furtehrmore, method of surgical approach depends on the sites of subperiosteal abscess.

Treatment of Intra-Oral Ranula with Picibanil(R) in Children / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although surgical excision has been considered to be the treatment of choice by most of the surgeons, sclerotherapy of ranula has gained popularity during recent years. A prospective clinical trial was conducted to evaluate the efficacy of Picibanil(R) sclerotherapies for treating ranula children. SUBJECTS AND METHOD: Three patients were enrolled in the study conducted during 2002. All patients were not hospitalized. Picibanil(R) was injected into the lesion. One girl and two boys with ages ranging from 8 to 12 years were treated. RESULTS: Disappearance or marked reduction of the lesion and no recurrence of the ranula were observed in all children. Following each injection, local pain at the injection site was observed in 2 children and transient fever was observed in one child, but such problems resolved within a few days and no serious complication was developed. CONCLUSION: Our experience gives a suggestion that intralesional injection therapy using Picibanil(R) for intraoral ranula is relatively safe and can be used as a substitute for surgery in the treatment of ranula.

Wegener's Granulomatosis Involving Nasal Cavity / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Wegener's granulomatosis is a chronic multisystem vasculitis. The otolaryngologist has an important role in the early diagnosis of Wegener's granulomatosis because of the high incidence of nasal involvement. In this study, we analyze seven cases of Wegener's granulomatosis involving nasal cavity and describe clinical features, laboratory findings, treatments and outcomes. MATERIALS AND METHOD: Selected for this study were 7 inpatients with Wegener's granulomatosis treated at the department of otolaryngology of Korea University Medical Center from January, 1985 and December, 2002. Their clinicopathologic records were reviewed retrospectively. RESULTS: The nasal manifestations included nasal crusting, nasal obstruction, serous and bloody nasal discharge, septal perforation and saddle nose. All patients showed positive cytoplasmic antineutrophil cytoplasmic antibody (c-ANCA) and an elevated erythrocyte sedimentation rate (ESR). Wegener's granulomatosis was confirmed by the results of nasal mucosal biopsy performed in all patients. CONCLUSION: If multiple and large biopsy sites were selected properly, the diagnostic efficacy of nasal biopsy in Wegener's granulomatosis may increase and it may help early diagnosis since nasal mucosa is the most commonly affected site in Wegener's granulomatosis and nasal cavity is an easily accessible biopsy site.

Acute Epiglottitis in Adults: A Review of 85 Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Acute epiglottitis is a disease that may become serious or even fatal because of sudden upper airway obstruction. The incidence of acute epiglottitis in children has declined with introduction of the Haemophilus influenza type b vaccine. However, there have been few reports about acute epiglottitis in adults up until now. The aim of this study was to assess clinical characteristics of adult cases of acute epiglottitis. SUBJECTS AND METHOD: We retrospectively reviewed 85 hospitalized adult patients who had been admitted to the Department of Otolaryngology-Head and Neck surgery, Korea University Hospital from January 1998 to December 2002, and diagnosed with acute epiglottitis. RESULTS: Among the 85 patients, 23 cases (27%) and 24 cases (28%) were found in fourth and sixth decades of age, respectively. The male-to-female ratio was 1.6:1. Monthly distribution showed that 12 cases (14%) were in March and 11 (13%) in July. The most common symptom was in the order of throat pain (78%). Others were dysphagia (68%), voice change (67%) and dyspnea (42%). All patients were treated with antibiotics and steroids. About a half of all cases (54%) were hospitalized for 4 to 5 days. Tracheostomy was performed in 2 patients and orotracheal intubation in one patient. CONCLUSION: Throat pain and dysphagia were most common symptoms of acute epiglottitis. In most cases, therapies using intravenous antibiotics and short-term steroid were effective, but otolaryngologist must also suspect the possibility of sudden upper airway obstruction. We experienced emergency situations regarding airway obstruction in only three cases during the first week of hospitalization.

A Case of Bilateral Otosyphilis in the Patient with HIV Infection

Syphilis was a common cause of progressive or sudden sensorineural hearing loss. After introduction of penicillin, the incidence of syphilis decreased in general population. However, with the prevalence of HIV infection, it's incidence is increasing. Many studies have substantiated the aggressive and rapidly progressive behavior of neurosyphilis, including otosyphilis, in the presence of HIV infection . We report a case of 38-year-old man HIV infected patient with bilateral sensorineural hearing loss and bilateral total vestibular loss caused by otosyphilis which was resistant to treatment.

Clinical Analysis of the 22 Cases of Plunging Ranula / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The plunging ranula is a relatively uncommon phenomenon which represents a mucus escape reaction occurring from disruption of the sublingual salivary gland. We present a series of 22 patients treated at Korea University Hospital during a 20-year period. The purpose of this study was to examine the clinical characteristics of plunging ranula in order to provide our experience for its correct diagnosis and treatment. MATERIALS AND METHOD: A retrospective review of 22 patients with this condition was undertaken. Information was collected on age, sex, history of onset, predisposing factors, treatent, post-operative follow-up and outcome of treatment. RESULTS: The patients were all young adults with a median age of 19.8 years old. The sex distribution was male predominant with 15 men and 7 women. Except for one, no patients had any history of preceding trauma to the neck or oral cavity. Six patients had history of previous operation. Managements included 21 surgical approach and one sclerotherapy. There were no recurrences. One patient experienced transient paralysis of the marginal mandibular branch of the facial nerve postoperatively, but it was temporal and was sustained with no further complications. CONCLUSION: The incidence of plunging ranulas was not common. The precise etiology of its predisposition is unknown. Reoval of the sublingual gland via either a cervical or intraoral approach is important in the management of this condition.

Expression of Cathelin-Related Antimicrobial Peptide in the Eustachian Tube Epithelium of Mouse / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Antimicrobial peptides and proteins play an important role in innate host defense, and this may be particularly important at mucosal surfaces that form the initial barrier between the host and the external environment. Epithelial cells are the first line of defense mechanism against microorganisms, where antimicrobial peptides are the major participants. Cathelicidins are the precursors of potent antimicrobial peptides that have been identified in several mammalian species. Cathelin-related antimicrobial peptide (CRAMP) is one of the antimicrobial peptides and is the only member of cathelicidin family identified so far in mouse. The present study was undertaken to investigate the expression of CRAMP in the eustachian tube epithelium of mouse. MATERIALS AND METHOD: Tissue samples from the mouse eustachian tube were recovered from its pharyngeal, middle, and distal segments. CRAMP was localized by immunohistochemical staining and mRNA expression was determined by reverse transcriptase-polymerase chain reaction (RT-PCR). RESULTS: By immunohistochemical study, CRAMP was detected in epithelial cells and submucosal glands of the eustachian tube, but not in the negative control. Using RT-PCR, CRAMP mRNA was detected in the eustachian tube epithelium. CONCLUSION: The expression and localization of CRAMP in the epithelial cells and submucosal glands of the eustachian tube of mouse were defined. We found that CRAMP is one of the antimicrobial peptides found in the eustachian tube epithelium of mouse, and that it participates in the innate immune system of the eustachian tube.

Effect of Hypertonic Seawater (Sinomarin(R)) on Mucociliary Clearance in Normal Subjects

BACKGROUND AND OBJECTIVES: The effect of the hypertonic nasal douching solutions on mucociliary clearance was studied to ascertain the effect of hypertonic seawater. MATERIALS AND METHODS: Twenty-eight normal subjects were included in a randomized double -blind crossover trial. Hypertonic seawater (3%, Sinomarin(R)) was used as a hypertonic nasal douching solution. In order to determine the effect of hypertonic seawater on nasal mucosa, the mucociliary clearance was measured by the saccharin clearance time (SCT). RESULTS: The resultant SCT after administration of hypertonic seawater was significantly reduced compared with normal saline (0.9%)(p<0.05). CONCLUSION: This results showed that the hypertonic seawater improved mucociliary clearance time in the nasal cavity. The mechanism of this effect is probably brought about by changes in mucus viscoelastic properties.

Expression of Collectin in the Human Nasal Mucosa / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Collectins (surfactant protein A and D) are proteins with collagen tails and globular lectin domains that appear to play an important role in the first line of host defense in mammalians. However, it is not known if collectins are also present in human nasal mucosa. The purpose of this study was to investigate the expression of collectin proteins in human nasal mucosa and to compare the expressions of SP-A and D mRNA in the normal nasal mucosa and in chronic inflammatory nasal diseases. MATERIALS AND METHOD: Ten chronic rhinosinusitis patients were recruited and ten normal nasal mucosae were used as normal controls. Reverse transcriptase-polymerase chain reaction was performed to detect SP-A and SP-D mRNA. The level of collectin and GAPDH (glyceraldehyde-3-phosphate dehydrogenase) transcripts were semi-quantified with the desitometry. We have characterized the cellular localization of SP-A and SP-D protein using immunohistochemistry. RESULTS: SP-A2/GAPDH mRNA ratio in chronic rhinitis nasal mucosa is greater compared with that in normal nasal mucosa (p<0.05). SP-A protein was expressed in the nasal epithelium and in the epithelial cells of the submucosal glands. SP-D mRNA and protein were not expressed in the nasal mucosa. CONCLUSION: These data provide the first evidence of the presence of collectins in the human nasal mucosa. These results suggested that up-regulation of collectin in chronic rhinosinusitis may be a protective response for the nasal mucosa.

Effect of Smoking to Warthin's Tumor of Parotid Gland / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Warthin's tumor is known to be the second most common benign tumor of the parotid gland. Recent reports describe epidemiological changes of Warthin's tumor in other nations, however its clinical manifestations are still the mainstay of domestic studies. The purpose of this study is to investigate the prevalence of this tumor from various standpoints and the correlation between smoking and the development of Warthin's tumor. MATERIALS AND METHOD: A retrospective review of medical records was carried out on 135 patients who underwent parotid surgery from January 1991 through December 2000 and were diagnosed pathologically as Warthin's tumor and pleomorphic adenoma. RESULTS: The overall incidences of Warthin's tumor and pleomorphic adenoma of parotid gland were 15% and 57% of all parotid tumors, respectively. The male to female ratio for Warthin's tumor was 3.8:1 and the median age at presentation was 57.4 years old. Smoking is significantly associated with the development of Warthin's tumor (p=0.0054). CONCLUSIONS: In this study, smoking seems to be a risk factor in the pathogenesis of Warthin's tumor.

Anthropometric Growth Study of the Auricle in Korean / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Knowledge of the postnatal growth of ear is decisive in determining the optimal time for ear reconstruction and planning the morphology of an artificial ear. However, basic population studies have not been carried out in Korea and the dynamics of ear growth and the age of maturation have not been clearly determined and established. The aim of this study was to establish the age of ear maturation and to help determine the optimal time of ear reconstruction for Koreans. SUBJECTS AND METHOD: From June 2000 through February 2001, we measured facial length and the 3 lengths of the auricle, i.e., length, width, the distance between the two insertion points of the auricle and facial length in 950 Korean subjects between the ages of 0 to 18. RESULTS: The auricle length reached 90% of its mature size at 14 years and width at 15 years. The distance between the two insertion points of the auricle was not significantly different in this study. CONCLUSION: The length and width of auricle reached 90% of the adult size at the age of 14 and 15, respectively. Therefore, when performing auriculoplasty, consideration should be given for auricle growth up to the age of 15 years.

Sudden Hearing Loss in Chronic Myelogenous Leukemia Implicating Hyperviscosity Syndrome / 대한이비인후과학회지

Sudden sensorineural hearing loss due to the initial manifestation of hematologic disease is very rare. Chronic myelogenous leukemia has been implicated as a causative factor of sudden sensorineural hearing loss. Leukemic infiltration, hemorrhage, infection, and hyperviscosity have been suggested as possible mechanisms in patients with chronic myelogenous leukemia. A 49-year-old male presented unilateral sudden sensorineural hearing loss. The patient was found to have chronic myelogenous leukemia during the work-up for the hearing loss. The WBC count upon admission was 485,100/mm(3). Hemoglobin, hematocrit, and platelet count were within the normal limits. The patient underwent three cycles of leukapheresis and chemotherapy with interferon alpha and hydroxyurea for the treatment of leukemia. The hearing threshold level was 75 dB on admission. It improved to 35 dB when the WBC count fell to 294,000/mm(3), and finally settled at 32 dB two weeks after the termination of chemotherapy when the WBC count was 125,900/mm(3). We present a case of a chronic myelogenous leukemia patient who initially presented with sudden sensorineural hearing loss. We presume that cochlear vessel occlusion as a result of elevated blood viscosity was responsible for this patient's hearing loss. Early onset of sudden deafness in a chronic myelogenous leukemia patient may be due to the hyperviscosity syndrome and be possible to reverse hearing loss through early leukapheresis.

Expression of Neurokinin 1 Receptor in Allergic Rhinitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In airway tissues, the substance P has been suggested as the neurotransmitter in the afferent sensory nerve which responds to various irritants and that it may be involved in airway allergic reactions. Neurokinin 1 receptor exhibits preferential affinity for the substance P. In contrast to the substance P, neurokinin 1 receptor has not been examined at the protein level in nasal mucosa with allergic rhinitis. The purpose of this study was to investigate the localization and distribution of the neurokinin 1 receptor in the nasal mucosa of normal subjects and allergic rhinitis subjects. MATERIALS AND METHOD: Biopsy specimens were collected from 10 normal control subjects and 10 allergic rhinitis subjects and were immunostained for the neurokinin 1 receptor. Expressions of neurokinin 1 receptor were quantified through a light microscope. RESULTS: Neurokinin 1 receptor was localized at the epithelium, inflammatory cells, vascular endothelial cells, and glandular cells in the nasal mucosa of both normal subjects and allergic rhinitis subjects. When comparing the distributions of normal nasal mucosa and neurokinin 1 receptor, the neurokinin 1 receptor was significantly increased in the epithelial cell layer of allergic rhinitis, but there was no difference in the submucosa between two groups. CONCLUSION: These results show that neurokinin 1 receptor in the nasal epithelial cells may play an important role in the pathogenesis of hyper-reactivity in allergic rhinitis.