A Case of Spindle Cell Lipoma on Nasal Dorsum of Nose / 대한이비인후과학회지

Spindle cell lipoma is a benign, lipomatous tumor arising most frequently in the subcutaneous on the back of the neck and shoulders in males aged in the third through seventh decade of life. However, we encountered a case of an unusual spindle cell lipoma arising in the subcutaneous and skin layer in the dorsum of nose. A total of two reports of spindle cell lipoma have been found in the nasal and nasal dorsum regions. To our knowledge, this is the first report of spindle cell lipoma in the nasal dorsum.

Decreased Pattern-Recognition Receptor-Mediated Cytokine mRNA Expression in Obese Children With Otitis Media With Effusion

OBJECTIVES: To assess innate and humoral immune responses in middle ear effusion of obese pediatric patients with otitis media with effusion (OME). METHODS: We evaluated 219 children with OME, of whom 21 were obese and 198 were non-obese. We compared the expression in middle ear effusion of mRNAs encoding toll-like receptors (TLR) 2, 4, 5, and 9; nucleotide-binding oligomerization domains (NOD) 1 and 2; retinoic acid-inducible gene (RIG)-I; interleukins (IL)-6, -10, and -12; interferon (IFN)-gamma; and tumor necrosis factor (TNF)-alpha mRNAs. We also compared the expression of immunoglobulins IgG, IgA, and IgM and the bacterial detection rate in the two groups. RESULTS: TLR2-mediated expression of IL-6 mRNA, TLR4-mediated expression of IL-6 and IL-10 mRNA, TLR5-mediated expression of IL-6, IL-10, and TNF-alpha mRNA, TLR9-mediated expression of IL-6 mRNA, and NOD2-mediated expression of IL-6, IL-12, and TNF-alpha mRNA were significantly lower in obese than in non-obese children (P0.05). CONCLUSION: Mean body mass index was higher and pattern-recognition receptor-mediated cytokine mRNA expression was lower in obese than in non-obese children with OME.

Herpes Simplex Encephalitis Suffered Rotatory Dizziness as a Primary Symptom / 대한평형의학회지

Herpes simplex encephalitis (HSE) is rare, serious sporadic encephalitis associated with high mortality in untreated cases. Although cognitive impairment with fever could be the clue of diagnosis, various symptoms can make it difficult to be diagnosed. Dizziness is one of the most frequent symptoms ENT doctors can encounter. Authors experienced the HSE patient suffered rotatory sense of dizziness as a primary symptom and treated the patient successfully without major complication. We reported our experience and findings of vestibular function test of patient. It could be helpful to other ENT doctors who encounter similar patients.

A Case of Spontaneous Temporomandibular Joint Herniation into the External Auditory Canal with Clicking Sound

A bony defect of the external auditory canal (EAC) and herniation of the temporomandibular joint (TMJ) can be caused by tumorous conditions, inflammation, trauma, and otologic procedures. Spontaneous TMJ herniation into the EAC can be caused by a congenital bony defect known as patent Huschke's foramen, which is a very rare condition. In our case, an objective clicking sound was produced when the patient opened his mouth. A protruding mass was found in the anterior wall of the EAC during mouth closing, and herniation of the TMJ was confirmed with computed tomography. Therefore, we thought the clicking sound of our case could have resulted from spontaneous TMJ herniation through the patent foramen of Huschke.

Short-Term Effect of Single Session Repetitive Transcranial Magnetic Stimulation in Chronic Unilateral Tinnitus / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The repetitive Transcranial Magnetic Stimulation (rTMS) is generally performed over the course of several weeks, as its theoretical and experimental validity has been identified in repetitive procedures. If short term application of rTMS is proven to be significantly effective, more effective treatment of tinnitus can be expected. This study was conducted to measure the effect of one session of sham rTMS & one real trial of rTMS in chronic unilateral tinnitus patients. SUBJECTS AND METHOD: rTMS stimulation of 1 Hz and 100% magnitude was given 1200 times per day to 33 patients with chronic unilateral tinnitus on their left side, between T3 and C3/T5, following the convention of the 10-20 International EEG system. Visual Analogue Scale (VAS) and Tinnitus Handicap Inventory (THI) scores were measured four times-immediately before rTMS, immediately after sham rTMS, immediately after real rTMS and two weeks after real rTMS. RESULTS: VAS and THI scores were found to show a tendency of declining. Immediately after real rTMS application, a significant decrease in VAS and THI scores was observed compared to those measured immediately before rTMS (p0.05) attributable to the direction of tinnitus were observed. CONCLUSION: A single session rTMS is thought to be a possible adjunctive treatment for tem-porary relief of tinnitus.

Clinical Manifestations of Aural Fullness

PURPOSE: Even though aural fullness is ubiquitous among patients presenting to otolaryngology clinics, the association between aural fullness and disease development has not yet been clearly determined. MATERIALS AND METHODS: Our study was performed on outpatients from June 2006 to February 2010 whose major complaint was "ear fullness", "aural fullness", or "ear pressure". We assessed their demographic and clinical characteristics, including sex, associated diseases, symptoms, otoscopic findings, audiology test results, and final diagnoses. RESULTS: Among 432 patients, 165 (38.2%) were males and 267 (61.8%) were females, with mean ages of 42+/-19 years and 47+/-17 years, respectively. Tinnitus, hearing disturbance, autophony (p<0.01) as well as nasal obstruction and sore throat (p<0.05) showed a statistically significant correlation with aural fullness. Among patients who complained of hearing fullness, tests and measures such as impedance audiometry, speech reception threshold, and pure tone audiometry generated statistically significant results (p<0.05). Ear fullness was most frequently diagnosed as Eustachian tube dysfunction (28.9%), followed by otitis media with effusion (13.4%) and chronic otitis media (7.2%). However, 13.4% of patients could not be definitively diagnosed. CONCLUSION: Among patients complaining of ear fullness, Eustachian tube dysfunction, otitis media with effusion, chronic otitis media were most commonly observed. Performance of otoscopy, nasal endoscopy, the Valsalva maneuver, and additional audiological tests is necessary to exclude other diseases.

Clinical Analysis of Auricular Benign Masses

BACKGROUND AND OBJECTIVES: Auricular masses are growths on the outer ear that have not been well characterized clinically. We assessed the clinical nature and treatment of auricular benign masses in patients at our institution. SUBJECTS AND METHODS: We retrospectively identified 63 patients with auricular benign masses who underwent excision and biopsy from May 1970 to April 2011. We determined the site, cause, size, pathology and postoperative results of these auricular masses. RESULTS: Auricular benign masses occurred most commonly on the lobule (44.4%), followed by the tragus (20.6%), crus of helix (11.1%), triangular fossa (6.3%), crus of antihelix-antitragus (3.1%) and scapha (1.5%). Pathologically, the most common type of auricular mass was epidermal cysts (25.3%), followed by hypertrophic scar (12.6%), fibrous tissue-accessory ear (9.5%), chronic inflammation-nevus (7.9%), keloid (6.3%), hemangioma (4.7%), and skin tag-seborrheic keratosis (3.1%). CONCLUSIONS: The most common site of auricular benign masses is the lobule and most common pathology is an epidermal cyst.

Rate of Isolation and Trends of Antimicrobial Resistance of Multidrug Resistant Pseudomonas Aeruginosa from Otorrhea in Chronic Suppurative Otitis Media

OBJECTIVES: To assess the rate of isolation of Pseudomonas aeruginosa (PA) and multidrug-resistant PA (MDR-PA) from patients with chronic suppurative otitis media (CSOM) otorrhea and the annual trend of antibiotic-resistance. METHODS: Otorrhea samples were collected aseptically from 1,598 CSOM patients. The rate of bacterial isolation and the results of antibiotic susceptibility testing were evaluated retrospectively. RESULTS: The PA isolation rate from CSOM otorrhea was 24.4%. Of the 398 isolated strains tested for their susceptibilities to 10 antibiotics, 395 strains showed definitive results. Of these, 183 (46.3%) were susceptible to whole antibiotics and 212 (53.7%) was resistant to more than 1 antibiotics, with the frequency of antibiotics-resistance increasing significantly over time. Although strains susceptible to all antibiotics decreased over time, the rate of isolation of MDR-PA did not change significantly. Resistance to aminoglycosides and quinolones was higher than to other antibiotics and significantly increased over time, whereas resistance to other antibiotics showed no trend. CONCLUSION: MDR-PA, assessed using five individual antibiotics and six antibiotic-classes, showed no tendency to increase or decrease over time. This may have been due to increased concern about antibiotic-resistant bacterial strains, leading to improved infection control within hospitals and healthcare centers.

Bacteriology of Chronic Otitis Media: Changing of Detection Rate of Methicillin-Resistant Staphylococcus Aureus and Pseudomonas Aeruginosa / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Chronic suppurative otitis media is one of the most common diseases in the otologic field. Along with development and widespread use of antibiotics, the kinds of pathogenic microorganisms and their resistance to antibiotics have been changed. It is thus significant to know the current trend of species and resistance rates of pathogens for choosing appropriate antibiotics. To investigate the current bacteriology of chronic suppurative otitis media and compare the current results with previous results. SUBJECTS AND METHOD: A retrospective study about chronic otitis media patients with otorrhea was performed from Jan, 2000 to Dec, 2005. RESULTS: The most commonly identified pathogenic bacterium was methicillin-resistant Staphylococcus aureus (MRSA). The next frequent pathogenic organisms were Pseudomonas, Coagulase (-) Staphylococcus (CNS) and methicillin-sensitive Staphylococcus aureus (MSSA). CONCLUSION: There was difference between the results of the present study and previous results regarding pathogenic organisms and antibiotics-sensitivity. Continuous and periodic surveillance about pathogens and antibiotics resistance is necessary to guide appropriate antibacterial therapy.

Difference of Polysomnographic, Anthropometric, Physical and Radiologic Findings in an Obstructive Sleep Apnea Syndrome Patient with Excessive Daytime Sleepiness

BACKGROUND AND OBJECTIVES: Excessive daytime sleepiness (EDS) is a well-known consequence of the obstructive sleep apnea syndrome (OSAS) and can be the cause of several psycho-social problems. The objective degree of EDS measured by the multiple sleep latency test is not correlated with the subjective degree of EDS. We examined EDS according to Epworth sleepiness scale (ESS) in OSAS and evaluated the difference between EDS group and non-EDS group. MATERIALS AND METHODS: One hundred sixteen patients diagnosed with OSAS and prepared for surgical treatment were evaluated for this study. They were divided between EDS and non-EDS groups by a Korean version of ESS questionnaire. Also, they were given a physical examination and checked for anthropometric parameters, factors related with respiration and sleep architecture during sleep. Then, we measured the difference of sleep parameters between the EDS group and non-EDS group and found correlated factors of sleep with EDS measured by ESS. RESULT: There were no significant differences in the physical examination, anthropometric factors and sleep architecture between the EDS group and non-EDS group. Only the parameters of arousal (arousal with respiration, total arousal) were different between the two groups. ESS score showed a correlation with parameters of arousal, apnea index and apnea-hypopnea index with weak correlation efficiency. CONCLUSION: The parameters related with arousal revealed that there was a difference between the EDS group and non-EDS group. Some parameters including apnea, apnea-hypopnea index showed a correlation with ESS score. It suggests that EDS could develop and be aggravated by sleep fragmentation occurring from OSAS.

A Case of Congenital Cholesteatoma : Combined with Ossicular Anomaly / 대한이비인후과학회지

Congenital middle ear cholesteatoma is presented as a pearl-like-material behind an intact tympanic membrane. Congenital cholesteatoma can be associated with other congenital anomalies, especially ossicular anomalies. The patient was a 10-year-old male with incidentally known hearing disturbance with intact tympanic membrane. The pure tone average through air conduction of his left ear was 55dB. During exploratory tympanotomy, congenital cholesteatoma was found in the middle ear cavity in a scattered pattern and fibrous stapes was located below the oval window with an intact stapedial footplate. We removed cholesteatoma matrix and performed ossiculoplasty with total ossicular replacement prosthesis (TORP). After 1 month, the postoperative pure tone average through air conduction of the left ear was 33dB. We report one case of congenital middle ear cholesteatoma with congenital ossicular anomaly with a review of the related literature.

Analysis of Allergic Rhinitis according to New Classification Regarded by ARIA(Allergic Rhinitis and its Impact on Asthma) Guideline : Difference with Classification by Antigen Detected by Multiple Allergen Simultaneous Test(MAST) / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES : Allergic rhinitis has previously been classified as seasonal, perennial or occupational according to duration of exposure to allergens ; this classification, however, has posed difficulty for care providers in planning the stepwise treatment of allergic rhinitis. According to the ARIA (Allergic Rhinitis and its Impact on Asthma) workshop report, allergic rhinitis was re-classified as intermittent or persistent according to duration of symptoms, and mild or moderate-to-severe according to severity of symptoms. There has been no reports regarding the distribution of allergic rhinitis by using the new ARIA classification. We aimed to find out the distribution of allergic rhinitis according to the new ARIA classification and its usefulness in clinical use. Subjects and METHOD : A total of 502 allergic rhinitis patients were subjected to this study. They were classified under the previous classification into seasonal, perennial, and multiple. They were classified by new ARIA classification into persistent mild, persistent moderate-to-severe, intermittent mild, and intermittent moderate-to-severe. Their distribution and characteristics were analyzed. RESULTS : When classified according to previous classification, patients sensitized with perennial allergens, seasonal allergens and multi-allergens were 326 (64.9%), 63 (12.5%) and 113 (22.5%) respectively. According to the new ARIA classification, persistent mild, persistent moderate-to-severe, intermittent mild and intermittent moderate-tosevere patients were 82 (16.3%), 161 (32.1%), 159 (31.7%) and 100 (19.9%) respectively. The patients sensitized with perennial allergen were classified to persistent mild (17.5%), persistent moderate-to-severe (32.5%), intermittent mild (31.6%), intermittent moderate-to-severe (18.4%) by new ARIA classification. Half of patients with intermittent symptoms were sensitized by perennial allergen. Among the patients sensitized by only seasonal allergen, 24 (36.5%) had persistent symptoms. There were no difference in group distribution between the rhinorrhea-sneezer and blocker groups. CONCLUSION : Patient distribution by the new ARIA classification was different from the previous classification. From the point of clinicians, the new ARIA classification might be more useful for stepwise treatment and exact evaluation of allergic rhinitis patients than the previous classification.

Expression of Toll-Like Receptor 2 and Toll-Like Receptor 4 in Cholesteatoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: One of the hallmarks of aural cholesteatoma is chronic and recurrent infection. Initiation and perpetuation of the inflammatory response of cholesteatoma may result from an exaggerated host defense reaction of the cholesteatoma epithelium. However, the role of innate immune system in cholesteatoma has not been fully elucidated. Toll-like receptors (TLRs) are a part of the innate immune system involved in the response to microbial pathogen. TLRs appear to respond to pathogens and induce NF-kappaB activation. TLR 2 and TLR 4 seem to be related to the initiation of immune responses against gram negative and positive bacteria. We have investigated the expression of TLR 2, and 4 in the normal external auditory canal skin and cholesteatoma. SUBJECTS AND METHOD: A real time RT-PCR was performed to determine and quantify the expression of TLR 2 and 4 mRNA. Immunohistochemical staining was performed for 17 cases of cholesteatoma and 8 cases of normal auditory canal skin to demonstrate the distribution of TLR 2 and 4. RESULTS: All cholestatoma and normal external auditory canal skin expressed both TLR 2 and 4 mRNA. The mRNA of TLR 2 and 4 were expressed significantly higher in cholesteatoma than in the normal external auditory canal skin (p<0.05). Immunohistochemistry using anti-TLR2 and anti-TLR4 antibody revealed the expression of TLR 2 and 4 in the epithelial cells of the cholesteatoma. CONCLUSION: These findings suggest that distinctive patterns of the innate immune related receptors, TLR 2 and 4 system, constitute a part of the innate immune system in the cholesteatoma.

Carcinoma Ex Pleomorphic Adenoma Including Malignant Component of Adenoid Cystic Carcinoma in the Parotid Gland / 대한이비인후과학회지

Carcinoma ex pleomorphic adenoma is rare, aggressive, poorly understood malignancy that occurs in the salivary glands. In carcinoma ex pleomorphic adenoma, an epithelial malignancy develops in association with primary or recurrent benign pleomorphic adenoma. The patient was a 37-year-old female with slow-growing preauricular mass that has been present for 2 years. She visited the hospital because of sudden increase of mass size. The initial cytologic finding by fine needle aspiration biopsy showed what was probably a benign tumor and the radiologic finding revealed a 2.0x1.9 cm sized mass without cervical lymphadenopathy. After right superficial parotidectomy, the histologic examination revealed that tumor was composed of epithelial and mesenchymal component of pleomorphic adenoma and cribriform areas mimicking adenoid cystic carcinoma. Additionally, we did right near-total parotidectomy and postoperative radiotheraphy for 6 weeks. We present a rare case of carcinoma ex pleomorphic adenoma including adenoid cystic component in the parotid gland.

Contact Laser Induced Prostatectomy: Preliminary Experience / 대한비뇨기과학회지

No abstract available.

The appendicolith in acute appendicitis: a radiological study

The diagnostic importance of finding an appendicolith in the plain x-ray of the abdomen has been well documented. However, most of the papers so far published have stressed x-ray findings of the preoperative abdomenin acute appendicitis. In the present study we have attempted to correlate incidences of appendicoliths insurgical specimen and plain x-ray of the abdomen. The materials were 37 surgical specimens of the appendix removed for acute appendicits at St. Mary's Hospital, St. Paul's Hospital, Kang Nam Hospital, Holy Family Hospital and Our Lady of Mercy Hospital of Catholic Medical College during the period of 6 months from August 1980. Each surgical specimen was subjected to soft tissue radiography to detect calcified appendicolith. Then the preoperative x-raysof abdomen were retrospectroscopically analysed for the presence of radiographically demonstrable appendicoliths.Our study revealed that in as many as 32% of 37 surgical specimens one or more calcified appendicoliths were demonstrated radiographically whereas only one of these was identified as such in the preoperative x-ray film ofthe abdomen. Such a great discrepancy between the incidences of appendicoliths in the surgical specimen andpreoperative x-ray films of the abdomen are ascribed to (1) relative smallness of appendicoliths (87% of the stones measured less than 1cm in diameter in radiographs of surgical specimen in our series), (2) overlapping of these small stones on the right iliac bone and (3) underpenetrating of the iliac bone area in x-ray films of theabdomen. For improving detctability of appendicoliths therefore it is recommended that the technique of radiography of plain abdomen should be such that a small appendicolity overlying the iliac bone can be brought outof trabecular shadows.