Retropharyngeal Lymph Node Metastasis of Thyroid Papillary Carcinoma / 대한이비인후과학회지

Thyroid papillary carcinoma shows 40% of the lymph node metastasis rate, but metastasis to retropharyngeal lymph node is known to be rare. Patients underwent operation via transcervical approach due to retropharyngeal lymph node metastasis of thyroid papillary carcinoma mimicking paraganglioma. Even though retropharyngeal lymph node metastasis is rare, it could go unnoticed with only history taking and physical examination of thyroid papillary carcinoma patients, especially since cervical ultrasonography is not a sufficient modality for the evaluation of retropharyngeal lymph node. Imaging studies such as MRI or CT scan is required to evaluate retropharyngeal lymph nodes.

A Case of Cochlear Implantation in Otosclerosis Histologically Diagnosed / 대한이비인후과학회지

Otosclerosis is a localized disorder of bone metabolism involving the endochondral bone of the otic and labyrinthine capsule. Both "advanced" and "very advanced" otosclerosis refer to the state of otosclerotic involvement of the otic capsule, which has progressed to result in profound deafness with undetectable bone and air conduction thresholds. Shea et al. estimated that 1.6% of patients with otosclerosis had developed profound hearing losses, and that hearing improvements after stapes surgeries in these patients were lower than the case of "not-advanced" otosclerosis. Stapedectomy and hearing aid amplification could be tried, but cochlear implantation is an established intervention for patients with profound sensorineural hearing loss due to otosclerosis. Although the reported results of cochlear implantations in otosclerosis patients are not significantly different from those of other cochlear implantees not affected by otosclerosis, in former conditions, potential ossification of cochlea, facial nerve stimulation, and instability of the results might take place. We report a case of otosclerosis histologically diagnosed for the first time here in Korea, and for which cochlear implantation was successfully performed.

Effect of Intratympanic Chemical Labyrinthectomy with Streptomycin on Auditory Symptoms / 대한평형의학회지

BACKGROUND AND OBJECTIVES Intratympanic treatment with aminoglycosides for Meniere's disease has been used, trying to eliminate vertigo complaints, while preserving hearing. This study was undertaken to evaluate the therapeutic outcomes for auditory symptoms in Meniere's disease patients after intratympanic application with single low-dose streptomycin powder. MATERIALS AND METHODS Ninty-eight patients diagnosed with definite Meniere's disease who underwent chemical labyrinthectomy with streptomycin at Yonsei University Medical Center from March 1997 to June 2006 were enrolled. Low dose streptomycin powder (10 mg) was applied into the round window niche directly. Changes of hearing threshold, tinnitus and aural fullness were evaluated postoperatively according to Committee on Hearing and Equilibrium guidelines for the diagnosis and evaluation of therapy in Meniere's disease of American Academy of Otolaryngology?Head and Neck Surgery. RESULTS Hearing threshold was not changed significantly after the procedure (from 65.5+/-19.1 to 69.3+/-20.0 p>0.05) and was improved in 7% of the patients. Hearing deterioration after the procedure was detected only in 17%. Tinnitus and aural fullness was improved in 51% and 25% respectively. CONCLUSION Single application of streptomycin powder filling round window niche showed minimal deterioration of hearing threshold. It is the useful method to improve or prevent the progress of auditory symptoms in patients with Meniere's disease

A Case of Vestibular Schwannoma Treated with Revision Middle Cranial Fossa Approach to Preserve Facial Nerve Function and Hearing Ability / 대한이비인후과학회지

The aim of surgery for vestibular schwannoma is to accomplish complete tumor removal while preserving facial function and hearing ability. The middle cranial fossa approach represents one such surgical approach for resection of vestibular schwannoma with hearing preservation. As more experience has been gained with this approach, hearing preservation rates have increased. However, even if gross tumor removal is done completely, residual tumor can show regrowth microscopically. Such residual vestibular schwannoma may be treated by different options. We present a case of residual vestibular schwannoma treated with revision middle cranial fossa approach to preserve facial function and hearing ability.

A Case of Small Cell Carcinoma in Tonsil with Aggressive Systemic Metastasis / 대한이비인후과학회지

Small cell carcinoma is a highly malignant tumor that is most commonly of bronchogenic origin and well recognized for its aggressive clinical behavior. Extrapulmonary small cell carcinoma is rare, accounting for 2-5% of all small cell carcinomas, and the head and neck origin of small cell carcinoma is especially uncommon. Small cell carcinomas arising in the head and neck have been reported to date in larynx, salivary glands, palate, base of tongue, sinonasal tract, and tonsil. Only a few cases of small cell carcinoma of the tonsil have been reported worldwide, and it is the first case to be reported here in Korea. With the report of this case, we suggest that systemic chemotherapy should be considered for all patients with small cell carcinoma in tonsil because of its high incidence of extensive local invasion and metastasis.

A Case of Dumbbell-Shaped Facial Nerve Schwannoma of the Internal Auditory Canal / 대한이비인후과학회지

Schwannoma is a benign neoplasm of the nerve sheath and is the most common neoplasm of the internal auditory canal (IAC) and cerebellopontine angle. A dumbbell-shaped schwannoma is defined as a mass with two bulbous segments, one in the IAC fundus and the other in the membranous labyrinth of the inner ear or the geniculate ganglion of the facial nerve connected to labyrinth segment. This kind of schwannoma should not be missed because it can affect the type of surgery and so the prognosis of the patient. We present one case of dumbbell-shaped facial nerve schwannoma which was completely excised without any complication.

Clinical Significance of Vestibular Evoked Myogenic Potentials in Patients With Benign Paroxysmal Positional Vertigo

OBJECTIVES: To investigate the vestibular evoked myogenic potentials (VEMP) results in benign paroxysmal positional vertigo (BPPV) patients and to verify its clinical applications in BPPV. SUBJECTS AND METHODS: Forty-one patients with diagnosis of BPPV and 92 healthy volunteers who underwent VEMP testing. Patients were treated by canalith repositioning maneuvers according to the affected canal, and testing of VEMP was performed at diagnosis and after treatment. RESULTS: VEMP results of BPPV patients showed prolonged p13 and n23 latencies compared with those of the control group, and we could not find any significant difference in VEMP latencies between patients with posterior and horizontal canal type of BPPV. The number of times that the maneuver was repeated did not correlate with the degree of latency prolongation, but in the "no response" group, the number of times was considerably greater than those in the "response" group. CONCLUSIONS: We found that VEMP latencies are increased in BPPV patients, which may signify neuronal degenerative changes in the macula of the saccule. When an extensive neuronal damage was suspected by VEMP results such as "no response" in VEMP, the disease progress showed a chronic and resistive course. Therefore, we propose that VEMP could be a useful method to determine a clinical prognosis of patients with BPPV.

IL-1beta Induces Lysozyme Overexpression through a Mechanism Involving ERK/p38 Mitogen Activated Protein Kinase Activation in Human Airway Epithelial Cells

BACKGROUND AND OBJECTIVES: Lysozyme, a major serous component of airway epithelial secretions, plays an important role in airway defense. However, little is understood about the regulation of its expression and the associated signaling pathway. The object of this study is to investigate the regulation of lysozyme expression, the downstream signaling pathway of lysozyme expression, and the related protein kinases under inflammatory conditions using the IL-1beta, which acts as a significant cytokine in many airway inflammations. MATERIALS AND METHODS: After the IL-1beta treatment of normal human nasal epithelial cells (NHNE), lysozyme mRNA expression was determined by RT-PCR. Expressed levels of ERK/p38 kinase were determined by Western blot analysis. RESULTS: IL-1beta treated NHNEcells had over-expressed lysozyme compared to the control group. Activated ERK/p38 kinase level showed marked increment by treating NHNE with IL-1beta. Lysozyme expression and ERK/p38 kinase levels decreased when inhibitors of ERK/p38 MAP kinases were added to the IL-1beta treated cells. Finally, expression of lysozyme and activated level of ERK/p38 MAP kinases decreased in a dominant-negative cell line even when treated with IL-1beta. CONCLUSION: From these results, we concluded that IL-1beta induces over-expression of lysozyme via ERK/p38 MAP kinase signaling pathways in airway epithelial cells.

Gender Difference in Self-Esteem of Medical Students / 한국의학교육

PURPOSE: Many studies from the past have indicated that women tend to have lower self- esteem than men. This cross-sectional study looks for this tendency in a medical school in Korea, where men are still thought to comprise much of a dominating force despite the current growth in number of female students in student body. Along with the cross-examination of possible gender difference in self-esteem, the significant and relevant factors will also be sought and discussed. METHODS: Questionnaires were obtained from 202 junior and senior students (125 male and 77 female students) in a medical school in Korea. Self-esteem was determined using the Rosenberg self-esteem scale (reliability = 86% in our study). Multiple regression analysis was used to determine gender difference in self-esteem and statistical relevance in each covariate. RESULTS: There was no statistically significant difference in self-esteem between male and female medical students. Significant factors related to self-esteem include school rank, physical attractiveness, and depression, among which of them, depression was the strongest. CONCLUSION: Innate limitation of cross-sectional studies and evaluation of selected junior and senior students of a single medical school could possibly explain for the absence of gender difference in self-esteem in this study. Academic achievement and physical attractiveness are shown to be positive factors for self-esteem, while depression puts negative force in one's self-esteem.