Clinical Features of Otomycosis Co-occurring with Chronic Otitis Media and the Causative Fungi / 대한의진균학회지

BACKGROUND@#Otomycosis is a fungal infection that comprises 7~10% of outer ear infections. Although the occurrence is higher in humid climates, relatively few studies have investigated otomycosis occurrences in humid environments. While recurrent chronic otitis media discharge in the ear creates a milieu in which otomycosis is likely to occur, investigations of otomycosis co-occurring with chronic otitis media have been rare.@*OBJECTIVE@#To examine the characteristics of patients with otomycosis co-occurring with chronic otitis media and identify causative fungi.@*METHODS@#The study included 60 patients with chronic otitis media who presented typical otomycosis findings in the outer ear canal and the presence of fungi. Patients were treated in the department of otolaryngology, Daegu Catholic University Medical Center, between July 2011 and June 2018.@*RESULTS@#The mean patient age was 57.77 years, and our study included 20 men and 40 women (p=0.010). The lesion was on the right in 39 patients and on the left in 21 (p=0.020). Ear discharge was the most common chief complaint at diagnosis. Of the 54 patients over age 19, 10 had diabetes (18.5%). Aspergillus was causative in 29 patients and Candida in 31. Aspergillus niger was identified in 15 patients, Aspergillus sp. in 14, Candida parapsilosis in 12, Candida sp. in six, and Candida albicans in five.@*CONCLUSION@#Otomycosis and chronic otitis media co-occurrences increase with age. The Aspergillus and Candida genera were similar in proportion. A. niger was the most common Aspergillus species, while C. parapsilosis was the most common Candida.

Comparison of Manuka, Kanuka, and Black Locust Honey on the Production of Chemical Mediators by Peripheral Blood Mononuclear Cells

BACKGROUND AND OBJECTIVES: Honey has various biological and pharmacological activities and has been used as treatment against various inflammatory diseases. The aim of this study was to compare the anti-inflammatory characteristics of manuka, kanuka, and black locust honey. MATERIALS AND METHOD: Peripheral blood mononuclear cells (PBMCs) from healthy human volunteers were isolated and then stimulated with lipopolysaccharide (LPS) with or without pre-treatment of various concentrations of honey for 72 hours. The cytotoxic effects of honeys were measured using an aqueous cell proliferation kit, and the supernatants were analyzed for interleukin-5 (IL-5), IL-10, interferon-γ (INF-γ), and tumor necrosis factor-α (TNF-α) using an enzyme-linked immunosorbent assay. RESULTS: Samples of 1% manuka and kanuka honey were found to have cytotoxic effects on PBMCs. Honey itself enhanced the production of IL-10 and TNF-α production. Manuka and kanuka honeys suppressed LPS-induced IL-10 and INF-γ production, while black locust honey only suppressed IL-10 production from PBMCs. CONCLUSION: Honeys had immunomodulatory properties of both immunostimulatory and immunosuppressive effects on PBMCs. Different honeys might have different immune modulatory functions due to their different components.

A Case of Engorged Female Hard Tick in the External Auditory Canal of an Infant

An oval-shaped mass with a smooth surface was found in the ear canal of a 22-month-old male infant. Although the mass appeared to be almost entirely blocking the ear canal, it was successfully removed under a surgical microscope without general anesthesia at the outpatient department. Under an optical microscope with hematoxylin and eosin staining, the specimen was observed to have a cuticle with a serrated surface and a pore canal, as well as parts of the capitulum, salivary glands, muscles, midgut, and the legs. The specimen was identified as a hard tick of the family Ixodidae, based on gross and histological findings. This paper is the first report in Korea on the diagnosis and treatment of a tick bite in the ear canal.

Alternaria Induces Production of Thymic Stromal Lymphopoietin in Nasal Fibroblasts Through Toll-like Receptor 2

PURPOSE: Chronic rhinosinusitis with nasal polyps is a chronic inflammatory disease with markedly increased eosinophils, Th2-type lymphocytes, fibroblasts, and goblet cells. Fungi are commonly associated with airway inflammatory diseases, and thymic stromal lymphopoietin (TSLP) is important in the development of Th2 inflammatory responses. The aim of this study was to investigate the interaction between airborne fungi and nasal fibroblasts in TSLP mRNA and protein expression. METHODS: Inferior turbinate and nasal polyp fibroblasts were stimulated with Alternaria and Aspergillus, respectively, for 48 hours, and TSLP mRNA and protein expressions were measured. The reverse transcriptase polymerase chain reaction was performed for the Toll-like receptor (TLR) mRNA expression of the nasal fibroblasts. To determine the role of TLR in the induction of TSLP, the fibroblasts were transfected with siRNA against TLR2 and TLR5. RESULTS: Alternaria induced TSLP mRNA and protein expression in both inferior turbinate and nasal polyp fibroblasts. The nasal polyp fibroblasts responded more strongly to the fungi. TLR2 and TLR5 mRNA expressions were significantly increased with fungal stimulation and TSLP production was significantly inhibited by siRNA against TLR2. CONCLUSIONS: The results of this study show that TSLP expression could be induced in nasal fibroblasts by exposure to Alternaria and that TLR2 may be involved in the process. The promotion of TSLP production in nasal fibroblasts by airborne fungi may facilitate the development or exacerbation of Th2-type nasal inflammation, especially in CRS with nasal polyps.

A Case of Early Developed Labyrinthine Fistula after Canal Wall Down Mastoidectomy / 대한평형의학회지

Labyrinthine fistula refers to a condition caused by an abnormal connection between the inner ear and surrounding structures. Most cases of that occur as a result of a complication brought about by cholesteatoma. It may also be generated by long repeated infections of a mastoid cavity that has been exposed to the outside after canal wall down mastoidectomy (CWDM). The infection is usually repeated for several years or decades after surgery. Therefore, labyrinthine fistula after CWDM is known as a late complication. In this case, labyrinthine fistula occurred in two months after surgery due to postoperative infection. Although cholesteatoma was removed after CWDM and the horizontal semicircular canal (HSCC) was not damaged during the operation, this labyrinthine fistula was thought to develop very early after surgery. Two months after surgery, the patient complained of dizziness, we identified the opened bony labyrinth and damaged endosteum of the HSCC in the patient.

Therapeutic Effects of Zinc on Patients Who Have Sudden Sensorineural Hearing Loss with Normal Serum Zinc Level / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Zinc has antioxidant effect, anti-inflammatory effect and neuromodulative function. The purpose of this study was to investigate whether treatment with zinc can improve the outcome of sudden sensorineural hearing loss (SSNHL). SUBJECTS AND METHOD: The study group consisted of 143 patients diagnosed as SSNHL. Of the patients, 82 were given corticosteroid treatment (group Ct) and 61 were given oral zinc plus corticosteroid treatment (group Zn). In group Zn, serum zinc level was checked before treatment and the patients with normal serum zinc level were included. Hearing was assessed before therapy and at 2 weeks, 1 month and 2 months after the initiation of therapy. RESULTS: A significantly larger hearing gain in pure tone average (group Ct vs. group Zn=26.40 dB HL vs. 34.28 dB HL) and at 2000 Hz (group Ct vs. group Zn=24.93 dB HL vs. 33.60 dB HL) and 8000 Hz (group Ct vs. group Zn=11.64 dB HL vs. 20.66 dB HL) were seen in group Zn compared with the group Ct. CONCLUSION: Oral zinc supplementation may have beneficial effects in the treatment of SSNHL, especially at 2000 and 8000 Hz.

Transition from Canalolithiasis to Cupulolithiasis by the Head-Bending Posture and Canalith Repositioning by Using the Side-Lying Position in Benign Paroxysmal Positional Vertigo of Horizontal Semicircular Canal / 대한평형의학회지

Benign paroxysmal positional vertigo is the most common disease of the peripheral vestibular disorder. A 51-year-old man showed geotropic horizontal nystagmus in the head roll test. After head-bending posture, the nystagmus of the patient was changed to apogeotropic horizontal nystagmus in the head roll test. We concluded that transition of canalolithiasis into cupulolithiasis happened during head-bending posture. The cupulolithiasis was returned to canalolithiasis by using side-lying position with the affected ear downward for approximately 45 minutes.

A Case of Extranasopharyngeal Angiofibroma Originating from Superior Turbinate

Angiofibromas originate predominantly from the posterolateral wall of the nasopharynx and are typically seen in adolescent males, but they may also exist outside of the nasopharynx. Nine patients with extranasopharyngeal angiofibromas have been reported in Korea. The inferior turbinate was the most commonly affected site, and patients reported experiencing various nasal symptoms, such as epistaxis and nasal obstruction. Extranasopharyngeal angiofibroma arising from the superior turbinate is extremely rare and has not been reported to date. Recently we experienced a case of angiofibroma of the left superior turbinate in a 68-year-old male that was successfully treated with endoscopic surgery.

The Effect of Omnaris(R) on the Inflammatory Reaction and Mucin Gene Expression from Nasal Polyp Epithelial Cells / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Glucocorticoids are a potent anti-inflammatory agent. The au-thors conducted this study to investigate the effect of Omnaris(R) on suppression of inflammation induction and mucin gene expression in nasal polyp epithelial cells. SUBJECTS AND METHOD: Primary nasal polyp epithelial cells were stimulated by 5 ug/mL of streptococcal enterotoxin B (SEB) and lipopolysaccharide (LPS). To determine the effects of Omnaris(R), cells were pretreated with 200, 100, 10, 1 ng/mL of Omnaris(R). The anti-inflammatory effect of epithelial cells were confirmed by measuring interleukin (IL)-6, IL-8, and granulocyte-macrophage colony stimulating factor (GM-CSF), and mucin gene expressions were determined by real time PCR for MUC4, MUC5AC, MUC5B, MUC8. RESULTS: SEB and LPS enhanced the production of IL-6, IL-8, and GM-CSF from nasal polyp epithelial cells. The increased cytokine levels were significantly suppressed by Omnaris(R) at 100 and 10 ng/mL. The expressions of MUC4, MUC5AC, MUC5B, MUC8 mRNA, and MUC4 mRNA were increased by SEB and LPS, respectively. The increased expression of these mucin genes were significantly suppressed by 100, 10, and 1 ng/mL of Omnaris(R). CONCLUSION: Omnaris(R) significantly suppressed the production of chemical mediators and mucin gene expression, which indicated that Omnaris(R) is effective in improving and treating inflammatory diseases in the nasal cavity.

A Case of Intratympanic Membrane Congenital Cholesteatoma / 대한이비인후과학회지

Intratympanic membrane congenital cholesteatoma (ITMCC) is extremely rare in patients without previous trauma or surgery of the ear. There are multiple theories to the pathogenesis of middle ear congenital cholesteatoma but none are applicable for ITMCC. When the size of ITMCC is small, there are usually no ear symptoms. However, surgery is needed early, as in any other type of cholesteatoma, because early treatment before middle ear involvement enables enucleation without the need for other procedures such as myringoplasty. We report an incidental finding of a small pearl at the umbo in a 2-year-old boy. The cholesteatoma involved only the outer epidermic layer of the tympanic membrane (TM). A transcanal approach was performed and the cholesteatoma was enucleated from TM.

Comparison of the Efficacy of Systemic and Combined Highly Frequent Intratympanic Steroid Treatment on Sudden Sensorineural Hearing Loss

BACKGROUND AND OBJECTIVES: Corticosteroids have been used for therapeutic management of sudden sensorineural hearing loss (SSNHL). Because of the complications associated with systemic steroid therapy and low levels of steroid in the inner ear after systemic administration, intratympanic steroid injection (ITSI) is currently used. The purpose of this study was to compare the efficacy of systemic steroid therapy with systemic combined high frequency ITSI therapy. SUBJECTS AND METHODS: Forty-six SSNHL patients were divided into the only systemic dexamethasone therapy group (systemic steroid IV group, 27 patients) and the systemic with frequent intratympanic dexamethasone injection group (combined ITSI group, 19 patients). In the systemic steroid IV group, dexamethasone was administered intravenously for 5 days followed by oral tapered doses for 10 days. In the combined ITSI group, intratympanic dexamethasone was administered 5 times per day for 5 consecutive days in addition to intravenous administration of dexamethasone. Hearing was assessed both before therapy and at 15 days, 4 weeks, and 8 weeks after the initiation of therapy. RESULTS: The recovery rate and hearing gain were 74% (20 out of 27 patients) and 33 dB mean improvement in the systemic steroid IV group and 73.6% (14 out of 19 patients) and 41.5 dB mean improvement in the combined ITSI group. There was no statistically significant difference in hearing gain and the recovery rate between the two groups. CONCLUSIONS: The therapeutic effect of a combination of highly frequently administered intratympanic dexamethasone and systemic steroid therapy was not superior to only systemic steroid injection therapy.

The Effects of Bee Venom on the Proliferation and Activation of Peripheral Blood Mononuclear Cells

BACKGROUND AND OBJECTIVES: Bee venom (BV) has been used as a traditional medicine to treat a variety of diseases, and the anti-inflammatory, antinociceptive, and anticancer activity of BV has been studied over the past few years. This study was designed to investigate the effects of BV on the production of cytokines by peripheral blood mononuclear cells (PBMCs) and on the proliferation of these cells. In addition, we investigated the potential cytotoxic effects of BV on PBMCs. MATERIALS AND METHODS: PBMCs from healthy human volunteers were stimulated with 5 microg/mL phytohaemagglutinin (PHA) and 10 microg/mL lipopolysaccharide (LPS) in the presence of different concentrations of BV. The cytotoxic effects of BV were measured using an aqueous cell proliferation assay kit and the supernatants were analyzed using an enzyme-linked immunosorbent assay. Tumor necrosis factor-alpha (TNF-alpha), interleukin-5 (IL-5), and interferon-gamma (INF-gamma) levels were measured to determine the activation status of PBMCs. RESULT: Although BV alone did not have a cytotoxic effect on PBMCs, PHA- and LPS-induced cytokine production was significantly inhibited by BV. TNF-alpha and INF-gamma production was inhibited by a lower concentration (0.5-1 microg/mL) of BV than IL-5 (6 microg/mL). CONCLUSION: BV seems to be relatively safe as a modulator of cytokine production by PBMCs. These experimental data suggest that BV could be used to treat immunologic and inflammatory diseases.

Effect of Bimodal Hearing in Speech Perception Under Noisy Environment According to Residual Hearing / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In this study, we evaluated the effect of bimodal hearing in the speech perception test and the increasing level of bimodal hearing over cochlear implantation in speech perception score regarding residual hearing. SUBJECTS AND METHOD: Nineteen prelingually deaf patients, who had used bimodal hearing over a period of 8 months, were divided in two groups in accordance to their low frequency residual hearing. The children were tested in open-set speech perception under +10 SNR and +20 SNR. The scores of bimodal hearing and unilateral cochlear implantation were compared by the Wilcoxon signed-rank test. Also, the increased level of speech perception scores of bimodal hearing over cochlear implantation alone were calculated using the formula, [bimodal score (%)-unilateral cochlear implantation (%)], and was compared between groups. RESULTS: In pure tone audiometry under silent condition, the result of bimodal hearing was similar to unilateral cochlear implantation in magnitude in both groups. Under the noisy condition, both groups had better result in bimodal hearing in terms of speech perception. Also, the increased level was higher in bimodal hearing over unilateral cochlear implantation in the better residual hearing group. However, since the sample size was small enough, it is considered that there was no statistical significance. CONCLUSION: Cochlear implanted patients with residual hearing are expected to get better speech perception in noisy environment with bimodal hearing regardless of the level of residual hearing.

Endoscopic Repairment of Septal Perforation with Using a Unilateral Nasal Mucosal Flap

OBJECTIVES: Nasal septal perforation is an anatomic defect of the cartilaginous and bone tissues of the nasal septum. Many approaches and techniques to repair nasal septal perforations have been reported on. The purpose of this paper is to report on our surgical technique and the results of the treatment for nasal septal perforations. METHODS: From May 2001 to March 2008, 14 patients (12 males and 2 females; mean age: 41.3 yr) were enrolled. The mean perforation size was 15 mm, and all the perforations were located at the cartilaginous portion. Our surgical technique is based on an endoscope-assisted endonasal approach, with dissection of unilateral advanced mucosal flaps with using a temporalis fascia graft. The follow-up periods ranged from 3 to 23 months (mean follow-up period: 8 months). RESULTS: Using our surgical technique on 14 patients, 12 cases (85.7%) of septal perforation were closed without complication. The remaining two patients (14.3%) had incomplete closures (about 2-3 mm) without any significant symptoms related to the remaining perforation. CONCLUSION: Our technique is a viable procedure with a high success rate for achieving closure of nasal septal perforations. It has the advantages of shortening the operative time, no external incision and avoiding any other perforation during the operation. Therefore, we consider it to be a good alternative for repairing nasal septal perforations.

A Case of Angiomyoma of the Inferior Turbinate

Vascular leiomyoma (Angiomyoma) is a benign tumor composed of smooth muscle cell and vascular endothelium. Most of them occur at the skin of the lower leg. Cases of vascular leiomyomas developing in the nasal cavity and paranasal sinuses are extremely rare. Most common symptoms are nasal obstruction, epistaxis and nasal pain but none are specific for diagnosis. Complete surgical excision is the treatment of choice and was used in all cases reported. Local recurrence rate is very low. We experienced a case of vascular leiomyoma in the inferior turbinate of a 70-year-old woman who complained of intermittent epistaxis. The tumor was successfully removed via an endoscopic approach. It displayed the characteristic histological findings of abundant thick-walled blood vessels blending with proliferative smooth muscle tissue.

Correlation Analysis between SF36 and Polysomnographic Measures in Patients with OSAS / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Despite the trend in the medical field to understand the effect of diseases on the quality of life, such a study regarding sleep apnea has not been prevailing in Korea. This study analyzed the result of a Medical Outcome Study Short Form-36 (SF-36), which is widely used to evaluate the effect of sleep apnea on patient's medical condition. SUBJECTS AND METHOD: This study included 131 patients of over 18 years of age and who participated in the SF-36 survey and finished the polysomnography study. The relationship between parameters was conducted with Spearman, and the comparison with the independent variables was done by running a paired t-test. RESULTS: AHI was on average 30.9+/-23.5 and BMI was on average 26+/-3.9 kg/m. Except body pain, all values which derived from the statistics of eight categories of SF-36 from the patients was significantly lower than those of the healthy control. In the comparable analysis of polysomnography and SF-36, AHI, the total sleep time, and the sleep efficacy (%) had significant correlation, but correlation coefficient was low (r<3.0). CONCLUSION: It is recommended that the quality of life of OSAS patients should be evaluated beside PSG in order to find out the degree of seriousness of OSAS and result of treatment.