Three Cases of Posterior Inferior Cerebellar Infarction Mimicking Acute Peripheral Vestibulopathy / 대한이비인후과학회지

Vestibular neuritis represents as a spinning type of dizziness accompanied by nausea, vomiting. Central vertigo such as cerebellar infarction may present with nonspecific symptoms similar to those of vestibular neuritis. Basilar artery supplies the cerebellum by branching out into superior cerebellar artery, anterior inferior cerebellar artery, and posterior inferior cerebellar artery. The patient had spinning type of vertigo, nausea, vomiting on the day of visit without any otologic symptoms. Only spontaneous nystagmus was observed. After admission, the patient's dizziness aggravated and emergency brain magnetic resonance imaging was performed. As a result, infarction in the posterior inferior cerebellar artery area was observed. Anticoagulant therapy was performed. Dizziness decreased, the follow-up imaging study showed improvement of the infarction, and the patient was discharged. We experienced three cases of PICA infarction presenting as peripheral types of dizziness, and therefore we are reporting the case.

A Promotive Effect of Low-Level Laser on Hair Cell Regeneration Following Gentamicin Induced Ototoxicity in Postnatal Organotypic Culture of Rat Utricles / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In normal postnatal mammalian inner ear sensory epithelium, regeneration of hair cells is a very rare event, but there is hair cell regeneration with partial restoration of the vestibular sensory epithelium following ototoxic damage. In this study, the effects of low-level laser on hair cell regeneration following gentamicin exposure in postnatal organotypic culture of rat utricles were investigated. MATERIALS AND METHOD: A long term organotypic culture of 2 to 7 day old rat utricular maculae was established to study aminoglycoside-induced vestibular hair cell renewal. The utricles were exposed to 1 mM of gentamicin for 48 hr and allowed to recover in a culture medium only or in a medium with daily irradiation of low-level laser, whereas the control group was not exposed to gentamicin. Whole-mount utricles were stained with FM1-43, which are known to be an efficient marker, to identify live hair cells in cultured tissues. RESULTS: Loss of hair cells was nearly stopped from 2 days after exposure to gentamicin ; a peak of regeneration was reached after 18 days and sustained for two weeks in the medium with the irradiation of low-level laser. CONCLUSION: These results suggest that low-level laser promotes spontaneous hair cell regeneration following gentamicin damage in utricular explants.

Results of Otolithic Function Testing and Related Clinical Features in Unilateral Definite Meniere's Disease

BACKGROUND AND OBJECTIVES: The purpose of this study is to identify the typical pattern of otolithic function tests in unilateral definite Meniere's disease patients. And we compared with clinical features and other tests results of patients who showed abnormal otolithic function tests. MATERIALS AND METHOD: We reviewed 42 patients (29 patients are female and 13 patients are male) who were diagnosed as unilateral definite Meniere's disease and underwent otolithic function tests in Hospital from December 2005 to April 2007. RESULTS: The patients who showed abnormal findings in vestibular evoked myogenic potential (VEMP) have suffered for longer period than the others. Those results of VEMP had positive correlation with summating potential/action potential (SP/AP) ratio. The average deviation of subjective visual vertical/ horizontal (SVV/SVH) were relatively higher in that disease patients than normal controls. There was no significant relation between VEMP results and other clinical features and result of other tests (caloric test and pure tone audiometry). CONCLUSION: The longer prevalence period of Meniere's disease is, the more susceptability of abnormal VEMP we can expect. In those, SVV/H can go out of normal range. Like a electrocochleography, otolithic function test could play a supportive role in diagnosing of Meniere's disease.

Correlation between Spontaneous Nystagmus and Vestibular Function Test Parameters according to Gender and Age in Vestibular Neuritis

BACKGROUND AND OBJECTIVES: There are caloric test, SCEP, DP in Step velocity and VOR asymmetry in SHA test as parameters for evaluation in unilateral peripheral vestibulopathy in parameter of vestibular function test. The aim of this study is to assess the correlation between these parameters and intensity of spontaneous nystagmus in vestibular neuritis. MATERIALS AND METHOD: We evaluated 75 patients who were diagnosed as vestibular neuritis with 3 degree spontaneous nystagmus at vestibular function test lab from January 2000 to July 2005 in Dankook university hospital. The correlations between direction and intensity of spontaneous nystagmus and monothermal caloric test, SCEP and DP in step velocity, VOR asymmetry (0.01, 0.04, 0.16 Hz) in SHA test were analysed. And correlations according to sex, age were also analysed. RESULTS: The correlation coefficient between intensity of spontaneous nystagmus and monothermal caloric test was 0.60. The correlation coefficient between intensity of spontaneous nystagmus and SCEP was 0.35. The correlation coefficient between intensity of spontaneous nystagmus and Tc DP was 0.36 and it showed no significant correlation. The correlation coefficient between intensity of spontaneous nystagmus and VOR asymmetry (0.01, 0.04, 0.16) was 0.57, 0.46, 0.51, respectively and there was higher correlation in man, age under 60. CONCLUSION: Intensity of spontaneous nystagmus showed close relations to monothermal caloric test, VOR asymmetry of SHA, Tc DP, SCEP DP in sequence. In addition, young male patients tends to be closely related to intensity of spontaneous nystagmus.

A Promotive Effect of Low Level Laser on Hair Cell Viability in Postnatal Organotypic Culture of Rat Utricles

BACKGROUND AND OBJECTIVES: To culture and maintain mammalian hair cells is still a big challenge. In this study, long-term organotypic culture of rat utricular maculae was established to study vestibular hair cell. The effects of low level laser on hair cell viability in postnatal organotypic culture of rat utricles were investigated. MATERIALS AND METHOD: Uticular explants were prepared from postnatal 2 to 7 rats and cultured. To improve hair cell survival, the utricles were irradiated daily with low level laser. Whole-mount utricles were stained with FM1-43 which is known to be an efficient marker to identify live hair cells in cultured tissues. Such cells visualized directly through tissue culture dish with cover glass bottom by Confocal laser scanning microscope at specific time points. RESULTS: The explanted utricular hair cells were cultured for up to 31 days in in vitro culture system. In low level laser irradiation group, utricular hair cells were more survived at 24 DIV and 31 DIV. CONCLUSION: These results suggest that low level laser promotes hair cell viability in utricular explants.

A Promotive Effect of Low Level Laser on Hair Cell Viability in Postnatal Organotypic Culture of Rat Utricles

BACKGROUND AND OBJECTIVES: To culture and maintain mammalian hair cells is still a big challenge. In this study, long-term organotypic culture of rat utricular maculae was established to study vestibular hair cell. The effects of low level laser on hair cell viability in postnatal organotypic culture of rat utricles were investigated. MATERIALS AND METHOD: Uticular explants were prepared from postnatal 2 to 7 rats and cultured. To improve hair cell survival, the utricles were irradiated daily with low level laser. Whole-mount utricles were stained with FM1-43 which is known to be an efficient marker to identify live hair cells in cultured tissues. Such cells visualized directly through tissue culture dish with cover glass bottom by Confocal laser scanning microscope at specific time points. RESULTS: The explanted utricular hair cells were cultured for up to 31 days in in vitro culture system. In low level laser irradiation group, utricular hair cells were more survived at 24 DIV and 31 DIV. CONCLUSION: These results suggest that low level laser promotes hair cell viability in utricular explants.

Clinical Features and Management of Dizziness in the Aged

BACKGROUND: Vertigo in the aged is relatively common but only a few studies are available. The purpose of this study is to analyze the clinical features and treatment outcome in aged patients. METHOD: A total of 240 patients of age over 70 with vertigo or dizziness who visited dizziness center of a tertiary care university hospital from January 1999 to January 2003 were studied. The patients' charts were retrospectively reviewed. Thorough otolaryngologic and neurotologic evaluations were performed in every case to determine the specific cause of dizziness. Electronystagmogram, rotating chair testing, and posturography were performed on all patients. The intensity of vertigo or dizziness was evaluated by questionnaires before and after the treatment. General vestibular rehabilitation therapy(VRT) was performed in 103 cases and it was not done on the other 46 cases. All the patients were treated with Ginko biloba. RESULTS: The average age was 76.5+/-6.2(70~88) years. In 153 case(63%), no specific causes for the vertigo or dizziness were found. The VRT group showed significant improvement in vertigo or dizziness compared to the non-VRT group by the VAS(verbal analogue scale) and ABC(Activities specific balance confidence scale) obtained three weeks and three months after the initiation of VRT. CONCLUSION: Many elderly patients with dizziness do not show any specific causes of dizziness other than old age(presbyastasis). General VRT seems to be effective treatment for this elderly group in addition to Ginkgo Biloba.

Clinical Features and Management of Dizziness in the Aged

BACKGROUND: Vertigo in the aged is relatively common but only a few studies are available. The purpose of this study is to analyze the clinical features and treatment outcome in aged patients. METHOD: A total of 240 patients of age over 70 with vertigo or dizziness who visited dizziness center of a tertiary care university hospital from January 1999 to January 2003 were studied. The patients' charts were retrospectively reviewed. Thorough otolaryngologic and neurotologic evaluations were performed in every case to determine the specific cause of dizziness. Electronystagmogram, rotating chair testing, and posturography were performed on all patients. The intensity of vertigo or dizziness was evaluated by questionnaires before and after the treatment. General vestibular rehabilitation therapy(VRT) was performed in 103 cases and it was not done on the other 46 cases. All the patients were treated with Ginko biloba. RESULTS: The average age was 76.5+/-6.2(70~88) years. In 153 case(63%), no specific causes for the vertigo or dizziness were found. The VRT group showed significant improvement in vertigo or dizziness compared to the non-VRT group by the VAS(verbal analogue scale) and ABC(Activities specific balance confidence scale) obtained three weeks and three months after the initiation of VRT. CONCLUSION: Many elderly patients with dizziness do not show any specific causes of dizziness other than old age(presbyastasis). General VRT seems to be effective treatment for this elderly group in addition to Ginkgo Biloba.

A Case of Synovial Sarcoma Arising in the Tongue Base / 대한이비인후과학회지

Synovial sarcoma (SS) is defined as a malignant biphasic tumor of soft tissue of uncertain histogenesis characterized by epithelial glands situated within a spindled fibrosarcomatous stroma. SS comprising 5.6-10% of primary adult soft tissue sarcomas are more prevalent in adolescents and young adults aged 15-40 years. About 85-95% of SS arise in the extremities, only 3-10% arise in the head and neck region and rarely presents in the tongue. Males are affected twice as often as females. The hypopharynx and retropharynx are the most common sites of involvement in the head and neck. Fewer than 100 cases of SS have been reported in the head and neck area. We experienced a 21-year-old male patient who first complained of oral bleeding and dysphagia. Initial transoral biopsy specimen of the tongue base lesion was consistent with sarcoma. Surgical excision through left modified neck dissection with tongue base tumor excision and postoperative radiotherapy were performed. We will introduce this rare case report of SS with a literature review.

Effectiveness of Esophagography as a Screening Test of LPR / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Laryngopharyngeal reflux (LPR), a most common cause of non-infectious laryngitis, occupies 20~30% of ENT outpatients, and over a half of patients who complains of voice disorder and laryngeal symptoms are associated with LPR. So we evaluate the usefulness of the esophagography as an initial screening test for patients suspected of LPR. SUBJECTIVES AND METHOD: From 2000 to 2002, we performed esophagography with water-siphon (WS) test for 540 patients with typical symptoms and telescopic findings. The results of esophagography were compared with those of 113 patients confirmed with gastroesohageal reflux (GER) and 174 patients without LPR or GER. The results of WS test were classified into normal, mild, moderate and severe according to the degree of reflux. RESULTS: In the WS test of LPR group, 48 patients were normal (8.9%), 166 mild (30.7%), 143 moderate (26.5%) and 183 severe degree of reflux (33.9%). We evaluated moderate and severe degree of reflux as having positive findings of the WS test because mild degree of reflux can be seen in physiologic conditions. In the LPR group, the positive ratio of WS test was 60.4%. In GER group, 12 patients were normal (10.6%), 30 mild (26.5%), 31 moderate (27.7%), 40 severe degree of reflux (35.4%) and 62.8% of positive WS test. In 174 patients without LPR or GER, 73 patients were normal (42.0%), 40 mild (23.0%), 17 moderate (9.8%) and 44 presented severe degree of reflux (25.2%). Fourty-two patients of the 540 LPR group (7.8%) showed esophageal lesions in esophagography. CONCLUSION: In literature, the sensitivity of esophagography is reported as 33%, but reflux provocation using the WS test increases the sensitivity over 60%. Also, esophagography can demonstrate esophageal abnormalities that might otherwise be missed. So we confirmed the effectiveness of esophagography as a strong initial screening test for LPR.

A Clinicopathologic Study of Epiglottic and Vallecular Cysts / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The epiglottic and vallecular cysts are uncommon and almost benign lesions. Newman classified laryngeal cyst as an epithelial, tonsillar and oncocytic cyst (1984: Modified working classification). The purposes of this study are to find out the relationship between the anatomical location of cyst and the histopathology, and identify the effectiveness and advantages of CO2 laser excision of epiglottic and vallecular cysts. SUBJECT AND METHOD: A retrospective study of medical records was carried out for 34 patients with epiglottic and vallecular cysts. They underwent laryngomicroscopic surgery with CO2 laser between January 1995 and April 2003 at the Dankook university hospital. In this article, the authors review epiglottic and vallecular cysts from both the clinical and histopathological points of view. RESULTS: The epiglottic and vallecular cysts were more common in men than in women, and the mean age was 47 years old. The most common symptom was globus sensation in throat (67%). There was no complication such as bleeding or edema in all cases during operation and postoperative period. The mean hospital stay was 2 days. The epithelial cysts and tonsillar cysts were 28 and 6 cases, respectively. Most of epithelial cysts were located in lingual surface of epiglottis. All tonsillar cysts were located in the valleculae except for one case. We encountered recurrence in 2 cases, where the cysts ruptured during operation and reoperation was done. CONCLUSION: The most common histopathologic type of epiglottic cyst was epithelial cyst. However, that of vallecular cyst was tonsillar cyst. The CO2 laser excision was an effective modality for treatment of epiglottic and vallecular cysts.

Recurrent Episodic Vertigo Controlled by Phenytoin Sodium

BACKGROUND:Many patients with symptom of recurrent episodic vertigo can neither be diagnosed nor treated. The purpose of this study is to review clinical features of a group of patients with recurrent episodic vertigo that is not defined to specific diagnosis of vertigo and to test the effectiveness of phenytoin sodium in the patients. METHOD & MATERIAL:11 of 32 patients with recurrent vertigo not defined to specific diagnostic category of vertigo who visited dizziness center of a tertiary care university hospital from November 1995 to April 2004 were studied. The patient's charts were reviewed retrospectively. A thorough otolaryngologic and neurotologic evaluation was performed in every case to determine the specific cause of dizziness. Vestibular function test, hearing test, magnetic resonance imaging of brain, electroencephalogram, and 24 hour Holter EKG monitoring were performed in all cases. Consultations to psychiatrist and neurologist were obtained. All patients were treated with phenytoin sodium. RESULT:The results of the vestibular function test, audiogram, MRI of brain, electroencephalogram, 24-hr holter monitoring were normal. Any definitive diagnosis could not be reached to this group. Vertigo was controlled by phenytoin sodium in all 11 cases. CONCLUSION:We report a group of patients with recurrent episodic vertigo that is not defined to any specific diagnosis of vertigo. The vertigo symptom was controlled successfully by phenytoin sodium. This patients were diagnosed as benign episodic vertigo as a separate disease entity.

Clinical Analysis of the Laryngeal Leukoplakia / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Leukoplakia is a descriptive term designating a white patch or plaque of the mucosa and must be complemented by histology. The aim of this study was to analyze the laryngeal leukoplakia clinically. MATERIALS AND METHOD: 48 patients were included from 1995 to 2001. All presented themselves with laryngeal leukoplakia in telescopic examination. The available medical record are age, sex, duration of smoking, histopathological finding, treatment and follow up result. RESULTS: The patients were composed of 46 males and 2 females. There were 7 patients (15%) with specific diagnostic lesion (polyps, lymphoma, tuberculosis, chronic inflammation and papilloma), 19 patients (40%) with simple hyperplasia or hyperkeratosis, 4 patients (8%) with mild dysplasia, 2 patients (4%) with moderate dysplasia, 2 patients (4%) with severe dysplasia, 2 patients (4%) with carcinoma in situ, and 1 patient (2%) with microinvasive carcinoma and 11 patients with invasive squamous cell carcinoma. Rebiopsy was performed to 10 cases during follow up period. CONCLUSION: The results of our study show that the leukoplakia was presented in 15% of all cases with specific diagnostic lesion and that the patient was treated according to their specific diagnosis. Almost all of the case with precancerous conditions were cured with cord stripping, cordectomy or radiation therapy.

Clinical Analysis of Bilateral Vestibulopathy

From retrospective review of medical charts of patients diagnosed as bilateral vestibulopathy during the past seven years, this study investigated incidence, etiologies, symptoms, vestibular function test findings; electronystagmography (ENG) studies, rotatory chair testing, and posturography, and post-vestibular rehabilitation (VRT) follow-up results. we have an incidence of 1.2% of all the 3423 patients who have undergone vestibular function test. Ototoxicity was the first known etiology and we had a lot of patients of idiopathic bilateral vestibulopathy. Most patients in our study had experiences of sudden onset vertigo rather than slowly progressive symptoms. The most frequently complained symptoms were dysequilibrium and oscillopsia. Post-VRT courses were better in patients whose initial gain of vestibulo-ocular reflex(VOR) was high or ascending type.

Angiolymphoid Hyperplasia (Kimura`s Disease): A Case Report / 대한비뇨기과학회지

Angiolymphoid hyperplasia with eosinophilia (Kimura`s disease) is a pathologic term, given to a lesion starting usually as a papule or a cluster of papules in the skin of the head, neck and elsewhere of adults. This lesion is as extraordinary in its behavior as it is in its histology. Histologically, the characteristic features include abnormal vascular proliferations due to the growth of atypical histiocytic cells as the common dominator for all of these lesions. These lesions were apparently benign and can usually cured by surgical excision, adrenocorticosteroids and irradiation. Spontaneous remission also occurs. Herein, We report a case of this rare entity involving scrotum, reviewing the similar descriptions in western literature under various different headings.