Intratympanic injection for treatment of inner ear diseases

Intratympanic injection has emerged as a novel approach to bypass the blood-labyrinth barrier and effectively deliver drugs into the inner ear. This technique is used for treatment of various inner ear diseases and overcomes the limitations of systemic drug therapy. In this paper, we provide an overview of the application of intratympanic injection using steroids and gentamicin and highlight the major diseases and summarize the reported efficacy of this approach.Current Concepts: Intratympanic steroid injections have been used for treatment of various inner ear diseases, including sudden sensorineural hearing loss, Ménière disease, and tinnitus. Therapeutic effects of steroids include reducing inflammation, modulating the immune response, improving cochlear blood flow, and maintaining ion homeostasis. Intratympanic gentamicin injections are primarily used to minimize hearing loss and control vertigo symptoms in patients with Ménière disease. Gentamicin selectively injures vestibular hair cells with minimal ototoxicity compared with other aminoglycoside antibiotics.Discussion and Conclusion: Intratympanic injections offer several advantages, including targeted drug delivery, minimal systemic adverse effects, and rapid action. Reportedly, intratympanic steroid injections used as primary or salvage treatment are associated with positive outcomes in patients with sudden sensorineural hearing loss. Ménière disease also shows positive outcomes following intratympanic steroid and gentamicin injections. However, studies have reported conflicting results, and further research is required to standardize dosing and administration protocols. Intratympanic injections are a promising therapeutic option, and ongoing research is essential to optimize their efficacy and safety.

Treatment Efficacy of Various Maneuvers for Lateral Canal Benign Paroxysmal Positional Vertigo With Apogeotropic Nystagmus: A Randomized Controlled Trial

Objectives@#The aim of this study was to determine the most effective treatment approach by comparing the impacts of various otolith reduction techniques in patients with apogeotropic lateral semicircular canal benign paroxysmal positional vertigo (LC-BPPV). @*Methods@#We performed a multicenter randomized prospective study from January to December 2015, involving 72 consecutive patients with apogeotropic LC-BPPV. The patients were divided into three treatment groups: therapeutic head-shaking (group A), the Gufoni-Appiani maneuver (group B), and the cupulolith repositioning maneuver (CuRM; group C). Each group underwent evaluation and treatment up to the fourth week. Treatment success was defined as the disappearance of positional vertigo and nystagmus. @*Results@#This study included 72 patients (49 male and 23 female), with a mean (±standard deviation) age of 55.4±13.5 years. The mean duration of vertigo experienced prior to treatment was 3.9±4.4 days. The mean latency and duration of nystagmus were 2.7±3.0 seconds and 47.9±15.8 seconds, respectively. The overall treatment frequency was 2.0±0.9. The number of treatments differed significantly among the three groups (P0.05). However, CuRM was the only method with a 100% treatment success rate. @*Conclusion@#While no clear difference was observed among the three treatments for LC-BPPV, CuRM was found to be superior to the other approaches in the long term.

Machine Learning Models for Predicting the Occurrence of Respiratory Diseases Using Climatic and Air-Pollution Factors

Objectives@#. Because climatic and air-pollution factors are known to influence the occurrence of respiratory diseases, we used these factors to develop machine learning models for predicting the occurrence of respiratory diseases. @*Methods@#. We obtained the daily number of respiratory disease patients in Seoul. We used climatic and air-pollution factors to predict the daily number of patients treated for respiratory diseases per 10,000 inhabitants. We applied the relief-based feature selection algorithm to evaluate the importance of feature selection. We used the gradient boosting and Gaussian process regression (GPR) methods, respectively, to develop two different prediction models. We also employed the holdout cross-validation method, in which 75% of the data was used to train the model, and the remaining 25% was used to test the trained model. We determined the estimated number of respiratory disease patients by applying the developed prediction models to the test set. To evaluate the performance of each model, we calculated the coefficient of determination (R2) and the root mean square error (RMSE) between the original and estimated numbers of respiratory disease patients. We used the Shapley Additive exPlanations (SHAP) approach to interpret the estimated output of each machine learning model. @*Results@#. Features with negative weights in the relief-based algorithm were excluded. When applying gradient boosting to unseen test data, R2 and RMSE were 0.68 and 13.8, respectively. For GPR, the R2 and RMSE were 0.67 and 13.9, respectively. SHAP analysis showed that reductions in average temperature, daylight duration, average humidity, sulfur dioxide (SO2), total solar insolation amount, and temperature difference increased the number of respiratory disease patients, whereas increases in atmospheric pressure, carbon monoxide (CO), and particulate matter ≤2.5 μm in aerodynamic diameter (PM2.5) increased the number of respiratory disease patients. @*Conclusion@#. We successfully developed models for predicting the occurrence of respiratory diseases using climatic and air-pollution factors. These models could evolve into public warning systems.

MicroRNAs Related to Cognitive Impairment After Hearing Loss

Objectives@#. Our research group has previously demonstrated that hearing loss might be a risk factor for synaptic loss within the hippocampus and impairment of cognition using an animal model of Alzheimer disease. In this study, after inducing hearing loss in a rat model of Alzheimer disease, the associations of various microRNAs (miRNAs) with cognitive impairment were investigated. @*Methods@#. Rats were divided randomly into two experimental groups: the control group, which underwent sham surgery and subthreshold amyloid-β infusion and the deaf group, which underwent bilateral cochlear ablation and subthreshold amyloid-β infusion. All rats completed several cognitive function assessments 11 weeks after surgery, including the object-in-place task (OPT), the novel object recognition task (NOR), the object location task (OLT), and the Y-maze test. After the rats completed these tests, hippocampus tissue samples were assessed using miRNA microarrays. Candidate miRNAs were selected based on the results and then validated with quantitative reverse transcriptionpolymerase chain reaction (qRT-PCR) analyses. @*Results@#. The deaf group showed considerably lower scores on the OPT, OLT, and Y-maze test than the control group. The microarray analysis revealed that miR-29b-3p, -30e-5p, -153-3p, -376a-3p, -598-3p, -652-5p, and -873-3p were candidate miRNAs, and qRT-PCR showed significantly higher levels of miR-376a-3p and miR-598-3p in the deaf group. @*Conclusion@#. These results indicate that miR-376a-3p and miR-598-3p were related to cognitive impairment after hearing loss.

Novel Tie Method for the Fixation of a Brain Infusion Cannula in a Murine Model / 대한이비인후과학회지

Although brain infusion cannula is a good method to deliver compounds directly into the brain, fixation of the brain infusion cannula is essential for successful delivery. Dental cements and adhesive gel are the commonly used materials for fixation of the infusion cannula. However, these materials take time to harden and occasionally, fixation may fail. Therefore, we developed a novel method to fix the brain infusion cannula. Brain infusion cannulas were implanted into seven Wistar rats using the novel tie method. One, three, and seven days after the surgery, displacement of the brain infusion cannula and cerebrospinal fluid (CSF) leakage were evaluated in all the rats. None of the animals showed displacement of the brain infusion cannula or leakage of CSF at any point of time. In this study, we showed the successful results of the novel tie method for fixation of the brain infusion cannula, which needs no additional materials. It only requires a thread which is used for skin sutures.

Effect of Temporal Bone Fracture on the Prognosis of Benign Paroxysmal Positional Vertigo / 대한이비인후과학회지

Background and Objectives@#This study aimed to investigate whether benign paroxysmal positional vertigo (BPPV) accompanied by temporal bone fracture would be more resistant to canalith repositioning procedures (CRPs) than idiopathic BPPV.Subjects and Method Seventy-eight patients with BPPV were included in this study. Among them, 13 patients had temporal bone fractures and 65 had no temporal bone fractures. To identify the factors related to the number of CRPs performed until the remission of BPPV, sex, age, the presence of temporal bone fracture, hypertension, diabetes, dyslipidemia or osteopenia, BPPV affected side, and the type of affected semicircular canal were analyzed using the univariable regression analysis. Thereafter, the multivariable regression analysis was performed using only the variables that had a p-value of 0.2 or less in the univariable analysis. @*Results@#In the univariable analysis, temporal bone fracture, diabetes mellitus, and BPPV side showed relatively significant association with the number of CRPs (p<0.2). In the multivariable analysis, only temporal bone fracture showed a significant association with the number of CRPs (p=0.043, β=0.532, 95% CI: 0.017-1.046). @*Conclusion@#The major finding of this study is that BPPV, accompanied by temporal bone fracture, precipitated more resistance to CRPs than idiopathic BPPV did. Thus, patients with temporal bone fracture might need more intensive examination and treatment for BPPV than those without temporal bone fracture.

Residual Dizziness after Benign Paroxysmal Positional Vertigo / 대한이비인후과학회지

Benign paroxysmal positional vertigo (BPPV) is one of the most common diseases that cause dizziness. It can be resolved relatively easily using canalith-repositioning maneuvers. However, some patients suffer from dizziness even after successful canalith-repositioning. This is an atypical dizziness felt in the absence of typical nystagmus after resolution of BPPV and named residual dizziness. Otolithic organ disorder, anxiety and persistence of debris in the canal have been reported to be associated with residual dizziness. Although 31-61% of BPPV patients suffer from residual dizziness, residual dizziness has not yet been clearly known not only the treatment but also the pathophysiology. This article investigate the factors associated with residual dizziness and treatment and prediction methods for residual dizziness.

Losartan Prevents Maladaptive Auditory-Somatosensory Plasticity After Hearing Loss via Transforming Growth Factor-β Signaling Suppression

OBJECTIVES: Hearing loss disrupts the balance of auditory-somatosensory inputs in the cochlear nucleus (CN) of the brainstem, which has been suggested to be a mechanism of tinnitus. This disruption results from maladaptive auditory-somatosensory plasticity, which is a form of axonal sprouting. Axonal sprouting is promoted by transforming growth factor (TGF)-β signaling, which can be inhibited by losartan. We investigated whether losartan prevents maladaptive auditory-somatosensory plasticity after hearing loss. METHODS: The study consisted of two stages: determining the time course of auditory-somatosensory plasticity following hearing loss and preventing auditory-somatosensory plasticity using losartan. In the first stage, rats were randomly divided into two groups: a control group that underwent a sham operation and a deaf group that underwent cochlea ablation on the left side. CNs were harvested 1 and 2 weeks after surgery. In the second stage, rats were randomly divided into either a saline group that underwent cochlear ablation on the left side and received normal saline or a losartan group that underwent cochlear ablation on the left side and received losartan. CNs were harvested 2 weeks after surgery. Hearing was estimated with auditory brainstem responses (ABRs). Western blotting was performed for vesicular glutamate transporter 1 (VGLUT1), reflecting auditory input; vesicular glutamate transporter 2 (VGLUT2), reflecting somatosensory input; growth-associated protein 43 (GAP-43), reflecting axonal sprouting; and p-Smad2/3. RESULTS: Baseline ABR thresholds before surgery ranged from 20 to 35 dB sound pressure level. After cochlear ablation, ABR thresholds were higher than 80 dB. In the first experiment, VGLUT2/VGLUT1 ratios did not differ significantly between the control and deaf groups 1 week after surgery. At 2 weeks after surgery, the deaf group had a significantly higher VGLUT2/VGLUT1 ratio compared to the control group. In the second experiment, the losartan group had a significantly lower VGLUT2/VGLUT1 ratio along with significantly lower p-Smad3 and GAP-43 levels compared to the saline group. CONCLUSION: Losartan might prevent axonal sprouting after hearing loss by blocking TGF-β signaling thereby preventing maladaptive auditory-somatosensory plasticity.

Can A Sudden Sensorineural Hearing Loss Occur Due to Miliary Tuberculosis?

Miliary tuberculosis is a severe form of tuberculosis resulting from dissemination of Mycobacterium tuberculosis bacilli. Since symptoms appearing in patients due to miliary TB are diverse and atypical, depending on the site of invasion, early diagnosis and treatment are important. A paradoxical response of tuberculosis is a rare phenomenon and it can be a clinical difficulty to treatment especially when involving the central nervous system. We present a case report with a review of related literature about the patient who developed sudden hearing loss due to tuberculosis infection in vestibulocochlear area.

The Anti-Inflammatory Effects of Oral-Formulated Tacrolimus in Mice with Experimental Autoimmune Encephalomyelitis

Multiple sclerosis (MS) is a T-lymphocyte-mediated autoimmune disease that is characterized by inflammation in the central nervous system (CNS). Although many disease-modifying therapies (DMTs) are presumed effective in patients with MS, studies on the efficacy and safety of DMTs for preventing MS relapse are limited. Therefore, we tested the immunosuppressive anti-inflammatory effects of oral-formulated tacrolimus (FK506) on MS in a mouse model of experimental autoimmune encephalomyelitis (EAE). The mice were randomly divided into 3 experimental groups: an untreated EAE group, a low-dose tacrolimus-treated EAE group, and a high-dose tacrolimus-treated EAE group. After autoimmunization of the EAE mice with myelin oligodendrocyte glycoprotein, symptom severity scores, immunohistochemistry of the myelination of the spinal cord, and western blotting were used to evaluate the EAE mice. After the autoimmunization, the symptom scores of each EAE group significantly differed at times. The group treated with the larger tacrolimus dose had the lowest symptom scores. The tacrolimus-treated EAE groups exhibited less demyelination and inflammation and weak immunoreactivity for all of the immunization biomarkers. Our results revealed that oral-formulated tacrolimus inhibited the autoimmunization in MS pathogenesis by inactivating inflammatory cells.

A Case of Subdural Hematoma due to Brandt-Daroff Habituation Excercise / 대한이비인후과학회지

Subdural hematoma is a common disease of intracranial hemorrhage that accounts for 11-21% of all head trauma patients. It is defined as a hematoma that develops between dura mater and subarachnoid space. In elder patients, mild trauma may not always be accurately recognized and symptoms may not develop slowly due to the large area of subdural space. Headache is the most common symptom of subdural hematoma and may be associated with hemiplegia, dysarthria, sensation disorder, conscious disorder, and etc. We present, with a literature review, a case of a patient who developed subacute subdural hematoma after performing Brandt-Daroff habituation exercise to treat benign paroxysmal positional vertigo.

Expression of CAIII and Hsp70 Is Increased the Mucous Membrane of the Posterior Commissure in Laryngopharyngeal Reflux Disease

PURPOSE: We tried to evaluate the difference in the expression of carbonic anhydrase (CA) III and heat shock protein (Hsp) 70 between laryngopharyngeal reflux disease (LPRD) and non-LPRD patients. MATERIALS AND METHODS: The study involved 28 patients who underwent laryngeal microsurgery due to benign laryngeal disease from March to August 2008. Reflux symptom index (RSI) and reflux finding score (RFS) were measured for each person, and they were assigned either to the LPRD group (n=10) or non-LPRD group (n=18). Tissue samples were obtained from the mucosa of posterior commissure, and immunohistochemistry (IHC) staining of CAIII and Hsp70 was performed. The IHC scores were measured and compared with clinical features including RSI and RFS. RESULTS: Total 10 patients were assigned as LPRD group, and 18 patients were as control group. The mean IHC score of CAIII and Hsp70 was 1.70+/-1.06 and 1.90+/-0.88, respectively, in LPRD patients, whereas the mean IHC score of CAIII and Hsp70 was 0.78+/-0.73 and 0.94+/-0.87, respectively, in non-LPRD patients. The difference between two groups was statistically significant (p<0.05). CONCLUSION: CAIII and Hsp70 expressions were higher in LPRD patients that in non-LPRD patients, suggesting the possibility as one of biomomarker in LPRD diagnosis.

Efficacy and Safety of Hyaluronic Acid with and without Radiofrequency for Forehead Augmentation: A Pilot Study Using Three-Dimensional Imaging Analysis

No abstract available.

Leptomeningeal Carcinomatosis of Gastric Cancer Misdiagnosed as Vestibular Schwannoma

Gastric cancer is one of the most common causes of cancer-related death in Asian countries, including Korea. We experienced a case of leptomeningeal carcinomatosis (LC) from gastric cancer that was originally misdiagnosed as vestibular schwannoma based on the similar radiological characteristics. To our knowledge, LC from gastric cancer is very rare. In conclusion, our experience with this case suggests that clinicians should consider the possibility of delayed leptomeningeal metastasis when treating patients with gastric cancer.

Multicenter Study on the Clinician's Diagnostic and Therapeutic Approaches for Benign Paroxysmal Positional Vertigo in Korea / 대한평형의학회지

BACKGROUND AND OBJECTIVES: It is necessary to establish the most efficient diagnostic and therapeutic method for benign paroxysmal positional vertigo (BPPV), which is appropriate for Korean healthcare system. We aimed to evaluate current state of Korean clinician's diagnostic and therapeutic approaches for BPPV. MATERIALS AND METHODS: A 16-item survey was emailed to the members of dizziness department of Otology Research Interest Group in the Korean Otologic Society (n=68). 43 were returned and analyzed. RESULTS: All respondents (100%) used Dix-Hallpike test as a diagnostic tool for vertical canal-BPPV. Supine roll test was used for diagnosing lateral canal BPPV in nearly all the respondents (97.7%). Epley maneuver was chosen as otolith repositioning maneuver (ORM) for posterior canal BPPV in all respondents and barbecue rotation (BBQ) was used for treating lateral canal BPPV with geotropic nystagmus in 95.3% of respondents. Extreme variation was noted for therapeutic approach of lateral canal BPPV with ageotropic nystagmus BBQ, with 4 kinds of ORM and adjunctive measures to liberate otolith from cupula, while BBQ was again the most commonly used ORM (76.7%). CONCLUSION: The development of practical and efficient ORM for lateral canal BPPV with ageotropic nystagmus is necessary.

A Case of Arachnoid Cyst Causing Unilateral Sudden Hearing Loss / 대한이비인후과학회지

Arachnoid cyst develops due to cerebrospinal fluid increase in the subarachnoid space and is mostly located in the middle cranial fossa, which may be associated with non-specific symptoms such as headache, unsteadiness and ataxia. However, it rarely occurs in the posterior cranial fossa and is mostly asymptomatic. When symptoms do develop, they are usually headache and psychomotor retardation, which make diagnosis very difficult. Diagnosis is generally made through magnetic resonance imaging and surgical treatment is indicated for cases where there are displacement and compression of its surrounding neurovascular component, and aggravation of symptoms. We present a case of unilateral sudden hearing loss possibly developing from an arachnoid cyst in the posterior cranial fossa with a review of literatures.

A Case of Fungal Sphenoid Sinusitis with Visual Loss / 대한의진균학회지

The maxillary sinus is the most commonly affected in the fungal infection of the sinus, but sphenoid sinus is only occasionally occurred. Because of the adjacent structures in sphenoid sinus, however, its complication may cause fatal outcome. Visual loss due to optic neuritis, which is defined as an inflammatory neuropathy of the optic nerve, is extremely rare, which may occur via direct spread of fungus. We experienced a case of fungal sphenoid sinusitis, which damaged the optic nerve and led to visual loss in a 74 year-old male. It was treated by endoscopic sinus surgery with steroid therapy. We present this case with a brief review of these disease's entities.

The Measurement of Optimal Power Distance in LEDs / 대한피부과학회지

BACKGROUND: The use of light technology in dermatology has grown rapidly over the last decade, with many developments in its use for the treatment of a wide variety of skin conditions from non-melanoma skin cancers to facial resurfacing for photo-damaged skin. Light-emitting diodes (LEDs) have attracted much attention in medical fields. OBJECTIVE: (1) To assess the optimal distance of 630 nm LEDs (OmniLux(R), (Phototherapeutics Ltd, the UK)) and 830 nm LEDs (Healite(R) (Lutronic, Korea)) for maximum power as determined by a power meter and (2) to apply theory to practical use. METHODS: Two separate hinged planar light emitting diode arrays were studied: 1) the Omnilux Revive(TM) (Phototherapeutics Ltd, the UK), which delivers non-coherent red light at a wavelength of 633+/-3 nm and 2) the Lutronic Healite (Korea), which delivers non-coherent light at a wavelength of 830+/-5 nm. An X93 power meter (Gigahertz-Optik, Germany) was placed against a black background in order to reduce the amount of reflected light. We measured the LED powers over a range of 3~25 cm in 1 cm increments. RESULTS: On the irradiation side of the LED, power increases according to the mass effect of the radiation angle. However, at a certain distance, the power decline effect predominated over the amassment effect. In this respect, the LED light was estimated to be emitted in a reverse V shape. The proper irradiation distance for use in medical fields can thus be determined. CONCLUSION: The proper irradiation distance of LED will be useful and the proper use of LED under the subjects' shape will be done in many medical fields.

Distribution of Malassezia Species on the Scalp in Korean Seborrheic Dermatitis Patients

BACKGROUND: Malassezia species play an important role in the pathogenesis of seborrheic dermatitis. In particular, M. restricta and M. globosa are considered to be the predominant organisms in seborrheic dermatitis of Western countries. However, species distribution of Malassezia in seborrheic dermatitis has not been clearly determined yet in Asia. OBJECTIVE: To identify the distribution of Malassezia species on the scalp of seborrheic dermatitis patients in Korea using 26S rDNA PCR-RFLP analysis. METHODS: A total of 40 seborrheic dermatitis patients and 100 normal healthy volunteers were included in this study. For the identification of Malassezia species, the scalp scales of the subjects were analyzed by 26S rDNA PCR-RFLP analysis. RESULTS: The most commonly identified Malassezia species were M. restricta in the seborrheic dermatitis patients, and M. globosa in the normal controls. In the seborrheic dermatitis group, M. restricta was identified in 47.5%, M. globosa in 27.5%, M. furfur in 7.5%, and M. sympodialis in 2.5% of patients. In the healthy control group, M. globosa was identified in 32.0%, M. restricta in 25.0%, M. furfur in 8.0%, M. obtusa in 6.0%, M. slooffiae in 6.0%, and M. sympodialis in 4.0% of subjects. CONCLUSION: M. restricta is considered to be the most important Malassezia species in Korean seborrheic dermatitis patients.

A Case of Acute Aggravation of Fungal Maxillary Sinusitis after Zygomaplasty / 대한의진균학회지

In patients with sinusitis, nasal obstruction and purulent discharge from the maxillary sinus are frequently observed. Mostly, it responds to antibiotic treatment. But in case of not responding, although fungal infection is a rare entity, we have to consider fungal sinusitis. We recently experienced a case of acute aggravation of fungal maxillary sinusitis after zygomaplasty. Endoscopic sinus surgery was performed and foreign materials were observed inside the right maxillary sinus. They were gauzes, which had been used during previous surgery. Intraoperative examination demonstrated a dark brown, cheese-like material in the sinus. After surgery, the patient's symptoms disappeared gradually. The culture examination identified the surgical sample to be Trichosporon asahii. So we reported with a review of literature.