Alpha-Defensin 1: An Emerging Periodontitis Biomarker.

Background: Research on the development of reliable diagnostic targets is being conducted to overcome the high prevalence and difficulty in managing periodontitis. However, despite the development of various periodontitis target markers, their practical application has been limited due to poor diagnostic accuracy. In this study, we present an improved periodontitis diagnostic target and explore its role in periodontitis. Methods: Gingival crevicular fluid (GCF) was collected from healthy individuals and periodontitis patients, and proteomic analysis was performed. The target marker levels for periodontitis were quantified in GCF samples by enzyme-linked immunosorbent assay (ELISA). Mouse bone marrow-derived macrophages (BMMs) were used for the osteoclast formation assay. Results: LC-MS/MS analysis of whole GCF showed that the level of alpha-defensin 1 (DEFA-1) was higher in periodontitis GCF than in healthy GCF. The comparison of periodontitis target proteins galactin-10, ODAM, and azurocidin proposed in other studies found that the difference in DEFA-1 levels was the largest between healthy and periodontitis GCF, and periodontitis was more effectively distinguished. The differentiation of RANKL-induced BMMs into osteoclasts was significantly reduced by recombinant DEFA-1 (rDEFA-1). Conclusions: These results suggest the regulatory role of DEFA-1 in the periodontitis process and the relevance of DEFA-1 as a diagnostic target for periodontitis.

Role of cathepsin D induced by Porphyromonas gingivalis lipopolysaccharide in periodontitis.

Periodontitis is an inflammatory disease of tooth-supporting tissues caused by oral bacteria. Periodontal ligament loss and alveolar bone destruction occur in progressive periodontitis. Since gingival crevicular fluids (GCF) reflects the inflammatory environment of the periodontal pocket, it is a very important specimen for developing targets for periodontitis diagnosis. An antibody array was performed using GCF collected from healthy participants and patients with periodontitis to identify the proteolytic enzymes involved in periodontitis. Of 21 targets on the antibody array membrane, kallikrein 6 (KLK6), kallikrein 10 (KLK10), cathepsin A (CathA), and cathepsin D (CathD) showed higher levels in periodontitis GCF than in GCF from healthy participants. Lipopolysaccharide stimulation of Porphyromonas gingivalis (PG-LPS) in immortalized gingival fibroblasts only increased CathD protein levels among the four targets. The substrate cleavage activity of CathD was increased in PG-LPS-treated immortalized gingival fibroblast extract. The PG-LPS-induced substrate cleavage effect was abolished by the CathD inhibitor pepstatin A. Osteoclast formation was promoted by treatment with conditioned media from PG-LPS- treated immortalized gingival fibroblasts but inhibited by the CathD inhibitor pepstatin A. These results suggest that PG-LPS affected the osteoclast formation process by increasing CathD expression in cells around the alveolar bone, thereby participating in periodontitis progression.

Efficacy of nasal septal splints for preventing complications after septoplasty: A meta-analysis.

BACKGROUND: The efficacy of nasal septal splints, which are used as alternatives to nasal packs for preventing complications such as synechia and maintaining septal stability after septoplasty, remains controversial. The present meta-analysis assessed the efficacy and safety of nasal septal splints used after septoplasty. METHODS: PubMed and Google Scholar databases were systematically searched until June 20, 2019. Randomized controlled trials or cohort or case-control studies comparing patients who received nasal septal splints with those who did not receive splints after septoplasty were included. Primary outcomes included postoperative pain, infection, bleeding, hematoma formation, synechia, and perforation. Random effects models were used to calculate risk differences and risk ratios with 95% confidence intervals (CIs). RESULTS: Thirty-three eligible studies were included. The estimated rate of synechia was significantly lower in the splint group (0.037, 95% CI 0.024-0.056) than in the no splint group (0.087, 95% CI 0.055-0.135; P = 0.003), while visual analog scale scores for pain and the estimated rates of infection, bleeding, hematoma, and perforation were comparable between groups. CONCLUSIONS: These findings suggest that the use of nasal septal splints as alternatives or in addition to nasal packing prevent synechia after septoplasty without increasing other complications, including pain, thus adding to evidence supporting the use of septal splints, particularly in cases where postoperative synechia is expected.

Tinnitus in the side with better hearing.

OBJECTIVES: We aimed to confirm the characteristics of patients with tinnitus in the better-hearing side. MATERIALS AND METHODS: Among the 778 patients who visited the tinnitus clinic complaining of unilateral tinnitus at a local university hospital between March 2014 and December 2017, we recruited 62 patients who showed tinnitus in the better-hearing side on pure-tone audiometry. The mean hearing threshold was calculated using the arithmetic mean of the pure tone thresholds at 1, 2, 3, and 4 kHz. In addition, patients' medical history, tinnitus questionnaires, and other audiologic test results were thoroughly analyzed together for diagnosis. RESULTS: Fluctuating hearing loss without vertigo or Ménière's disease were the most common etiologies (n = 16, 25.8%), followed by high-frequency hearing loss (n = 13, 21.0%), sudden idiopathic hearing loss (n = 6, 9.7%), and presbycusis (n = 6, 9.7%). Somatosensory tinnitus was also observed in seven patients. Neck pain was associated with tinnitus in five patients (8.1%), and two other patients (3.2%) experienced temporomandibular disorder in the same side as the tinnitus. CONCLUSION: Tinnitus was associated with deterioration of hearing even when it occurred in the better-hearing side. Among the possible etiologies, fluctuating hearing loss in the tinnitus side was the most common audiologic finding. Assessment of hearing level at each frequency was more effective in detecting high-frequency hearing loss rather than the use of the mean hearing level. In addition, somatosensory tinnitus should not be ignored.

Characteristics of Stimulus Intensity in Transcutaneous Vagus Nerve Stimulation for Chronic Tinnitus.

OBJECTIVES: We aimed to assess the clinical significance of the intensity of transcutaneous vagus nerve stimulation (tVNS) in chronic tinnitus. MATERIALS AND METHODS: Four sessions of tVNS were performed over a 2-week period for 24 patients with unilateral, non-pulsatile chronic tinnitus. The cavum, cymba, and tragus were sequentially stimulated to the maximal sensory thresholds. One month later, after the four sessions, the level of tinnitus distress and changes in stimulus intensity were assessed. RESULTS: The stimulus intensity did not differ according to sex or laterality. However, a moderate positive correlation between tinnitus distress and the initial stimulus intensity was observed. This correlation was not observed during the subsequent sessions. The stimulus intensity at the cavum changed significantly (p=0.018), and notable differences in tinnitus annoyance were observed between the responders and non-responders (p=0.006). CONCLUSION: The effect of stimulus intensity on the treatment outcome seems to be limited. An increasing trend in the stimulus intensity for tinnitus annoyance at the cavum was observed in the responders. Therefore, the cavum may be an optimal stimulation site for tVNS.

Audiometric Profiles in Patients With Normal Hearing and Bilateral or Unilateral Tinnitus.

HYPOTHESIS: Patients with subjective nonpulsatile tinnitus and a normal conventional audiogram have more objective audiologic evidence of hidden hearing loss and deafferentation-related pathology than patients without tinnitus. BACKGROUND: The aim of this study was to assess the epidemiologic characteristics and audiologic profiles, including auditory brainstem response (ABR), distortion product otoacoustic emission, and threshold-equalizing noise test results, in patients with tinnitus and a normal audiogram. METHODS: The test results for 20 patients complaining of nonpulsatile chronic tinnitus were compared with those of 91 subjects with normal hearing and no tinnitus. RESULTS: Patients with unilateral tinnitus had higher tinnitus handicap inventory scores than those with bilateral tinnitus (p < 0.05). Threshold-equalizing noise tests were normal in all study participants. In patients with unilateral tinnitus, the ABR and distortion product otoacoustic emission test results were similar to those of controls. In contrast, patients with bilateral tinnitus showed a shortening of latency in wave III of the ABR on the right (p = 0.047) and in wave V on the left (p = 0.024). Logistic regression analysis revealed that enhanced wave III/I (p = 0.018) and V/I (p = 0.012) ratios on the left and poorer pure-tone average on the right were significant risk factors for bilateral tinnitus. CONCLUSION: The mechanism involved in the development of tinnitus may depend on its laterality. Bilateral tinnitus may be associated with hyperactivity at the level of the cochlear nucleus whereas a higher-order cortical area may be involved in unilateral tinnitus.

Characteristics of patients with acute peripheral facial palsy showing Varicella zoster virus DNA in saliva.

Infection caused by Varicella zoster virus (VZV) is a common etiology of acute peripheral facial palsy (APFP). We aimed to assess the clinical significance of detecting VZV DNA from the saliva of patients with APFP. Saliva collected from 36 patients with unilateral APFP at initial visit was analyzed to detect VZV DNA by polymerase chain reaction. The House-Brackmann (HB) scale was used to evaluate FP severity on admission day, at week 2, and at weeks 10-12 after start of treatment. Among the 28 patients without rash, VZV DNA was detected in 3 patients (10.7%); 6 of 8 patients (75.0%) with rash showed VZV DNA (P = 0.001). VZV DNA-positive patients had worse hearing than VZV DNA-negative patients (P < 0.05). A significantly higher proportion of VZV DNA-negative patients (96.3%) showed complete recovery than VZV DNA-positive patients (55.6%) (P = 0.006). In conclusion, VZV DNA-positive patients had worse hearing and incomplete recovery compared to VZV DNA-negative patients, irrespective of the presence of rash. Tests for the detection of VZV DNA in saliva may be helpful for early differential diagnosis and choosing an appropriate medical treatment of APFP.

Esthetic nasolabial angle according to the degree of upper lip protrusion in an Asian population.

BACKGROUND: The positioning of the nasal tip is as esthetically important as the tip projection when rhinoplasty is being considered. It is not uncommon for Asians to have a protruding upper lip and teeth that affect the nasolabial angle (NLA). This study aimed to find the preferred NLA according to the degree of upper lip protrusion in an Asian population. METHODS: A left-side lateral photograph of each participant was used for simulation of six different tip angles by using a photoshop program. First, the angles of the upper lip protrusion were changed into 10, 20, and 30° by a perpendicular line to the Frankfort line in each image; then, the NLAs were changed into six different angles (from 75 to 110°) for each of the three angles of upper lip protrusion for each model. Newly transformed images of nasal tips, six for the male model and six for the female model, were made by using presentation software slides and were placed in a random order. Then, 120 Korean raters were asked to choose the most preferred image from among the slides. RESULTS: In 10° of upper lip protrusion, the preferred mean ± standard deviation (SD) NLAs for the male and female models were 88.7 ± 6.4° and 92.9 ± 6.9°, respectively. In 20° of upper lip protrusion, the preferred mean ± SD NLAs for the male and female models were 80.9 ± 6.9° and 83.9 ± 5.7°, respectively. In 30° of upper lip protrusion, the preferred mean ± SD NLAs for the male and female models were 78.4 ± 5.5° and 79.0 ± 5.4°, respectively. CONCLUSION: In an Asian population, the preferred NLA was changed to a more acute angle according to the degree of upper lip protrusion.

Combined Bifrontal Transcranial Direct Current Stimulation and Tailor-Made Notched Music Training in Chronic Tinnitus.

BACKGROUND AND OBJECTIVES: We evaluated the short-term treatment outcomes of combined bifrontal transcranial direct current stimulation (tDCS) and tailor-made notched music training (TMNMT) in tinnitus patients. The associations of patient characteristics with treatment responsiveness were investigated. SUBJECTS AND METHODS: Four sessions of bifrontal tDCS (F4: anode, F3: cathode) and TMNMT were conducted over a 2-week period in tinnitus patients. For tDCS, the stimulation intensity was 1.5 mA and the duration was approximately 20 min. During tDCS, patients listened to music lacking the frequency band within 1 octave of the tinnitus frequency. Patients were also instructed to listen to this music at home for at least 2 hours per day. One month after the final tDCS session, loudness (LD), awareness (AW), annoyance (AN), and effect on life (EL) of tinnitus were assessed subjectively using a visual analog scale. RESULTS: A total of 14 patients were enrolled in this study. After treatment, a 50% or greater improvement in AN, AW, EL, and LD was observed in 57.1, 42.9, 35.7, and 28.6% of patients, respectively. Furthermore, 78.6% of patients showed a 50% or greater improvement in their tinnitus handicap inventory scores. For AN, the absence of sleep disturbance was significantly associated with treatment responsiveness (p=0.041, OR=24.0). CONCLUSIONS: Combined bifrontal tDCS and TMNMT is a promising treatment for chronic tinnitus. To maximize the treatment outcomes of this therapy, sleep disturbances should also be addressed in candidate patients.

Magnetic resonance imaging predicts chronic dizziness after benign paroxysmal positional vertigo.

OBJECTIVES: We aimed to evaluate the clinical implications of magnetic resonance imaging (MRI) findings in patients with benign paroxysmal positional vertigo (BPPV). METHODS: A total of 120 patients diagnosed with BPPV completed MRI at the emergency room between December 2012 and June 2015 and met our criteria for inclusion in this study. Epidemiologic characteristics, the results of audio-vestibular testing, and MRI findings were retrospectively analyzed. RESULTS: The most common findings were white matter hyperintensities (70.0%), sinusitis (34.2%), and brain atrophy (25.0%). There were no significant differences in MRI findings or epidemiologic characteristics according to BPPV subtype (p>0.05). A multiple regression analysis revealed that BPPV recurrence (odds ratio, 6.88; 95% confidence interval, 1.67-34.48; p=0.009) and brain atrophy (odds ratio, 4.39; 95% confidence interval, 1.11-21.28; p=0.036) were positively associated with dizziness lasting longer than 3months. CONCLUSION: Brain atrophy was independently associated with long-lasting dizziness after BPPV. Although the mechanism is unclear, brain atrophy may have relevance to otoneurotologic disease-related changes in brain structure.

Intralesional triamcinolone injections for the treatment of preauricular sinus infections.

OBJECTIVES: The aim of this study is to confirm the effect of adjuvant intralesional triamcinolone acetonide injections (TRIAM) for the treatment of an infected preauricular sinus (PAS). METHODS: The medical charts of 103 patients diagnosed with PAS from March 2013 to December 2015 were reviewed and documented. The mean duration of treatment and postoperative follow-up period were compared between patients who received TRIAM and patients who received conventional treatment. RESULTS: Fifteen patients received TRIAM. The mean duration of treatment was 12.5±11.0days in patients treated with TRIAM, which was significantly shorter than patients without TRIAM (25.5±25.7days, p=0.010). In addition, the percentage of patients experiencing early recovery (within 10days) was 4.15 times higher with TRIAM (95% confidence interval: 1.07-16.13, p=0.040). The mean postoperative follow-up period revealed a similar tendency; patients treated with TRIAM required a shorter follow-up period (8±2.6days) than patients not treated with TRIAM (13.5±7.4days). However, this difference was not significant (p=0.242). CONCLUSION: Although the sample was small, patients with PAS infections who were treated with TRIAM as an adjuvant therapy required a significantly shorter treatment duration than patients receiving conventional treatment alone. This finding suggests a beneficial effect of TRIAM for the short-term control of PAS infections. Clinicians should consider TRIAM as an adjuvant treatment option.

Unidentified Bright Objects on Brain Magnetic Resonance Imaging Affect Vestibular Neuritis.

OBJECTIVES: The aim of this study was to investigate the differences in clinical manifestations of in two groups of vestibular neuritis (VN) patients with or without unidentified bright objects (UBOs). METHODS: A prospective, observational study with 46 patients diagnosed with VN between May 2013 and November 2013 was executed. A caloric test, a cervical vestibular-evoked myogenic potentials (cVEMPs) test, brain magnetic resonance imaging (MRI), spontaneous nystagmus test, head impulse test, and head-shaking nystagmus test were performed. RESULTS: Of the patients, 56.5% (n=26) were classified as UBO-positive by MRI. These showed lower caloric weakness and more prominent cVEMP asymmetry compared with the UBO-negative group (P<0.05). Total VN (TVN) was the most common in the UBO-positive group (45.0%), followed by superior VN (SVN, 30.0%), and inferior VN (IVN, 25.0%). However, in the UBO-negative group, SVN (75.0%) was the most common, followed by TVN and IVN (P<0.05). The recovery rate was not influenced by UBOs (P>0.05). CONCLUSION: UBOs on T2-weighted or fluid attenuated inversion recovery MRI may affect the patterns of the vestibular nerve in patients with VN.

The Effect of Intravenous Dexamethasone on the Nausea Accompanying Vestibular Neuritis: A Preliminary Study.

PURPOSE: We undertook a preliminary assessment of the efficacy of administering intravenous dexamethasone (DEX) for relieving the nausea and dizziness accompanying vestibular neuritis (VN). METHODS: Between November 2013 and October 2014, 26 patients with VN were prospectively enrolled in this study. The patients were randomly assigned to treatment with a combination of 20 mg/d of intravenous metoclopramide, 100 mg of oral dimenhydrinate, and 5 mg/d of intravenous DEX or 20 mg/d of intravenous metoclopramide, 100 mg of oral dimenhydrinate, and intravenous normal saline as a placebo therapy. Patients' subjective assessments of the severity of their nausea and dizziness were recorded using a visual analog scale on the day of admission and 2 days, 3 days, 1 month, and 3 months thereafter. Bedside examinations consisted of spontaneous nystagmus (SPN) assessment, the head shaking nystagmus test, and the head impulse test, which were performed at every follow-up visit. FINDINGS: The severity of nausea and dizziness was significantly reduced over time (both P < 0.05). However, there was no significant effect of DEX injection on the severity of nausea or dizziness (P > 0.05). The presence of SPN was solely associated with nausea (hazard ratio = 3.34; 95% CI, 1.85-6.02). IMPLICATIONS: The administration of intravenous DEX did not relieve nausea or dizziness any better than a placebo treatment. However, further research is required to confirm whether there is a dose-dependent effect of DEX on the control of nausea or dizziness in VN.

Acute-Onset Tinnitus Is Associated with Contralateral Hearing in Sudden Deafness.

OBJECTIVE: We aimed to evaluate the prognostic factors for acute-onset tinnitus associated with unilateral idiopathic sudden sensorineural hearing loss (ISSNHL) and to assess the relationship between these factors and the final recovery. METHODS: A total of 770 patients with unilateral ISSNHL were enrolled retrospectively and their medical records reviewed. Patients were classified into two groups according to the presence of acute-onset tinnitus at the initial examination. Patient characteristics and the results of pure-tone audiometry were compared between the two groups initially and 3 months later. RESULTS: A total of 70.9% (n = 546) of patients had tinnitus initially. There was no significant difference in the mean hearing thresholds of the affected ear irrespective of accompanying tinnitus. In contrast, patients with tinnitus in the affected ear tended to have significantly better mean hearing thresholds in the nonaffected ear (p < 0.05). The logistic regression analysis revealed that better mean hearing thresholds in the nonaffected ear were associated with tinnitus occurrence (p < 0.05). Better hearing thresholds in the nonaffected ear, younger age, absence of dizziness, low-tone hearing loss, and combined intratympanic dexamethasone injection were associated with full recovery (p < 0.05). However, tinnitus was not an independent risk factor for full recovery. CONCLUSION: Better contralateral hearing was associated with both an increased incidence of concurrent tinnitus and a better final recovery. However, tinnitus was not related to full recovery.

Therapeutic effect of combined steroid-lipoprostaglandin E1 for sudden hearing loss: a propensity score-matched analysis.

OBJECTIVES: The aim of this study is to analyze the synergistic effect of combined steroid-lipoprostaglandin E1 for the treatment of sudden hearing loss. METHODS: A prospective observational, non-randomized study with a historical cohort was performed at a university hospital. Between 2005 and 2012, 421 patients with idiopathic sudden sensorineural hearing loss were enrolled in this study and treated with combined steroid-lipoprostaglandin E1 treatment. Additionally, 132 patients were prospectively enrolled and treated with steroid treatment alone between January 2013 and March 2014. After performing a propensity score-matched analysis, final hearing levels and the degree of recovery were compared according to treatment options. RESULTS: A total of 240 patients were enrolled after propensity score-matching, with 180 patients classified as combined steroid-lipoprostaglandin E1 treatment group (group I) and 60 patients as steroid treatment alone group (group II). The final hearing level (35.56±34.64dB) in group I was not significantly different from that in group II (34.64±24.67dB) (p<0.05). Logistic regression analysis revealed that the combined treatment did not influence recovery, and the probability of recovery was 1.881 times higher in the absence of dizziness (95% confidence interval: 1.022-3.464, p=0.042), and 1.026 times higher in patients with better hearing in healthy ears (95% confidence interval: 1.010-1.041, p=0.001). CONCLUSION: Compared to steroid treatment alone, combined steroid-lipoprostaglandin E1 treatment failed to improve sudden hearing loss.

Carcinosarcoma of the maxillary sinus.

Carcinosarcoma is a highly malignant tumor characterized by dual malignant histologic differentiation of epithelial and mesenchymal components. The tumor is extremely rare in the sinonasal tract. We report a case of a 62-year-old man with carcinosarcoma involving the maxillary sinus.