A simulation-based continuing professional development course for the first 5 minutes of cardiac arrest in the resource-limited local clinics.

PURPOSE: Using simulation in continuing professional development (CPD) courses for local practitioners is uncommon in Korea. The aim of our study was to evaluate the responses of the local practitioners for a simulation-based short CPD course. METHODS: Following the targeted needs assessment of local practitioners, we developed and implemented a 3-hour simulation-based CPD course for the first 5 minutes of cardiac arrest in the resource-limited local clinics. We evaluated the participant's responses to the course using a questionnaire. RESULTS: During the 3-year implementation period, 115 practitioners participated in 10 courses, and 113 (98%) responded to the questionnaire. The overall course satisfaction (10-point scale) was very positive (10 in 93 [82.3%], 9 in 19 [16.8%], and 8 in 1 [0.8%]). The level (5-point scale) of recommendation to the others was also high (5 in 103 [91.2%] and 4 in 10 [8.8%]). Many participants positively commented on the authentic practical experience of the uncommon crisis in their contexts. CONCLUSION: A simulation-based short CPD course for in-hospital cardiac arrest could provide an authentic practical experience for local practitioners working in resource-limited clinics.

Characteristics of Plasma Flow for Microwave Plasma Assisted Aerosol Deposition.

To validate the possibility of the developed microwave plasma source with a novel structure for plasma aerosol deposition, the characteristics of the plasma flow velocity generated from the microwave plasma source were investigated by a Mach probe with pressure variation. Simulation with the turbulent model was introduced to deduce calibration factor of the Mach probe and to compare experimental measurements for analyses of collisional plasma conditions. The results show calibration factor does not seem to be a constant parameter and highly dependent on the collision parameter. The measured plasma flow velocity, which witnessed fluctuations produced by a shock flow, was between 400 and 700 m/s. The optimized conditions for microwave plasma assisted aerosol deposition were derived by the results obtained from analyses of the parameters of microwave plasma jet. Under the optimized conditions, Y2O3 coatings deposited on an aluminum substrate were investigated using scanning electron microscope. The results presented in this study show the microwave plasma assisted aerosol deposition with the developed microwave plasma source is highly feasible for thick films with >50 µm.

Biomarker barcodes: multiplexed microfluidic immunohistochemistry enables high-throughput analysis of tissue microarray.

We present a multiplexed microfluidic immunohistochemistry (IHC) technology that enables high-throughput analysis of tissue microarrays (TMAs) using the patterns of biomarker barcodes, which consist of a series of expressed linear patterns of specific biomarkers. A multichannel poly(dimethylsiloxane) microfluidic device was reversibly assembled by the pressure of simple equipment for multiplexed IHC on each core of TMA or cell microarray (CMA) section slides. By injecting primary antibodies from different biomarkers independently into each channel, multiplexed immunostaining can be performed on each core of TMA. We confirmed the equal immunostaining quality regardless of the channel orders and core positions in the slide. Four different biomarkers (ER, PR, HER2, and Ki67) were used for the demonstration of distinctive expression patterns on CMAs which consist of six different breast cancer cell lines, and it was confirmed that these bar-like signals could be a biomarker barcode for the TMA core. A biomarker barcode of breast cancer patient-derived TMA was quickly scanned by a slide scanner and compared to the conventional method for breast cancer diagnosis. This "barcode-IHC" concept, which has been verified by performing multiplexed microfluidic IHC on CMA and TMA samples, provides high reproducibility and the potential of high-throughput screening with molecular diagnostic capability.

Predictive Values of Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and Other Prognostic Factors in Pediatric Patients With Bell's Palsy.

BACKGROUND AND OBJECTIVES: Bell's palsy (BP) is the most frequent cause of unilateral facial paralysis, and inflammation is believed to play an important role in pathogenesis. Due to its rarity, however, no consensus has been reached regarding optimum treatment or factors affecting prognosis. In the present study, treatment outcomes and prognostic factors of BP were investigated in pediatric patients who underwent steroid therapy. The goal was to investigate the relationship between BP and inflammation using multiple inflammatory markers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), and red cell distribution width (RDW). MATERIALS AND METHODS: In all, 54 patients diagnosed with BP and 39 healthy randomly selected controls were enrolled in this retrospective study. Demographic characteristics and complete blood cell count test results were compared. In addition, prognostic factors were sought by dividing the 54 patients with BP into 2 groups according to the House-Brackmann grading system: low grade BP (grades II and III) and high grade BP (grades IV and V). Serum samples were analyzed retrospectively on initial presentation and 6 months after the symptom begins. Meaningful hematological parameters include NLR, PLR, MPV, and RDW. RESULTS: The NLR values in the BP group were significantly higher than in the control group. The NLR value in the 2 groups of patients with BP differed significantly. The mean PLR value in the BP group was higher than in the control group; however, there were no significant differences between the low-grade and high-grade BP groups nor were there any statically significant differences in the other characteristics. CONCLUSION: The NLR and PLR values are readily accessible parameters that may be useful prognostic markers in pediatric patients with BP. Further studies are required to confirm these results and their utility in predicting prognosis and treating pediatric patients with BP.

Rate of chronic otitis media operations and cholesteatoma surgeries in South Korea: a nationwide population-based study (2006-2018).

The aim of this study was to estimate the total number and rate of chronic otitis media (COM) operations and cholesteatoma surgeries in South Korea, using a nationwide survey which analysed a 13-year trend (2006-2018). This study also analysed the trend of COM operations and cholesteatoma surgeries according to year, sex, and age using a nationwide population-based database, and the 13-year trend was analysed according to age groups. This study used nationwide data from the National Health Information Database (NHID), which is a government-affiliated agency under the Korean Ministry of Health and Welfare that supervises all medical activities in Korea. Retrospective medical data of patients of all ages were extracted from the NHID from January 2006 to December 2018 (NHIS-2018). This study was conducted by the Research Committee of the Korean Society of Otorhinolaryngology-Head and Neck Surgery, and the Korean Audiological Society reviewed and confirmed the study. There was a 1.5 fold increase in COM operation rates in 2018, compared to 2007 figures. The annual total number of COM operations was 5,935 in 2007, 8,999 in 2012 (peak), and 8,870 in 2018 (17 in 100,000). Meanwhile, the total annual number of cholesteatoma surgeries decreased from 3,502 in 2006 to 3,199 in 2018 (6 in 100,000). The rate of COM operations was higher (1.27 fold) in the female population than in the males in 2018. However, cholesteatoma surgery rates were higher (1.2 fold) in the male population than in the females in 2018. According to the 2018 data, COM operations were most commonly performed in patients in their 50s. COM operation rates increased rapidly in patients aged 51-80. In other age groups however, rates were constant or showed a decrease in figures, especially in the 40s age group (1st rank in 2006 to 3rd rank in 2018). According to the 2018 data, cholesteatoma surgery was most commonly performed in patients in their 50s. Cholesteatoma surgery rates increased dramatically from 2006 to 2018 in patients aged 0-10 years due to congenital cholesteatoma. Cholesteatoma surgery rates also increased in patients aged 61-80 years due to ageing population. Cholesteatoma surgery rates decreased in patients aged 41-50 years, ranking 1st in 2006 and 4th in 2018. In conclusion, the annual rate of COM operations was 0.017%, and no longer increases, but stabilizes/decreased after a peak point in the advanced country. The mean rate of cholesteatoma surgery was 0.006%, and decreased annually. There was female dominance in COM operations, but male dominance in cholesteatoma surgery. Major age groups of patients who underwent COM/cholesteatoma surgery were the 50s and 60s, and congenital cholesteatoma (0-10 years) accounted for about 20% of all cholesteatoma surgery.

Predictive values of neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and other prognostic factors in pediatric idiopathic sudden sensorineural hearing loss.

BACKGROUND AND OBJECTIVES: No consensus has been reached regarding the optimum treatment or factors affecting prognosis in pediatric idiopathic sudden sensorineural hearing loss (ISSNHL) due to its rarity. In the present study, treatment outcomes and prognostic factors of ISSNHL were investigated in pediatric patients who underwent steroid therapy. SUBJECTS: and Methods: Forty-two patients diagnosed with ISSNHL were enrolled in this retrospective study and compared with 39 normal healthy controls with respect to demography and complete blood cell count test results. In addition, prognosis factors were sought by dividing the 42 ISSNHL patients to 3 groups according to their response to the treatment. RESULTS: Neutrophil-to-lymphocyte ratio (NLR) value in the ISSNHL group were significantly higher than in the control group. NLR value in the three treatment response groups differed significantly. Early treatment with steroid and accompanying tinnitus were positive prognostic factor for hearing recovery. Other characteristics were not significant. CONCLUSION: The results of this study suggest that good hearing recovery in children may be associated with early time of initial treatment and accompanying tinnitus. Also, NLR value might be useful readily accessible prognostic markers in pediatric ISSNHL patients. Further studies are required to confirm prognostic factors useful to predict prognosis and treat ISSNHL in pediatric patients.

Microfluidic on-chip immunohistochemistry directly from a paraffin-embedded section.

We present here a novel microfluidic platform that can perform microfluidic on-chip immunohistochemistry (IHC) processes on a formalin-fixed paraffin-embedded section slide. Unlike previous microfluidic IHC studies, our microfluidic chip made of organic solvent-resistant polyurethane acrylate (PUA) is capable of conducting on-chip IHC processes consecutively. A narrow channel wall structure of the PUA chip shows effective sealing by pressure-based reversible assembly with a section slide. We performed both on-chip IHC and conventional IHC processes and compared the IHC results based on the immunostaining intensity. The result showed that the effects of the on-chip deparaffinization, antigen retrieval, and immunoreaction processes on the IHC result were equivalent to conventional methods while reducing the total process time to less than 1/2. The experiment with breast cancer tissue shows that human epidermal growth factor receptor 2 (HER2) classification can be performed by obtaining a clearly distinguishable immunostaining intensity according to the HER2 expression level. We expect our on-chip microfluidic platform to provide a facile technique suitable for miniaturized, automated, and precise diagnostic devices, including a point-of-care device.

High-throughput culture and embedment of spheroid array using droplet contact-based spheroid transfer.

Spheroids are one of the most representative models of 3D cell culture, which can be easily formed using conventional hanging drop method. However, medium change and spheroid transferring process are the bottlenecks that reduce the throughput of the entire process in the hanging drop culture. In addition, the embedment of spheroid into hydrogel still depends on the individual pipetting process. To overcome these issues, we present poly(dimethylsiloxane) (PDMS)-based simple devices which can exploit droplet contact-based spheroid transfer using a drop array chip (DAC) having an array of well structures and peripheral rims. When the upper spheroid-containing drops were in contact with the lower liquid drops, the air-liquid interface disappeared at the merged surface and the spheroids settled down due to gravitational force. This method was applied to repetitive medium change and live/dead staining of spheroids cultured with the hanging drop method. To simultaneously embed the spheroids into the corresponding collagen hydrogel drops, a PDMS-based pillar array chip (PAC) was contacted in advance with the spheroid-containing DAC. The contacted PAC then contained the spheroids trapped in small drops of liquid reduced in volume to around 0.5 µl. Consequently, the spheroids were embedded into the collagen drops at once by contacting the spheroid-containing PAC with the collagen-loaded DAC. The embedded spheroids using the DAC-PAC contacting method showed a reliable invasion behavior compared to the embedded spheroids using conventional manual pipetting.

A Microfluidic Immunostaining System Enables Quality Assured and Standardized Immunohistochemical Biomarker Analysis.

Immunohistochemistry (IHC) plays an important role in biomarker-driven cancer therapy. Although there has been a high demand for standardized and quality assured IHC, it has rarely been achieved due to the complexity of IHC testing and the subjective validation-based process flow of IHC quality control. We present here a microfluidic immunostaining system for the standardization of IHC by creating a microfluidic linearly graded antibody (Ab)-staining device and a reference cell microarray. Unlike conventional efforts, our system deals primarily with the screening of biomarker staining conditions for quantitative quality assurance testing in IHC. We characterized the microfluidic matching of Ab staining intensity using three HER2 Abs produced by different manufacturers. The quality of HER2 Ab was also validated using tissues of breast cancer patients, demonstrating that our system is an efficient and powerful tool for the standardization and quality assurance of IHC.

Pipetting-driven microfluidic immunohistochemistry to facilitate enhanced immunoreaction and effective use of antibodies.

Immunohistochemistry (IHC), which has been used to detect antigens in cells of a tissue section using an immunoreaction between an antibody and an antigen, is a practical tool for identifying the type and stage of diseases in cancer diagnosis and scientific research. However, conventional IHC requires long, laborious process times and high costs. Although microfluidic IHC platforms have been developed to overcome these limitations, the application of microfluidic IHC in real-world environments is still limited due to the additional equipment needed to operate the microfluidic systems. In addition, continuous flow in a microfluidic channel leads to a waste of unbound antibodies. In this study, we demonstrate a novel and easy-to-use microfluidic IHC platform operated only using a manual pipette that is commonly available in research laboratories or hospitals. No other device such as a pump or a controller is required to operate our system. Bidirectional flows of the antibody solution in a microfluidic device are induced by repetitive manual pipetting which facilitates the enhanced antigen-antibody reaction and enables the effective use of a limited amount of antibody. When breast cancer cell and tissue sections are reacted with antibodies using our platform, pipetting for less than 2 min is sufficient to obtain immunostaining results without damaging the sample. The staining intensity by our method is similar to that of the sample stained for 1 h by a conventional batch process. We believe that this pipetting-based approach to the operation of a microfluidic system allows end users to use microfluidic IHC more conveniently and easily in real-world environments.

Frequency-Limiting Effects on Speech and Environmental Sound Identification for Cochlear Implant and Normal Hearing Listeners.

BACKGROUND AND OBJECTIVES: It is important to understand the frequency region of cues used, and not used, by cochlear implant (CI) recipients. Speech and environmental sound recognition by individuals with CI and normal-hearing (NH) was measured. Gradients were also computed to evaluate the pattern of change in identification performance with respect to the low-pass filtering or high-pass filtering cutoff frequencies. SUBJECTS AND METHODS: Frequency-limiting effects were implemented in the acoustic waveforms by passing the signals through low-pass filters (LPFs) or high-pass filters (HPFs) with seven different cutoff frequencies. Identification of Korean vowels and consonants produced by a male and female speaker and environmental sounds was measured. Crossover frequencies were determined for each identification test, where the LPF and HPF conditions show the identical identification scores. RESULTS: CI and NH subjects showed changes in identification performance in a similar manner as a function of cutoff frequency for the LPF and HPF conditions, suggesting that the degraded spectral information in the acoustic signals may similarly constraint the identification performance for both subject groups. However, CI subjects were generally less efficient than NH subjects in using the limited spectral information for speech and environmental sound identification due to the inefficient coding of acoustic cues through the CI sound processors. CONCLUSIONS: This finding will provide vital information in Korean for understanding how different the frequency information is in receiving speech and environmental sounds by CI processor from normal hearing.

Efficacy of Posterior Canal Wall Reconstruction Using Autologous Auricular Cartilage and Bone Pâté in Chronic Otitis Media with Cholesteatoma.

OBJECTIVE: This study was designed to investigate the long-term results using the technique of canal wall up mastoidectomy and reconstruction of the posterior canal wall using bone pâté and auricular cartilage in the treatment of chronic otitis media with cholesteatoma. MATERIALS AND METHODS: A retrospective review was performed on 42 patients who underwent canal wall up mastoidectomy and posterior canal wall reconstruction at a single institution between November 2005 and November 2012. RESULTS: Of the 42 patients, postoperative tympanic membranes were normal in 38 (90.5%), perforated in 1 (2.4%), and retracted in 3 (7.1%). Mean preoperative and postoperative values of the air-bone gap (ABG) were 29.4±12.8 and 23.4±11.7 dB, respectively, which represented a significant average improvement. For patients with ossiculoplasty (n=24), the mean preoperative and postoperative ABG values were 34.7±6.0 and 27.5±8.0 dB, respectively, which also represented a significant average improvement. Thirty-one (73.8%) of the patients were followed up without any complication, but 5 had otorrhea (11.9%), 4 had dizziness (9.5%), and 2 had facial palsy (4.8%). CONCLUSION: A canal wall up mastoidectomy with reconstruction of the posterior canal wall using auricular cartilage and bone pâté provides successful preservation of the anatomic structure and a significant improvement in hearing without the long-term disadvantages of a canal wall down mastoidectomy.

Automated measurement of multiple cancer biomarkers using quantum-dot-based microfluidic immunohistochemistry.

We report an automated multiple biomarker measurement method for tissue from cancer patients using quantum dot (QD)-based protein detection combined with reference-based protein quantification and autofluorescence (AF) removal. For multiplexed detection of biomarkers in tissue samples, visualization of QDs on cytokeratin was performed to create a multichannel microfluidic device on sites with dense populations of tumor cells. Three major breast cancer biomarkers (i.e., estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2) were labeled using QDs successively on cancer cells in tissue sections. For the automated measurement of biomarkers, a cytokeratin-based biomarker normalization method was used to measure the averaged expression of proteins. A novel AF-removal algorithm was developed, which normalizes the reference AF spectra reconstructed from unknown AF spectra based on random sampling. For accurate quantification of QDs, we automatically and accurately removed the AF signal from 344 spots of QD-labeled tissue samples using 240 reference AF spectra. Using analytical data with 10 tissue samples from breast cancer patients, the measured biomarker intensities were in good agreement with the results of conventional analyses.

Expression of autoantibodies in patients with sudden sensorineural hearing loss.

OBJECTIVES: The aim of this study was to establish the expression rate of autoimmunity in patients with sudden sensorineural hearing loss and to determine whether a positive marker is associated with a higher rate of hearing recovery after steroid treatment. METHODS: A prospective study was performed on 137 patients who experienced sudden sensorineural hearing loss and underwent immunoserologic investigations. Autoantibodies evaluated on the day of admission included anti-double-stranded DNA, rheumatoid factor, antiphospholipid immunoglobulins G and M, antinuclear antibody, and complements C3 and C4. RESULTS: Of 137 patients, 75 were male and 62 were female (mean age, 45.1 years). Hearing loss was found on the left side in 61 patients and on the right side in 76 patients. Elevation of at least 1 autoantibody or abnormal complement levels were found in 80 patients (58%), and abnormalities of 2 or more antibodies were found in 28 (20%). There were no statistically significant correlations between autoantibody abnormalities and age, initial hearing level, or positive treatment response. CONCLUSIONS: There is no clear evidence of a correlation between autoimmunity and hearing improvement in patients with autoantibody abnormalities. A high (but not significant) expression rate of autoantibody abnormality and complement level was seen in patients with sudden sensorineural hearing loss.

Associations between matrilin-1 gene polymorphisms and adolescent idiopathic scoliosis curve patterns in a Korean population.

Adolescent idiopathic scoliosis (AIS) is a complex disorder with an unclear etiology and pathogenesis. In previous studies, genome-wide linkage and genetic association analyses have been carried out to find genetic factors linked with AIS. In this study, we examined whether the susceptibility to AIS is associated with MATN1 gene polymorphisms in a Korean population, which included 166 individuals with AIS and 126 controls. We found that there were no statistically significant associations between any of the MATN1-linked allele or genotype frequencies between AIS and controls. However, statistically significant associations were found at single nucleotide polymorphism (SNP) rs1065755 when comparing the curve patterns of AIS with the controls. The A allele of SNP rs1065755 was associated with a higher risk of AIS than the allele G in the genotype-phenotype (curve pattern) analysis (P = 0.029). In addition, the frequency of the A allele of SNP rs1065755 in AIS with double major curves was higher than in controls (P = 0.021, ORs = 2.56 within 95% CI = 1.12-5.83). Additionally, among the predicted common haplotypes, the frequency of the haplotype GATT (31.3%) in AIS with double major curves was higher than in controls (15.2%) (P = 0.024, ORs = 2.54 within 95% CI = 1.11-5.84). We conclude that the A allele of SNP rs1065755 in the MATN1 gene is associated with AIS.

Activity of all JNK isoforms contributes to neurite growth in spiral ganglion neurons.

Jun N-terminal kinase (JNK) is a multifunctional protein kinase crucial for neuronal apoptosis as well as neurite growth. We have previously shown that JNK activity is correlated with spiral ganglion neuron (SGN) apoptosis following hair cell loss in rats (Alam et al., 2007) implying that JNK inhibition may have therapeutic potential to protect SGNs in deaf individuals. Here we investigated the role of JNK in neurite outgrowth from cultured neonatal rat and mouse SGNs. We show that JNK is required for initial growth of neurites and for continued extension of already established neurites. The effect of JNK inhibition on neurite growth is rapid and is also rapidly reversible after washout of the inhibitor. Using phosphoJNK immunoreactivity as an indicator, we show that JNK is activated in growth cones within 30 min after transfer to medium lacking neurotrophic stimuli (5 K medium) but activation in the nucleus and soma requires hours. By transfecting epitope-tagged JNK1, JNK2, or JNK3 isoforms into SGNs, we found that all are present in the nucleus and cytoplasm and that there is no preferential redistribution to the nucleus after transfer to 5 K medium. Cotransfection of dominant-negative (dn) JNK1 and JNK2 into SGNs reduced neurite growth, although transfection of dnJNK1 or dnJNK2 alone had no significant effect. SGNs cultured from JNK3(-/-) mice showed reduced neurite growth that was further reduced by transfection of dnJNK1 and dnJNK2. This indicates that all three JNK isoforms promote SGN neurite growth although there may be functional redundancy between JNK1 and JNK2.

Reliability of Triggered EMG for Prediction of Safety during Pedicle Screw Placement in Adolescent Idiopathic Scoliosis Surgery.

STUDY DESIGN: We performed a prospective study to evaluate the reliability of using triggered electromyography (EMG) for predicting pedicle wall breakthrough during the placement of pedicle screw in adolescent idiopathic scoliosis surgery. PURPOSE: We wanted to correlate pedicle wall breakthrough with the triggered EMG threshold of stimulation and the postoperative computed tomography (CT) findings. OVERVIEW OF LITERATURE: Pedicle wall breakthrough has been reported to be difficult to evaluate by radiographs. Triggered EMG had been found to be a more sensitive test to detect this breakthrough. METHODS: Seven patients who underwent the insertion of 103 pedicle screws were evaluated. The triggered EMG activity was recorded from several muscles depending on the level of screw placement. The postoperative CT scans were read by a spine surgeon who was a senior fellow in orthopedics, and a musculoskeletal radiologist. RESULTS: The mean age at surgery was 12.6 years (range, 11 to 17 years). The preoperative mean Cobb angle was 54.7° (range, 45 to 65°). There were 80 thoracic screws and 23 lumbar screws. All the screws had stimulation thresholds of ≥ 6 mA, except 3 screws with the stimulation threshold of < 6 mA. Ten screws (9.7%) showed violation of the pedicle wall on the postoperative CT scans. Five screws penetrated medially and another five penetrated laterally. No postoperative neurologic complications were noted in any of the seven patients. CONCLUSIONS: Measuring the stimulation threshold of triggered EMG helps to assess the pedicle screw placement. Pedicle screws that had stimulation threshold of ≥ 6 mA were safe, with 90.3% reliability, as was assessed on the postoperative CT scans.

Better functional outcome of salvage THA than bipolar hemiarthroplasty for failed intertrochanteric femur fracture fixation.

Failure of intertrochanteric fracture fixation often occurs in patients who have poor bone quality, severe osteoporosis, or unstable fracture patterns. The purpose of this study is to compare the results of total hip arthroplasty (THA) with bipolar hemiarthroplasty as the salvage procedures for failed fixation of intertrochanteric fractures of the femur. Eighteen consecutive patients who were treated for failed intertrochanteric fracture fixation were reviewed retrospectively. The patients were divided into 2 groups of salvage procedures: THA (9 patients) and bipolar hemiarthroplasty (9 patients). In the THA group, mean Harris Hip Score (HHS), visual analog scale (VAS) score, and Salvati and Wilson score were 82.1, 0.9, and 31.3, retrospectively. In the bipolar hemiarthroplasty group, mean HHS, VAS score, and Salvati and Wilson score were 68.6, 3.1 and 25.1, retrospectively. Total hip arthroplasty was better than bipolar hemiarthroplasty treatment in HHS (P=.040), VAS score (P=.001), and Salvati and Wilson score (P=.033). There were no significant differences in hospital stay, operating time, and transfusion volume between the 2 groups. Total hip arthroplasty seems to be more reliable salvage procedure for failed intertrochanteric fracture fixation in functional outcome and pain relief.

Bilateral simultaneous facial nerve palsy: clinical analysis in seven cases.

OBJECTIVE: To analyze clinical manifestations and prognosis of bilateral simultaneous facial nerve palsy (BS-FNP). STUDY DESIGN: : Retrospective case review with current follow-up wherever possible. SETTING: : Tertiary referral centers. PATIENTS: Patients (n = 7; 4 women and 3 men; mean age, 37 yr; range, 18-58 yr) diagnosed with BS-FNP at the time of their first visit. INTERVENTION: Therapy with systemic corticosteroids and antiviral agents and outpatient follow-up for 1 month to 4 years after discharge. MAIN OUTCOME MEASURE: Assessment of recovery from FNP using the House-Brackmann grading system. RESULTS: : The occurrence rate of BS-FNP of total FNP cases for the past 10 years was 0.4%. All patients showed palsy more severe than House-Brackmann Grade IV and similar grades of FNP bilaterally. Patients complained of the involvement of the other side within 1 to 6 days of the involvement of 1 side (mean period, 3.4 d). Bell's palsy was the most common cause (5 of 7; 71.4%), the other 2 being infectious mononucleosis and Ramsay Hunt syndrome zoster sine herpete (1 of 7; 14.3% each). Although most patients recovered completely within 1 to 6 months, 1 with a positive Varicella zoster virus immunoglobulin M titer showed bilateral House-Brackmann Grade II FNP after recovery. No recurrence was noted during the follow-up period. CONCLUSION: Bell's palsy is the most common cause of BS-FNP in authors' centers. Although BS-FNP may show more severe paralysis, the overall prognosis in most cases is as good as that in unilateral FNP, excluding life-threatening or traumatic cases. Differential diagnosis is very important because the treatment outcome of BS-FNP depends on the cause.

Clinical use of subjective visual horizontal and vertical in patients of unilateral vestibular neuritis.

OBJECTIVES: Subjective visual horizontal (SVH) and subjective visual vertical (SVV) used to assess otolith dysfunction and ipsilesional deviation of SVV and SVH in unilateral vestibular dysfunction is well known. The goal of this study was to investigate the clinical use of SVH/SVV and a dizziness scale in the clinical setting of acute unilateral vestibular neuritis. METHODS: Thirty-five patients with unilateral vestibular neuritis were investigated. Every patient was diagnosed by physical examination and electronystagmography. Subjective visual horizontal and SVV were assessed during the acute or subacute period; the Dizziness Handicap Inventory (DHI) and Vestibular Disorder Activities of Daily Living Scale (VADL) were used for a self-dizziness scale at the same time. All patients underwent rehabilitation therapy. Subjective visual horizontal/SVV and DHI/VADL were assessed again approximately 4 weeks later. Postrehabilitation SVH/SVV and DHI/VADL data were compared with initial data. RESULTS: Dizziness Handicap Inventory and VADL were improved after 4 weeks of rehabilitation, and the deviation toward ipsilesional side SVH and SVV was also improved. CONCLUSION: These results demonstrate that SVH and SVV correlated with clinical dizziness symptoms in patients with acute unilateral vestibular neuritis. Therefore, SVH and SVV would be useful tools for the evaluation of clinical manifestations of unilateral vestibular neuritis.