Postoperative Results of Canal Wall Up Mastoidectomy Only Performing Anterior Tympanotomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Retrospective reflect of canal wall up (CWU) mastoidectomy with posterior tympanotomy revealed some problems such as ineffectiveness against the recurrence of cholesteatoma, reclosure of ventilation route and that a posterior tympanotomy might be harmful to inner ear. Objectives of this study is to evaluate the effect of mastoidectomy with anterior tympanotomy on postoperative hearing results and complications. SUBJECTS AND METHOD: From January 1998 through July 2001, 29 cases of CWU mastoidectomy with anterior tympanotomy were reviewed retrospectively. All of the cases were difficult to perform posterior tympanotomy due to anatomical variations and had lesions restricted to anterior epitympanum. The hearing results were assessed by postoperative 1-year pure tone average and postoperative 1-year air-bone gap (ABG), and we checked complications. RESULTS: Of the 29 cases, 21 cases (72.4%) had ABG <20 dB in the postoperative 1-year, with the postoperative 1-year ABG of 14.9+/-9.2 dB. The postoperative hearing gain was 10.1+/-10.6 dB. There were 3 cases of chorda tympani nerve cutting, 1 case of accidental malleoincudal joint dislocation and 1 case of recurrence. CONCLUSION: Anterior tympanotomy could be a good approach for ventilation in selected CWU mastoidectomy approach, and further long term follow-up is needed to study about recurrence.

Clinical Efficiency of Adenoidectomy Using Microdebrider / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Remnant adenoid tissue after adenoidectomy or immoderate procedure result in various complications such as bleeding, damage to the mucosa of posterior nasopharyngeal wall or orifice of Eustachian tube. The purpose of this paper is to compare conventional adenoidectomy with microdebrider-assisted adenoidectomy based on postoperative outcome and intraoperative effectiveness. MATERIALS AND METHOD: We performed a prospective study comparing thirty cases of adenoidectomy using conventional approach with fifteen cases of transoral microdebrider adenoidectomy using an indirect laryngeal mirror. Skull lateral radiographs and a symptom scale were used to evaluate preoperative and postoperative states. RESULTS: There was no significant difference in the improvement of symptoms and postoperative outcome between the conventional group and the microdebrider adenoidectomy group. However, it was found that more adenoid tissue could be removed in the microdebrider group. Postoperative nasopharyngeal endoscopic views revealed that microdebrider removed adenoid tissue precisely and preserved the posterior nasopharyngeal wall better when compared to the conventional group. CONCLUSION: Compared with the conventional procedure, adenoidectomy using the transoral microdebrider with an indirect laryngeal mirror was similar in achieving symptom improvement and postoperative outcomes, but removed more adenoid tissue with higher precision. From this study, we suggest that using microdebrider with indirect laryngeal mirror is another valuable method of adenoidectomy in the aspect of precision.

Arterial Embolization in Rhinological Field: an Analysis of 19 Cases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The progress of arterial embolization made it possible to control intractable nasal bleeding and to reduce the blood supply of nasopharyngeal angiofibroma. MATERIALS AND METHODS: We reviewed 19 cases of patients who received arterial embolization from Jan. 1993 to Dec. 1999. We analyzed the cases according to the age, sex, hypertension, purpose, result and complications of arterial embolization. RESULTS: Thirteen patients received arterial embolization due to uncontrolled epistaxis by conservative management. Except one patient who had bleeding from the anterior ethmoidal artery, 12 patients stopped bleeding after successful embolization. Three patients received the arterial embolization for continuous bleeding after endoscopic sinus surgery, and other three patients received it for reducing the blood supply of the nasopharyngeal angiofibroma preoperatively. The complications were seizure like movements, fever and facial pain: but these complications were limited to few cases, and were minimal and temporary. CONCLUSION: Arterial embolization is a safe and effective method that should be considered in the treatment of refractory nasal bleeding and for reducing the intraoperative bleeding in angiofibroma.

The Clinical Significance of Vestibular Evoked Myogenic Potential Evoked by Click Sound / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The human vestibule is known to be able to induce cervical muscle potential secondary to strong acoustic stimulations. This reflex is assumed to originate in the saccule, and is called "vestibular evoked myogenic potentials" (VEMP). The responses consist of alternatively positive and negative successive waves (p13-n23). This study was designed to evaluate the clinical significance of VEMP. MATERIALS AND METHOD: We studied the difference among the latencies of p13, n23 and the amplitudes among the 10 normal volunteers, 5 patients with sudden sensorineural hearing loss and 10 patients with vestibulopathy. And we compared the result of the caloric test and VEMP in patients with vestibulopathy. RESULTS: In the normal group, VEMP was detected in all and all of the sudden sensorineural hearing loss patients showed VEMP both in the affected and unaffected side. In unilateral vestibulopathy patients, VEMP were present in the unaffected side but not in the affected side. The difference between the amplitudes and latencies were not found in those cases where VEMP was detected. In vestibulopathy patients, VEMP were well correlated with the result of the caloric tests. CONCLUSION: We confirmed that VEMP is originated from the vestibule, not from cochlea. VEMP could provide itself as an addition method for testing the vestibule.

Fibroblast Heterogeneity of Nasal Polyps in Non-Allergic and Allergic Rhinitis

BACKGROUND & OBJECTIVES: Some components of ground substances are known to be involved in developing nasal polyp. The fibroblasts are a major component of the ground substances in nasal polyp and have many immunologic roles. Heterogeneity of fibroblasts has been observed in other anatomical sites including the nasal mucosa. The aim of this study was to investigate the heterogeneity of fibroblasts of nasal polyps in non-allergic rhinitis and allergic rhinitis. MATERIALS & METHODS: Using the third passage of the fibroblasts taken from polyps of allergic and non-allergic patients, we measured the proliferating potential by comparing the cell growth in the culture system of fibroblasts and calculated the doubling time of the cell growth. We also compared the proliferating potentials between the two groups after stimulation with histamine or IL-4. RESULTS: Morphologic differences were examined by transmission electron microscopy. In the non-stimulated experiment, proliferation of fibroblasts was increased in the non-allergic polyp group (NAPG). When the fibroblasts were stimulated with histamine, the proliferation was not significantly changed on day 6 in both groups. When the fibroblasts were stimulated with IL-4, the proliferation was significantly increased in NAPG. Morphologic differences were demonstrated between the NAPG and the APG. CONCLUSION: The differences in cell proliferation potentials and morphological changes between both groups suggest that there is a heterogeneity of fibroblasts between them.

The Prevalence of Otitis Media with Effusion among Kindergarten and Elementary School Children in Song Buk, Seoul, Korea and Risk Factors / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Otitis media with effusion (OME) is the most common bacterial infection and the most frequent otologic indication for antimicrobial or surgical therapy in young children. It is also the leading cause of hearing disturbance in children. There have been few reports about the prevalence rate of OME in preschool children in Seoul. So, we investigated the prevalence of OME among kindergarten and elementary children in Song Buk Gu, Seoul, Korea. MATERIAL AND METHODS: Tympanometry and pneumatic otoscopic examination were performed on 3,364 children aged 3-7 years, from March to June of 1999. RESULTS: A total of 11.74% of the subjects had unilateral or bilateral OME. The prevalence rate of OME in 3 year-old children was 30.0% and that of 7 year-old children was decreased to 8.9%. The prevalence rate in March was 18.5% and that in June decreased to 6.5%. The majority of the cases were free of subjective symptoms, but some of significant symptoms were ear fullness, otalgia, tendency to increase the TV volume and autophonia. CONCLUSION: Significant risk factors are seasonal variation, age and the history of OME. There should be more attention paid to OME in children aged 7 years and younger, because its high prevalence and less symptoms.

The Three-Dimensional Co-Culture of Cholesteatomatous Keratinocyte and Fibroblast / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There has been considerable research interest in cholesteatoma in recent years but an understanding of the pathophysiology has been handicapped by the lack of a suitable research model. Recent advances in culture methods have contributed to the study of normal physiology or pathogenesis at the level of cells. However, the conventional keratinocyte culture of cholestearoma has some weak points, since it is done under a condition that is different from cellular environments and it cannot investigate cellular interaction among keratinocytes and other cells of cholesteatoma. The purpose of this study is as follows : first, we organize a new study model for cholesteatoma using a three-dimensional (3-D) culture method; and then we study fibroblast effects on keratinocytes under the 3-D culture system. MATERIALS AND METHODS: Aural cholesteatomas were obtained during middle ear operations. The keratinocytes and fibroblasts were first cultured separately and then co-cultured three-dimensionally. The pureness of keratinocyte layer was examined immunohistochemically. We studied fibroblast effects on keratinocytes under the 3-D culture system from the viewpoint of proliferation and differentiation. RESULTS: We could establish 3-D culture of keratinocytes under the influence of fibroblasts. The keratinocytes of the co-culture system showed more proliferation and less differentiation than keratinocytes under the same conditions except for anchoring fibroblasts. CONCLUSION: In this study, we successfully organized the 3-D culture system, a new study model for cholesteatoma, and identified fibroblast effects on keratinocytes. This new study model might be an effective tool for research on the interactions among various cells of cholesteatoma: however, further investigation and development would he necessary.

Expression of Vascular Endothelial Growth Factor and Platelet-Derived Endothelial Cell Growth Factor in Head and Neck Squamous Cell Carcinoma and It's Relation to Angiogensis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tumor angiogenesis is an essential process required for growth and metastasis in cancer. Vascular endothelial growth Factor (VEGF) and platelet-derived endothelial cell growth factor (PD-ECGF) are known to be angiogenetic factors. The objectives of this study were to measure the expression of VEGF, PD-ECGF and microvessel density (MVD) in head and neck squamous cell carcinoma (HNSCC) and compare them to normal larynx. We also evaluated relationships of VEGF, PD-ECGF and MVD to clinicopathologic findings in HNSCC. MATERIAL AND METHODS: The expression of VEGF, PD-ECGF and MVD were evaluated by immunohistochemical staining of 26 cases of HNSCC and 6 cases of normal larynx. RESULTS: The expressions of VEGF, PD-ECGF and MVD in HNSCC were significantly higher than in the normal control (p<0.05). MVD were significantly correlated with VEGF and PD-ECGF expressions in HNSCC (p<0.05). The VEGF, PD-ECGF expression and MVD correlated with many clinicopathologic findings in HNSCC. CONCLUSION: These results suggest that VEGF and PD-ECGF are involved in angiogenesis and are related to clinicopathologic findings of HNSCC. Furthermore, we propose that expressions of VEGF, PD-ECGF and MVD to be investigated more in the future as prognostic indicators of HNSCC.

Effect of Mahuangbujaseshintang and Soshihotang in animal model of allergic rhinitis / 천식및알레르기

BACKGROUND AND OBJECTIVE: Mahuangbujaseshintang (MBST) and soshihotang (SST) have been used for treatment of chronic disease of respiratory tract. It is necessary to clarify the mechanism of anti-allergic effects and to standardize the extracts. MATERIALS AND METHODS: The effects of MBST and SST were evaluated on histamine release in rat mast cells ex vivo. Several hours after administration of the extracts, mast cells were stimulated by DNP-ascaries and histamine contents were measured. Time course structural change of the cells was examined by dynamic study. In order to evaluate the effect of the extracts on the nasal patency, acoustic rhinometry was performed after administering of leukotriene D4 to both nasal cavities of guinea pig (GP). We examined the effects of the extracts with double-blind study, and also studied change of nasal patency after challenge of antigen by acoustic rhinometry in patients with allergic rhinitis. RESULTS: MBST at 4 hr and SST at 3 hr after oral administration remarkably inhibited histamine release from rat mast cells in a dose-dependent manner. MBST-treated GPs failed to show bi-phasic phenomena which indicated to reduce nasal volume at the time of early and late phases in allergic inflammation. Both groups of patients who took MBST and SST for 1 week or 2 weeks showed significant decreased symptom severity index (SSI) from treatment week 2 (p<0.05). The percent volume change after challenge of the antigen was decreased in 31 patients who took the extracts for 2 weeks. CONCLUSION: We can conclude that the herb medicine of MBST and SST may be effective for allergic rhinitis.

The Effect of All-Trans Retinoic Acid on Culture of Aural Cholesteatoma Keratinocytes / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Retinoids have recently become an interest to clinicians because of their ability to inhibit migration and proliferation of the premalignant squamous cells, while enhancing growth and proliferation of normal cells. Aural cholesteatoma is defined as the state of hyperproliferative keratinocytes in the middle ear cavity. An in vitro investigation was undertaken to determine whether all-trans retinoic acid (t-RA) exhibits an inhibitory effect on cholesteatoma cell proliferation. METHODS: Cholesteatoma tissue was obtained during a middle ear operation, and the explant was cultured on six well-plates in a culture medium of Medium M-154 (Cascade Biologics Inc., USA) for one week. T-RA was then treated with 10M, 10M, 10M, 10M concentrations, respectively. The cholesteatoma explant cultures were observed daily, and topographic maps were constructed weekly to quantify the proliferation area. The explant culture area was estimated by Multiscan. RESULTS: In the absence of t-RA, the cholesteatoma explant culture area reached 401.5mm in four weeks. But with the administration of t-RA, the cultured area decreased proportionally to t-RA concentrations which reduced to 224.0 mm, 94.4 mm respectively in four weeks with 10M, 10M concentration of t-RA (p<0.05). CONCLUSIONS: This investigation showed that t-RA has a significant inhibitory effect on cholesteatoma proliferation. These results suggest that retionoids may have a role in controlling cholesteatoma disease.

Correction of Deviated Nose Associated with High Septal Deformity with Spreader Graft

High septal deformities exert pressure on upper lateral cartilages and nasal bones and cause external deviation of the nose. However, detection of high septal deformities causing deviated noses is very difficult if a detailed intranasal examination is not performed. As well, the high septal border is a difficult area to approach via the endonasal rhinoplasty and is the weakest portion in the septum resulting in much difficulty in correcting deformities and in frequent later recurrence of deviation secondary to the healing process. In order to solve the above problems in 33 cases of deviated nose associated with high septal deformities, the authors evaluated deformities in the high septal border after separation of the septum from upper lateral cartilages and nasal bones. The high septal border is centralized by scoring after resection of the mid or lower-septal portion. And spreader grafts were applied to the convex sides of deviated septal borders to stabilize the high septal border and to prevent long-term recurrence of deviation. Also, to balance the traction force of side walls, the length of both upper lateral cartilages and nasal bones were equalized by resection in the longer side and grafting in the shorter side. Clinical follow-up ranged from 3 to 31 months. There was no surgical or septal complication. Also, there was no incomplete correction, recurrence of deviation, or compromized nasal support. All patients except 2 were satisfied with the aesthetic and functional results. We found that separation of septum from side walls allows detection and correction of higher septal deformities and that spreader graft allows long-term support and prevents later recurrence of deviation.

The Transforming Growth Factor-beta1 Expression in Normal Laryngeal Mucosa, Laryngeal Dysplasia and Laryngeal Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Transforming growth factor-beta1 (TGF-beta1) is a multifunctional regulator of cellular differentiation, motility and growth. Loss of sensitivity to the growth inhibitory effects by TGF-beta1 plays important roles in neoplastic progression. So expression of TGF-beta1 has been described in several tumors, but little is known about the role of TGF-beta1 in neoplastic progression of human larynx. The aim of this study was to investigate the role of TGF-beta1 in the neoplastic progression of human larynx. MATERIALS AND METHODS: We evaluated the expression of TGF-beta1 using immunohistochemical study in 6 cases of normal laryngeal mucosa, 6 cases of laryngeal dysplasia, 20 cases of laryngeal carcinoma. RESULTS: The results were as follows: 1) Normal laryngeal mucosa has no expression of TGF-beta1. 2) The expression of TGF-beta was 16.7% in laryngeal dysplasia, 50.0% in laryngeal carcinoma. CONCLUSION: The TGF-beta1 expression rate was correlated to the progression of laryngeal lesions when compared to normal laryngeal mucosa, laryngeal dysplasia and laryngeal carcinoma.

Expression of Protein Kinase C on Allergic Nasal Mucosa

Protein Kinase C (PKC) relays information in the form of a various extracellar signals across the membrane and is known to play an important role in the production of B lymphocytes and T lymphocytes, in the antigen-presentation of Langerhans cell, and in inflammatory reactions. The presentation of allergens to T lymphocytes is likely an important aspect in the pathophysiological mechanism of allergic rhinitis. Although several theories have been formulated in allergic rhinitis, signal transduction of this disease remains unknown. In this study, we focused on the role of the enzyme PKC in the allergic mucosa of the nose. Specifically, we investigated the role and the distribution of PKC isozymes in the mucous membrane of the nose. We obtained nasal mucous membrane specimens from 10 patients with house dust mite allergy and 10 patients with normal nasal mucous membrane. We performed an immunohistochemical study, an RT-PCR, and a densitometric measurement. PKCalpha, PKCbeta, and PKCzeta proteins were detected in the subepithelial layer of the allergic mucosa. However there were no detectable reactions in the nonallergic mucosa. In the RT-PCR for PKCalpha, PKCbeta and PKCzeta, there was no difference between the allergic and nonallergic nasal mucous membrane in terms of m-RNA expression. It is possible that the signal transduction pathway of PKC and over-expression of PKC protein at the post-transcription level contribute to the development of allergic inflammation in allergic nasal mucosa.

Monothermal Caloric Test: Comparison of Dizziness Sensation and Nystagmus Parameters according to Age Groups / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: here have been some studies on the influence of age on the results of vestibular function tests with conflicting results. In influence of age on the results of caloric test, we investigated the sensation of dizziness during caloric test by drawing a correlation between the direction of rotatory sensation and the direction of nystagmus. MATERIALS AND METHODS: We performed monothermal caloric test on 44 healthy adults and divided them into six age groups ranging from 16 and 67. RESULTS: During the test with eyes-closed, 80.23% of patients reported a sensation of self-rotation. Of those, 55.81% expressed the direction of rotation to be the same as that of the fast component of nystagmus, whereas 24.42% expressed the direction to be the same as that of the slow component of nystagmus. During caloric test with eyes-open in light, 59.30% reported a sensation that their surroundings rotated around them. Of those, 43.02% expressed the direction of rotatory sensation to be the same as that of the fast component of nystagmus, whereas 16.28% expressed the direction to be the same as that of the slow component of nystagmus. During caloric test with eyes-closed, most of the subjects felt themselves rotating, whereas most of the subjects felt the outside world were rotating in tests with eyes-open in the light. CONCLUSION: Nystagmus parameters (latency, duration, SPEV at eyes-open and at eyes-closed, visual suppression) did not result in significant differences among different age groups: therefore, we conclude that age doesn't influence the results of caloric tests.

Differences of Nasal Hypersensitivity between Smokers and Nonsmokers / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Smoking is regarded as one of the factors that bring about nonspecific hypersensitivity in allergic nasal mucosa. But it is uncertain how chronic smoking affects hypersensitivity in nasal mucosa. This study was designed to evaluate the relationship between smoking and nasal hypersensitivity. In this study, histamine is used since it is commonly used to evaluate nasal hypersensitivity. MATERIAL AND METHODS: Twelve smokers and 9 nonsmokers were participated in this study. Nasal mucosae of each subjects were stimulated by thiorphan followed by substance P. After stimulation, several dilutions of 10 to 5X104 ng/ml of histamine was instilled to both nasal cavity at intervals of 10 minutes. We measured the volume of nasal cavity by acoustic rhinometry in each step and counted the number of sneezing and nasal blowing at every 10 minute intervals. Changes in volume after each dillutions of histamine instillations were compared with the values measured after the stimulation by thiorphan and substance P., and this value was expressed as the percentage volume change. RESULTS: The nasal volume of smoker group was increased upto 100 ng/ml of histamine and decreased from 1000 ng/ml of histamine. The nasal volume of nonsmoker group decreased more than the smoker group with each dilution of histamine. The number of sneezing and nasal blowing increased in each group with each dilution of histamine. CONCLUSIONS: Chronic smoking may decrease susceptibility of hypersensitivity to histamine in nasal mucosa.

Downregulation of Protein Kinase C Isozymes on Cholesteatoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The exact pathogenesis of cholesteatoma remains unknown in spite of several theories that have been formulated. The most characteristic histologic finding of cholesteatoma is the proliferation of the squamous cell lining of the lesion. Protein Kinase C (PKC) is a family of phospholipid-dependent serine/threonin protein kinase that sends extracellular signals across the cell surface in order to regulate epithelial cell groweth and differentiation. This study attempted to provide the evidence for the role of PKC in cholesteatoma. MATERIALS AND METHODS: Twenty-five cholesteatoma specimens were obtained from patients for western blotting, immunohistochemical study, RT-PCR, and densitometry. RESULTS: The results of western blotting revealed that considerably lower levels of PKCalpha, PKCbeta, and PKCepsilon protein were detected in cholesteatoma than in the posterior auricular skin. In the immunohistochemical study, PKCalpha, PKCbeta, and PKCepsilon were detected both in the basal and suprabasal layer of posterior auricular skin, but they were not detectable in cholesteatoma. The results of PCR for PKCalpha, PKCbeta, and PKCepsilon showed that there were no differences between cholesteatoma and posterior auricular skin regarding the mRNA expression. CONCLUSION: Downregulation of PKCalpha, PKCbeta, and PKCepsilon in cholesteatoma suggests that abnormal epithelial growth is a possible mechanism of cholesteatoma. The results suggest the following there is an abnormal signal transduction through the PKC pathway in cholesteatoma: downregulation of PKC takes place in the post-transcription phase, and downregulation of PKC is associated with prolonged chronic inflammation of cholesteatoma.

A Case of Pseudotumor of the Maxillary Sinus / 대한이비인후과학회지

Pseudotumor is a term used to describe a space occupying inflammatory lesion which mimics a true neoplastic process in its clinical presentation and radiologic findings. Its occurrence in the maxillary sinus is rare. The etiology and pathophysiology of the maxillary pseudotumor is unknown. A large and longstanding pseudotumor may induce the erosion or destruction of the maxillary bone wall. Therefore it may be difficult to distinguish such a lesion from a malignant tumor, specific granulomatous disease (e.g. tuberculosis, sarcoidosis, Wegener's granulomatosis) and fungal sinusitis preoperatively. A diagnosis of maxillary pseudotumor must be based on histological evidence to exclude other disease. We report a case of a 49-year-old patient with left maxillary pseudotumor that simulated an aggressive neoplasm in its clinical presentation and radiologic findings.

Expression of Phospholipase C-beta1 and Phospholipase C-gamma1 on Cholesteatoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: A histological finding that is the most characteristic of cholesteatoma is the proliferation of the squamous cell. Signal transduction through phospholipase C(PLC) participates in the regulation of epidermal cell growth and differentiation. EGF, PDGF, and TGF-alpha bind to their receptors and thereby induce tyrosine phosphorylation of the phospholipase C-gamma1 (PLC-gamma1). PLC-gamma1 is a substrate for several receptor tyrosine kinases and its catalytic activity is increased by tyrosine phosphorylation. Tyrosine kinase phosphorylation of PLC-gamma1 stimulates PLC activation and cell proliferation. The G-protein has been shown to specifically activate PLC-beta1. However, the signal transduction pathway and the significance of PLC in cholesteatoma is unknown. This study attempted to provide some evidence that PLC plays a role in cholesteatoma by investigating the distribution and quantity of PLC-beta1 and PLC-gamma1 in the posterior auricular skin and cholestsatoma. MATERIALS AND METHODS: Western blotting and immunohistochemical study were performed for 20 cholesteatoma specimens obtained from patients who underwent operation. RESULTS: Western blot analyses revealed that PLC-beta1 protein and PLC-gamma1 protein were detectable in cholesteatoma and that these proteins were in higher levels compared with the control. In the imm-unohistochemical study, PLC-gamma1 was detected in the horny cell layer of posterior auricular skin but not in the suprabasal layer and the horny cell layer of cholesteatoma. PLC-beta1 was detected in the primary basal layer and a minor reaction was also noted in the spinous layer of posterior auricular skin. However, there were detactable reactions in both the basal and the suprabasal layers of cholesteatoma. CONCLUSION: The results of this study suggest that there are signal transduction pathways through PLC, over-expression of PLC, the different signaling mechanism by PLC in the basal and the suprabasal layer of cholesteatoma.

The Effect of Substance P on Nasal Mucosal Hypersensitivity through Sensory Nerve Axonal Reflex

The mucus secretion of airway glands is known to be controlled by the various autonomic neurotransmitters such as noradrenalin and acetylcholine. However, a recent study suggests that non-adrenergic, non-cholinergic (NANC) nerves may contribute to the secretory activity of glands. Substance P (SP) has been proposed as a neurotransmitter of the NANC nervous system. SP is present within nerve fibers innervating the airway mucosa and is known to be released from sensory nerves via an axonal reflex. SP activity is controlled by neutral endopeptidase (NEP) which degrades SP. In this study, we evaluated the effects of NEP inhibitor (thiorphan) and substance P on nasal mucosa and histamine on the nasal mucosa in healthy males. In the thiorphan-substance P experimental group, the nasal volume decreased after nebulization of substance P in proportion to the concentration of histamine. In the thiorphan-substance P experimental group, the frequency of sneezing increased in proportion to the concentration of histamine, but there was no increased frequency of sneezing from thiorphan, SP and normal saline. The results of this study suggest that axonal reflexes can play a role in the pathogenesis of nasal mucosal hypersensitivity and neurogenic inflammation.

Alport's Syndrome-A Case Report- / 대한이비인후과학회지

Alport's syndrome is a genetic disorder of basement membranes manifested by a progressive nephropathy and sensorineural hearing loss and ocular lesions. Type 4 collagen, main component of basement membranes, is composed of six genetically distinct chains. Mutation of gene COL4A5 which encodes the 5 chain of type IV collagen may prevent the normal incorporation of 3 and 4 into basement membranes. Main clinical features of this syndrome are hematuria, sensorineural hearing loss, ocular abnormalities including lenticonus and cataract. The characteristics of audiological manifestations are bilateral moderate sensorineural hearing loss with recruitment phenomenon and normal latencies of waves in brain stem evoked response audiometry. We recently experienced a case of Alport's syndrome in 10 year old male patient with sensori-neural hearing loss and esophageal achalasia. We report this case with review of literatures.