Recovery and long-term renal outcome of patients with antineutrophil cytoplasmic antibody-associated vasculitis who are on dialysis at presentation

Objective@#Renal involvement in anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) can lead to severe renal dysfunction requiring dialysis at diagnosis. We aimed to study the clinical and pathologic characteristics of patients with AAV dependent on dialysis at presentation and the long-term renal outcomes of patients who recovered from dialysis. @*Methods@#This retrospective study analyzed data of patients diagnosed with AAV who were on dialysis from July 2005 to May 2021 at a single tertiary center in Korea. @*Results@#Thirty-four patients were included in the study (median age: 64.5 years, females: 61.8%), of which 13 discontinued and 21 continued dialysis. The proportion of normal glomeruli (p<0.001) and interstitial fibrosis (p=0.024) showed significant differences between both groups. Multivariable analysis showed that the proportion of normal glomeruli was associated with dialysis discontinuation (odds ratio=1.29, 95% confidence interval 0.99~1.68, p=0.063), although without statistical significance. Treatment modalities, including plasmapheresis, did not show significance with dialysis discontinuation. In the follow-up analysis of 13 patients who had discontinued dialysis for a median of 81 months, 12 did not require dialysis, and their glomerular filtration rate values significantly increased at follow-up time compared to when they stopped dialysis (37.5 [28.5~45.5] vs. 24.0 [18.5~30.0] mL/ min/1.73 m²; p=0.008). @*Conclusion@#Approximately 38% of AAV patients on dialysis discontinued dialysis, and the recovered patients had improved renal function without dialysis during longer follow-up. Patients with AAV on dialysis should be given the possibility of dialysis discontinuation and renal recovery, especially those with normal glomeruli in kidney pathology.

Verification of the Performance of the Panbio COVID-19 Ag Rapid Test Device for Implementation in the Clinical Laboratory / 이화의대지

Objectives@#The Panbio COVID-19 Ag Rapid Test Device (Panbio COVID-19 Ag, Abbott Rapid Diagnostics) is a lateral flow immunochromatographic assay targeting the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleoprotein in nasopharyngeal specimens for the diagnosis of coronavirus disease 2019 (COVID-19). This study aimed to verify the performance of the Panbio COVID-19 Ag for implementation in clinical laboratories. @*Methods@#Sixty nasopharyngeal swab specimens (30 positive and 30 negative) dipped in transport medium, and COVID-19 was confirmed using real-time RT-PCR using Allplex SARS-CoV-2 assay (Seegene), were tested using the Panbio COVID-19 Ag. Reproducibility was evaluated using positive and negative control materials. Sensitivity and specificity were calculated based on the results of realtime RT-PCR as the standard test method. @*Results@#Reproducibility was confirmed by the consistent results of repeated tests of the quality control materials. The overall sensitivity and specificity of Panbio COVID-19 Ag were 50.0% and 100.0%, respectively. Panbio COVID-19 Ag demonstrated high sensitivity (88.2%) in analyzing the detection limit cycle threshold (Ct) value of 26.67 provided by the manufacturer as a positive criterion, and the sensitivity was 100.0% for the positive criterion of Ct values <25, although it was less sensitive for Ct ≥ 25. @*Conclusion@#Considering the high sensitivity for positive samples with Ct values <25 and the rapid turnaround of results, Panbio COVID-19 Ag can be used in clinical laboratories to diagnose COVID-19 in limited settings.

Thelazia Callipaeda Infestation with Tarsal Ectropion

PURPOSE: To report a case of Thelazia callipaeda infestation with tarsal ectropion.CASE SUMMARY: A 79-year-old man presented with epiphora and a sensation of a foreign body in his right eye that had persisted for several months. On the initial examination, he had conjunctival injection, conjunctival follicles, telangiectasia of the lid margins, meibomian gland dysfunction, and tarsal ectropion. We performed a lateral tarsal strip operation to treat the tarsal ectropion. During surgery, we identified and removed four parasites (about 1–2 cm in length and 0.5 mm in width) that had not been apparent on slit lamp examination. The parasites were identified as Thelazia callipaeda. The patient's symptoms subsequently improved considerably; he has followed up to the present time without recurrence.CONCLUSIONS: In the presence of continuous extraocular inflammation, as with infestation by Thelazia callipaeda, ectropion can be induced by several possible causes. Involutional ectropion can be accelerated mechanically through rubbing. Other causes include inferior force from inflammation of the connective tissue and temporary blepharospasm.

Short-term Results of Intravitreal Dexamethasone Implant Combined with Bevacizumab versus Intravitreal Bevacizumab for Treatment-naive Diabetic Macular Edema

Purpose@#To compare the visual and anatomical outcomes of intravitreal bevacizumab combined with the dexamethasone intravitreal implant (Ozurdex®) and bevacizumab monotherapy in eyes with treatment-naive diabetic macular edema. @*Methods@#We retrospectively reviewed 41 eyes of 41 patients with diabetic macular edema who underwent either intravitreal bevacizumab (1.25 mg) (21 eyes, intravitreal bevacizumab [IVB] group) injection alone or simultaneous injection of bevacizumab (1.25 mg) and dexamethasone implant (0.7 mg) (20 eyes, intravitreal dexamethasone [IVD] group). Best-corrected visual acuity (BCVA), central macular thickness (CMT), intraocular pressure, and retreatment percentages were accessed 1, 3, and 6 months after injection. @*Results@#At 3 and 6 months, the IVD group showed a significant improvement in BCVA compared to the baseline. Only a slight improvement in BCVA was observed in the IVB group during the initial 3 months; however, significant improvement was evident at 6 months compared with the baseline. During the first 3 months, the IVD group showed significant improvement in CMT compared with the IVB group; at 1 month after the initial injection, the CMT was 264.39 ± 54.95 μm for the IVD group versus 349.00 ± 112.18 μm for the IVB group (p = 0.011). At 3 months, the CMT in the IVD group had improved significantly compared with that of the IVB group (p < 0.001). The average number of additional intravitreal injections during the 6-month follow-up was 0.45 and 1.15 for the IVD and IVB groups, respectively. In the IVD group, cortical (7%) and posterior subcapsular (15%) cataracts developed by two grades or more during follow-up in phakic eyes. @*Conclusions@#In patients with diabetic macular edema, simultaneous therapy combining a dexamethasone implant plus bevacizumab showed significant improvement in CMT during the initial 3 months and the combined treatment group had fewer additional intravitreal injections.

Short-term Results of Intravitreal Dexamethasone Implant Combined with Bevacizumab versus Intravitreal Bevacizumab for Treatment-naive Diabetic Macular Edema

Purpose@#To compare the visual and anatomical outcomes of intravitreal bevacizumab combined with the dexamethasone intravitreal implant (Ozurdex®) and bevacizumab monotherapy in eyes with treatment-naive diabetic macular edema. @*Methods@#We retrospectively reviewed 41 eyes of 41 patients with diabetic macular edema who underwent either intravitreal bevacizumab (1.25 mg) (21 eyes, intravitreal bevacizumab [IVB] group) injection alone or simultaneous injection of bevacizumab (1.25 mg) and dexamethasone implant (0.7 mg) (20 eyes, intravitreal dexamethasone [IVD] group). Best-corrected visual acuity (BCVA), central macular thickness (CMT), intraocular pressure, and retreatment percentages were accessed 1, 3, and 6 months after injection. @*Results@#At 3 and 6 months, the IVD group showed a significant improvement in BCVA compared to the baseline. Only a slight improvement in BCVA was observed in the IVB group during the initial 3 months; however, significant improvement was evident at 6 months compared with the baseline. During the first 3 months, the IVD group showed significant improvement in CMT compared with the IVB group; at 1 month after the initial injection, the CMT was 264.39 ± 54.95 μm for the IVD group versus 349.00 ± 112.18 μm for the IVB group (p = 0.011). At 3 months, the CMT in the IVD group had improved significantly compared with that of the IVB group (p < 0.001). The average number of additional intravitreal injections during the 6-month follow-up was 0.45 and 1.15 for the IVD and IVB groups, respectively. In the IVD group, cortical (7%) and posterior subcapsular (15%) cataracts developed by two grades or more during follow-up in phakic eyes. @*Conclusions@#In patients with diabetic macular edema, simultaneous therapy combining a dexamethasone implant plus bevacizumab showed significant improvement in CMT during the initial 3 months and the combined treatment group had fewer additional intravitreal injections.

Malignant Mixed Mullerian Tumor with Small Bowel Metastasis: A Case Report

Malignant mixed Mullerian tumors (MMMT) are rare aggressive tumors that typically arise fromthe female genital tract. This malignancy has an extremely poor prognosis due to its rapid growthand the high associated incidence of both local recurrence and distant metastases. Althoughintraperitoneal metastasis from MMMT is relatively common, no reports exist regarding theradiologic findings of intestinal metastasis from MMMT. Here, we report a case of MMMT withsecondary small bowel metastasis and the associated radiologic findings.

Cumulative Radiation Exposure during Follow-Up after Curative Surgery for Gastric Cancer

OBJECTIVE: To quantify the cumulative effective dose (cED) of radiation due to repeated CT and PET/CT examinations after curative resection of gastric cancer and to assess the lifetime attributable risk (LAR) estimates based on Biological Effects of Ionizing Radiation VII models. SUBJECTS AND METHODS: Patients who underwent a curative resection for gastric cancer between January 2006 and December 2006 and were followed-up until May 2010 were included in this study. The cED was calculated by using the dose-length product values and conversion factors for quantitative risk assessment of radiation exposure. cED and LAR were compared between early and advanced gastric cancer patients and among American Joint Committee on Cancer TNM stage groups (stage I, II, and III). The nonparametric Mann-Whitney U and Kruskal-Wallis tests, followed by a post-hoc analysis with Bonferroni adjustment, were employed as part of the statistical analysis. RESULTS: The overall median cED was 57.8 mSv (interquartile range [IQR], 43.9-74.7). The cED was significantly higher in the advanced (median, 67.0; IQR, 49.1-102.3) than in the early gastric cancer group (median, 52.3; IQR, 41.5-67.9) (p < 0.001), and increased as the TNM stage increased. For radiation exposure, 62% of all patients received an estimated cED of over 50 mSv, while 11% of patients received over 100 mSv. The median LAR of cancer incidence was 0.28% (IQR, 0.20-0.40) and there were significant differences between the early gastric cancer and advanced gastric cancer group (p < 0.001) as well as among the three TNM stage groups (p = 0.015). The LAR of cancer incidence exceeded 1% in 2.4% of the patients. CONCLUSION: The cED increases proportionally along with tumor stage and, even in early gastric cancer or stage I patients, cED is much higher than that found among the general population. Considering the very good prognosis of early gastric cancer after curative surgery, the cED should be considered when designing a postoperative follow-up CT protocol.

Clinical Characteristics of 7 Patients with Lateral Semicircular Canal Dysplasia / 대한평형의학회지

BACKGROUND AND OBJECTIVES: Dysplasia of lateral semicircular canal (LSCC) is the most common inner ear malformation, because LSCC is the last single structure to be formed during inner ear embryogenesis. There have been several case reports about the LSCC anomaly which showed clinical spectrum ranging from no symptom to severe sensorineural hearing loss. The authors investigated the clinical characteristics of 7 patients with LSCC dysplasia. MATERIALS AND METHODS: The medical records of 7 patients who were diagnosed as LSCC dysplasia from temporal bone computed tomography were retrospectively reviewed. We analysed the findings of history taking, pure tone audiometry, speech audiometry, and caloric tests. RESULTS: The LSCC dysplasia was observed in all of 7 patients in which 5 showed unilaterally confined LSCC dysplasia, 1 showed bilaterally confined LSCC dysplasia, and 1 exhibited bilateral LSCC dysplasia combined with bilateral posterior semicircular canal dysplasia. From 7 patients, hearing loss was chief complaint only in 2 patients. Pure tone audiometry revealed sensorineural hearing loss in one patient, and conductive hearing loss in the other patient. Two patients complained of whirling type vertigo, and 3 complained of nonspecific dizziness. CONCLUSION: The patients with LSCC dysplasia may show variable symptoms such as sensorineural hearing loss, conductive hearing loss, vertigo and nonspecific dizziness.

Photodynamic Therapy for Recurrent Head and Neck Malignancy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: As a preliminary study, authors tried to verify clinical and side effects of Radachlorin in a photodynamic therapy for recurrent head and neck malignancy. Radachlorin shows an absorption peak at 662 nm, which indicates that it penetrates up to 10 mm. SUBJECTS AND METHOD: We treated 12 sites for 9 treatments in 6 recurrent head and neck malignacies, 4 cases of squamous cell cancers and each of adenoid cystic cancer, and undifferentiated nasopharyngeal cancer. A dose of 1 mg/kg or 2-5 mL of Radachlorin was i.v. injected into the mass according to the mass size. We used a diode laser, MILON-662 (Milon Laser Company, Russia) and Medlight cylindrical 10/20 radial diffuser and frontal diffuser as light delivery devices. About 3 hrs after intravenous injection, or 30 min after intralesional injection, a light dose of 200-300 J/cm2 or cm of laser was irradiated onto the tumor or intralesionally with the light dose of 200-300 J/cm2, or cm. RESULTS: There was partial tumor regression in three of the five primary tumors. In one case of metastatic node treated by intralesional injection and irradiation, tumor showed complete necrosis. But there was no effect in 2 cases of subcutaneous metastases. There were no side effects such as fever, chill and photosensitivity in any of the cases. CONCLUSION: The clinical effect of photodynamic therapy (PDT) using Radachlorin with 662 nm of laser light is not clear yet, but it seems to be a safe treatment for head and neck malignancy. We need to investigate the effect of this PDT system in untreated head and neck malignancies.

Cervical Vestibular-Evoked Myogenic Potentials Using Vibration and Sound in Normal Subjects / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate and compare the incidence and the characteristics of parameters of cervical vestibular-evoked myogenic potentials (cVEMPs) using air-conducted (AC) and bone-conducted (BC) stimulations in normal subjects. SUBJECTS AND METHOD: Twenty-four normal subjects (48 ears) with normal hearing and no previous history of dizziness were included. cVEMP responses were recorded by surface electrodes on sternocleidomastiod muscles in response to AC and BC stimuli sequentially. Variances of parameters, including thresholds, amplitudes and interaural amplitude difference ratios (IADR), were analyzed and compared. RESULTS: cVEMP responses were clearly observed in all 48 ears in both AC and BC cVEMP tests. There was no significant difference in latencies (p1 and n1). However, the thresholds in BC cVEMP testing were significantly lower than those in AC cVEMP testing, when compared to the maximum stimulation level. Interaural amplitude difference ratios showed no significant difference in between the two tests, although amplitudes at maximum stimulation intensity in BC cVEMP testing were significantly larger than those in AC cVEMP testing. CONCLUSION: This study shows that BC cVEMP testing shows lower thresholds compared to AC cVEMP testing in normal subjects, suggesting that the threshold value can be used as a parameter in detecting vestibular dysfunction in the clinic. Further studies in patients with various vestibular disorders are needed.

Antifungal Effects of New Synthetic Materials, KAF-200522 and KAF-200522-HCl, on in vitro and in vivo Models / 한국실험동물학회지

KAF-200522 and its chloride form, KAF-200522-HCl, were invented in Chemon inc. as new triazole antifungal agents with excellent activities in vivo and in vitro against wide range of fungi. As a result of in vitro susceptibility measurements, 80% minimum inhibitory concentrations (MIC80) of both test articles against Candida albican sp. and Aspergillus fumigatus sp. were below 0.0156 microg/mL, which were over 4,100 times lower than those of fluconazole against fluconazole resistant C. albican sp. and A. fumigatus sp., and were over 16 times lower than those of amphotericin B against above same fungi. Additionally, against representative dermatophytes, Trichophyton sp., the MIC80s of both test articles were below 0.0156 microg/mL which were over 64 times lower than those of fluconazole and amphotericin B. As in vivo antifungal activities in A. fumigatus sp. infected mouse models, KAF-200522 treatment group at 600 mg/kg showed 80% survival rate which was 2 times higher than that of amphotericin B and showed 13.7 days in the mean survival time (MST) which was about 2.1 times higher than that of amphotericin B. But in KAF-200522-HCl treatment groups, all animals were found dead in contrast to 40% survival rate in amphotericin B treatment group, however dose dependent increases in MST was revealed. In conclusion, antifungal activities of KAF-200522 and its mimics, KAF-200522-HCl in vitro and in vivo were confirmed in this study, therefore the potentiality of the present compounds to be developed into new antifungal drug was expected.

Results of Air Caloric and Other Vestibular Tests in Patients with Chronic Otitis Media

OBJECTIVES: Air caloric results are supposed to be influenced by anatomic changes of the middle ear. The aims of our study were to evaluate the incidence and characteristics of abnormal air caloric results in patients with unilateral chronic otitis media and without any history of vertigo, and to compare caloric results with there of other vestibular function tests (VFTs). METHODS: Twenty five patients with unilateral chronic otitis media (COM) who were scheduled for surgery underwent VFTs preoperatively. Hearing was assessed using pure-tone audiometry and vestibular function was assessed using a set of VFTs: air caloric, head-shaking nystagmus (HSN), vibration-induced nystagmus (VIN), and subjective visual vertical (SVV) tests. RESULTS: Six patients (24%) showed pathologic canal paresis (CP) on COM-sided ears. Two patients showed pathologic CP on the contralateral side. However, both of the two showed inverted nystagmus to warm air stimulation on the COM-side and hyperactive nystagmus to cold air stimulation on the COM-side, which means that the COM-sided ear was stimulated too much. There was pathologic HSN in 12 patients (48%), pathologic VIN in 7 (28%), and pathologic SVV in 5 (20%). Overall, 20 (80%) patients showed abnormal findings through a set of VFTs. Patients with an interaural difference of bone-conduction hearing thresholds > or =10 dB tended to show more abnormal VFT results than those for whom the interaural difference of bone-conduction hearing thresholds was <10 dB. CONCLUSION: Our data show that one-fourth of patients with unilateral COM show abnormal caloric results on the COM side. However, subclinical latent vestibular imbalances were found to be common, which might be related to the gradual vestibular involvement in inflammatory processes, regardless of the caloric results. Results of a set of VFTs should be referred to when determining vestibular imbalance in patients with COM.

The effects of intrathecal fentanyl for spinal anesthesia in lower extremity surgery / 대한마취과학회지

BACKGROUND: Intrathecal opioids in combination with bupivacaine has been shown to provide adequate sensory blockade and early recovery from spinal anesthesia. This study was investigated the added effects of intrathecal fentanyl 10 microgram to bupivacaine for spinal anesthesia. METHODS: Sixty patients undergoing lower extremity surgery were into three groups. Group I received bupivacaine 10 mg (0.5%), gruop II received bupivacaine 5 mg with normal saline 1 ml, and group III received bupivacaine 5 mg with fentanyl 10 microg and normal saline 0.8 ml. RESULTS: There was no significant difference between group I and group III in the peak level and duration of sensory block. But the intensity of motor blockade was decreased in group III compared with group I and side effects of spinal anesthesia with local anesthetics was decreased in group III compared with group I. In Group II, 7 patients were complained the pain during surgery. CONCLUSIONS: Intrathecal fentanyl 10 microgram with bupivacaine 5 mg on spinal blockade provide reliable anesthesia for lower extremity surgery.

Effects of Gaze Positions on Ocular Vestibular Evoked Myogenic Potentials / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Recent works have demonstrated the existence of ocular vestibular evoked myogenic potentials (OVEMPs), which reflects otolith-ocular reflex. The purpose of this study was to identify an appropriate gaze position to detect OVEMPs produced by air-conducted sound stimulation in healthy subjects. SUBJECTS AND METHOD: Twenty four healthy subjects (35 ears) were included in this study. Surface electromyographic activity was recorded from active electrodes placed inferior to each eye. Stimulation with 500 Hz short tone bursts was used to activate the vestibular end-organs. RESULTS: Sound stimulation evoked negative-positive biphasic responses on both ipsilateral and contralateral eyes, while responses were contralateral eye-dominant. Contralateral eye responses had higher response incidence and larger amplitudes. Altering the direction of gaze generally changed the incidence and size of the inter-peak amplitudes. The higher incidence and larger amplitudes were recorded when the eyes are directed to the superior and ipsilateral side to the sound stimulation. In that gaze position, the amplitude was 5.3 micronV, the first negative peak latency was 10.5 ms and the following positive peak latency was 15.4 ms on the average. CONCLUSION: OVEMPs can be evoked using an air-conducted 500 Hz tone burst and are best recorded contralaterally with a upward gaze towards the source of sound stimulation. Further changes of the test parameters are needed for higher and consistent responses.

Hearing Results of Tympanoplasties in 175 Patients with Chronic Otitis Media / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To report the hearing results of tympanoplasty for chronic otitis media with or without cholesteatoma. SUBJECTS AND METHOD: One hundred and seventy-five patients presenting chronic otitis media with or without cholesteatoma were involved in a retrospective study. Tympanoplasties were performed by the same surgeon over a 30-month period. Audiometric results were reviewed. Audiometric results according to the following techniques were measured: tympanoplasty type 1 (T1), interposition (Si) and/or columella (Sc) over stapedial head, and interposition or columella (Fic) over footplate. The follow-up period ranged from 6 to 32 months. Audiological parameters using the average of four frequencies were assessed pre- and post-operatively. RESULTS: Overall hearing results showed postoperative air-bone gaps (ABG) < or =20 dB in 69% of cases. ABG was closed to within 20 dB in 89% for T1, 67% for Sc, 58% for Si, and 30% for Fic. ABG was closed to within 30 dB in 95% for T1, 67% for Sc, 83% for Si, and 70% for Fic. There was a significant improvement between preoperative and postoperative ABGs. The overall improvement of the air-bone gap was 8+/-13 dB. There was no significant functional difference between different surgical techniques. CONCLUSION: Our hearing results after tympanoplasties were similar to those from other studies. The hearing results observed in this study confirmed that successful results can be obtained by applying the current principles and approach to ossicular reconstruction.

Follow-up Changes of Eye Movements by Caloric Stimulation in Patients With Vestibular Neuritis

BACKGROUND AND OBJECTIVES: A significant recovery of resting activity in the vestibular nuclei ipsilateral to the unilateral labyrinthectomy has been reported by the time symptoms such as spontaneous nystagmus and roll head tilt have largely disappeared. However, the dynamic vestibular response after unilateral vestibular loss to passively imposed vestibular stimuli does not recover. MATERIALS AND METHODS: We investigated changes of the caloric responses in 32 patients with vestibular neuritis during in- and out-patient visits separated by 2 months in an attempt to identify changes brought about by peripheral and/or central compensation processes. RESULTS: The slow-phase eye velocities stimulated by warm caloric stimulation at acute and follow-up stage were 6.6+/-6.6 degrees/s, 9.5+/-9.9 degrees/s in the lesioned side; 28.4+/-19.1 degrees/s, 24.5+/-11.6 degrees/s in the intact side. The slow-phase eye velocities stimulated by cold caloric stimulation at acute and follow-up stage were 5.9+/-7.7 degrees/s, 10.3+/-8.2 degrees/s in the lesioned side; 19.8+/-10.3 degrees/s, 18.8+/-9.9 degrees/s in the intact side. CONCLUSION: Our findings show that the recovery of caloric responses comes mostly from the recovery of the eye responses to the caloric stimulation in the lesioned side and the eye responses to the caloric stimulation in the intact side does not change over time after vestibular neuritis.

Tympanometry and CT Measurement of Middle Ear Volumes in Patients with Unilateral Chronic Otitis Media

OBJECTIVES: The goals of the study were to compare the middle ear (ME) volumes from both normal and lesioned ears, and these ME volumes were measured by a digital image processing computed tomography (CT) program in patients with unilateral chronic otitis media, and we wanted to compare the ME volumes of the lesioned ears by comparing the ME volumes obtained by tympanometry with those ME volumes measured by the digital image processing CT program. METHODS: Forty-four patients who had unilateral chronic otitis media (COM) and contralateral normal tympanic membranes (TM) and 100 subjects with normal TMs were included in the study. The normal volumes of the external auditory canal (EAC) were measured in the normal group. The tympanometric ME volumes in the ears with a perforated TM were calculated as the difference of the tympanometric volumes measured from the both ears in patients with unilateral COM. The CT ME volumes were measured by a digital image processing program. RESULTS: The tympanometric volumes of the EACs in the ears with normal TMs were 1.4+/-0.3 mL. There were no significant differences according to gender, age and the side of the face the ear was on. The tympanometric volumes of the EAC in the normal-side ear of the patients with unilateral COM showed no significant differences when compared with those from the normal group. The ME volumes of the intact ears, as measured by CT, showed significantly higher values than those ME volumes of the lesioned ears. The ME volumes of the lesioned ears, as measured by tympanometry, showed a strong, significant linear correlation with those ME volumes calculated by CT; however, the ME volumes of the lesioned ears, as measured by tympanometry (1.5+/-1.4 mL), were significantly larger than those ME volumes measured by CT (1.1+/-0.8 mL). CONCLUSION: Our results show that chronic otitis media causes reduced ME volumes compared to those ME volumes of the contralateral normal ears. Tympanometry can provide a valuable estimation of the ME volumes in chronic ears, although it tends to overestimate the ME volumes, and especially for the ears with a larger ME volume.

Effects of Changes of Plateau and Rise/Fall Times on Ocular Vestibular Evoked Myogenic Potentials

BACKGROUND AND OBJECTIVES: The ocular vestibular evoked myogenic potential (OVEMP) is a recently discovered test of labyrinthine function, analogous to the cervical VEMP. Recent works have demonstrated the existence of OVEMPs, which likely reflect otolith-ocular reflex. The purpose of this study was to identify the optimal plateau and rise/fall times of short tone bursts to detect OVEMPs in healthy subjects. MATERIALS AND METHODS: Thirteen healthy subjects (26 ears) were included in this study. Surface electromyographic activity was recorded from active electrodes placed inferior to each eye. Stimulation with 500 Hz short tone bursts was used. We used a variety of plateau and rise/fall times. Three different plateau times (1, 2, and 3 ms) and rise/fall times (0.5, 1, and 2 ms) were used. The incidence, amplitudes and latencies were compared. RESULTS: VEMP responses were clearly observed in all 26 ears at the plateau time of 2 ms and two rise/fall times (0.5 and 1 ms). The amplitudes in the individual ears tested were lower at the rise/fall time of 2 ms than at the other conditions. The amplitudes were lower at the plateau time of 3 ms compared to the other conditions. When the rise/fall time was prolonged from 0.5 to 2 ms, the n1 and p1 latencies were prolonged in parallel. However, there was no such change in latencies according to the plateau times. CONCLUSIONS: Our findings show that the ideal stimulation pattern for evoking OVEMP is at the rise/fall times of 0.5 or 1 ms and the plateau time of 2 ms. The waveform morphology of the VEMP responses observed with this stimulation pattern was simultaneously the most constant and marked.

A Case of Superior Canal Dehiscence Syndrome as a Cause of Step-Synchronous Tinnitus / 대한이비인후과학회지

The superior canal dehiscence syndrome (SCDS) is a rare disorder caused by the dehiscence of the temporal bone overlying the superior semicircular canal. It has become apparent that SCDS can lead to a variety of clinical manifestations, vestibular and/or auditory, in contrast to the typical symptoms, as initially described. We recently examined a 54-year-old woman with unilateral stepsynchronous tinnitus without any vestibular symptoms. Tinnitus is a quite unremarkable finding among variable symptoms of the syndrome; however, it can be one of the clues to identify SCDS when it is accompanied by low-frequency conductive hearing loss. Therefore, in diagnosing SCDS, attention must be also paid to those patients with nonspecific complaints, for example, stepsynchronous tinnitus.

Otolith Function Tests in Patient with Meniere's Disease

BACKGROUND AND OBJECTIVES: The aims of this study were to measure otolith function using subjective visual vertical (SVV) test and vestibular evoked myogenic potential (VEMP) test in patients with unilateral Meniere's disease, and to see the relationship of the otolithic impairment with caloric and audiologic results. MATERIALS AND METHODS:Twenty two patients with unilateral Meniere's disease who received treatment and also had been tested for pure tone, caloric, SVV and VEMP tests were enrolled. All the tests were done simultaneously. RESULTS: Five of 22 (23%) patients showed abnormal tilt to the lesion side in SVV test, and 13 of 22 (59%) patients showed abnormal VEMP results on the affected side. There was no correlation between SVV tilts and unilateral weakness (UW) in caloric tests or pure-tone average. There was also no difference of UW in patients with or without VEMP abnormalities. Two patients showed abnormal finding in both SVV & VEMP tests. One patient showed UW (47%) and SVV tilt (3.08degrees) to the lesion side, and the other showed normal UW and SVV tilt (3.22degrees) to the lesion side. CONCLUSION: Our results demonstrate that the otolith system was implicated in 16 out of 22 (73%) patients with Meniere's disease. However, there was no correlation between the abnormal results of the three tests and these findings suggest that impairment of the otolithic function is depending on the extent and/or the localization of Meniere's disease, suggesting vestibular rehabilitation for the specific lesion might be helpful.