The Similarity of Biomarkers Level between Direct Nasal Fluid and Nasal Lavage Fluid in Allergic Rhinitis Patients

Background and Objectives@#Biomarkers of allergic rhinitis (AR) have been studied; however, little is known regarding their practical application in the diagnosis of AR. Previous studies collected samples using saline lavage, nasal brushing, or nasal biopsy. To utilize nasal fluid as a diagnostic tool, we need to standardize the method of sample collection. Therefore, this study aimed to evaluate the difference in concentration of biomarkers depending on the method of nasal fluid collection.Materials and Method: Forty-five AR patients who had greater than moderate AR symptoms and who had positive results on skin prick test and serum-specific IgE tests were enrolled in this study. Nasal fluid was collected using the direct method or saline lavage method. The concentration of each biomarker was analyzed using enzyme-linked immunosorbent assay and the values compared. @*Results@#Nasal fluid samples were collected directly from 14 patients and were collected via saline lavage in 31 patients. No significant differences were found in the median value of each biomarker between the two methods of nasal sample collection. @*Conclusion@#Nasal fluid collection method does not significantly affect biomarker concentration.

The Similarity of Biomarkers Level between Direct Nasal Fluid and Nasal Lavage Fluid in Allergic Rhinitis Patients

Background and Objectives@#Biomarkers of allergic rhinitis (AR) have been studied; however, little is known regarding their practical application in the diagnosis of AR. Previous studies collected samples using saline lavage, nasal brushing, or nasal biopsy. To utilize nasal fluid as a diagnostic tool, we need to standardize the method of sample collection. Therefore, this study aimed to evaluate the difference in concentration of biomarkers depending on the method of nasal fluid collection.Materials and Method: Forty-five AR patients who had greater than moderate AR symptoms and who had positive results on skin prick test and serum-specific IgE tests were enrolled in this study. Nasal fluid was collected using the direct method or saline lavage method. The concentration of each biomarker was analyzed using enzyme-linked immunosorbent assay and the values compared. @*Results@#Nasal fluid samples were collected directly from 14 patients and were collected via saline lavage in 31 patients. No significant differences were found in the median value of each biomarker between the two methods of nasal sample collection. @*Conclusion@#Nasal fluid collection method does not significantly affect biomarker concentration.

Analysis of Risk Factors for Recurrence of Benign Paroxysmal Positional Vertigo: An 11-Year Nationwide Population-Based Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of dizziness with a high recurrence rate. This study aimed to analyze the recurrence rate and the risk factors for recurrence using the Korean National Health Insurance Service National Sample Cohort (NHIS-NSC 2002–2013) data. SUBJECTS AND METHOD: Patients aged 20 years or older who were diagnosed with BPPV in the period of 2002–2012 and had at least 1 year of monitoring period were included in this study. The diagnosis of BPPV was made when the code for BPPV (KCD-6 code H811) was used or when canalith reposition therapy (EDI code MX035) was entered even in cases with different diagnoses. The risk factors of BPPV recurrence were analyzed. RESULTS: Of the total of 21355 patients diagnosed with BPPV, 5876 patients (28%) demonstrated recurrence. Multiple recurrences were common. When using the univariate regression analysis, age, sex, vestibular disease, headache, osteoporosis, and ischemic heart disease were found significant. When the patients were classified into 4 groups according to age and sex, vestibular diseases were found as a common risk factor for recurrence in all groups, while headache, osteoporosis, hypertension, and ischemic heart disease were significant in females. CONCLUSION: The recurrence rate of BPPV in the Korean adult population was approximately 28% and recurrences were more common in patients aged over 65 and in females. Patients with vestibular diseases were at a higher risk of recurrence regardless of age or sex, while headache, osteoporosis, hypertension and ischemic heart disease increased the risk of recurrence in females.

Trans-tympanic Cartilage Chip Insertion for Intractable Patulous Eustachian Tube

BACKGROUND AND OBJECTIVES: Patulous Eustachian tube (PET) causes troublesome autophony. We treated PET using tragal cartilage chip insertion to fill in the concavity within the tubal valve and evaluated the feasibility of this method. SUBJECTS AND METHODS: This study used a prospective design. Eleven patients with PET disorder were included. Tragal cartilage chip insertion via a transcanal approach into the Eustachian tube (ET) was performed in 14 ears of those patients. They were followed-up for at least 12 months after surgery and were evaluated by symptom questionnaire scores. RESULTS: The average follow-up was 16.4 months. Thirteen of fourteen ears received immediate complete relief of autophony symptoms. Autophony symptoms at the last follow-up were as follows: four ears (28.6%) had complete relief; five ears (35.7%) showed satisfactory improvement; four ears (28.6%) showed significant but unsatisfactory improvement; and one ear (7.1%) was unchanged. The PET symptom questionnaire in the affected ears showed a significant reduction in autophony (p=0.047) and improvement in breathing sound conduction (p=0.047). There were no complications such as otitis media or occlusion symptom. CONCLUSIONS: Transtympanic cartilage chip insertion into the ET provides a safe and accessible surgical option for the treatment of PET.

A Study on Dietary Behavior and Food Preference of Sramanera·Sramanerika Monks in Nationwide Buddhist Monk's Universities / 대한지역사회영양학회지

OBJECTIVES: This study was designed to find out factors that are needed to be improved for the Buddhist training environment of Sramanera·Sramanerika monks, who have been newly adapted for their life style after becoming a monk, and to provide basic data for the development of the standard diet in Buddhist temples. METHODS: A self-administered questionnaire was applied to 365 Sramanera·Sramanerika monks at 11 Buddhist monk universities. The questionnaire was designed to investigate their dietary habits, dietary evaluation, satisfaction of food service, and food preferences. RESULTS: The study population consisted of 52.6% men, and 47.4% women. The subjects who had a vegetarian diet before joining the Buddhist priesthood were 27.7% women, and 13.5% men (p<0.01). 42.2% of the total subjects felt that they are healthy now and 19.4% felt weak. The most difficulty of dieting adaptation as soon as entering the priesthood was the strict diet rules (42.9%). The subjects considered health or nutrition (40.0%) highly when having meals. 94.8% women, 84.1% men ate breakfast every day (p<0.001). Women (55.4%) frequently ate snacks more than men (26.6%) (p<0.001). The results of the dietary evaluation indicated that the intake of milk, soy milk or dairy products and beans or tofu received lower than 3 points and women had lower point result than men (p<0.001). Foods with higher preference were grilled mushrooms, grilled laver, miso stew, sweet and sour mushrooms, steamed tofu with seasoning. CONCLUSIONS: Women were more interested in their health than men but they also required to improve the nutritional eating habits. It appeared that the lower intake rates of the calcium containing food (milk and dairy), and proteins (beans and tofu) could result in nutritional imbalance. Therefore, it is necessary to offer food based on the standard menu plan with consideration given to their food preferences in order to maintain their health and desirable dietary habits.

Idiopathic Sudden Sensorineural Hearing Loss Is Correlated with an Increased Risk of Stroke: An 11-Year Nationwide Population-Based Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sudden sensorineural hearing loss (S-SNHL) occurs abruptly, developing rapidly within 3 days. The criteria for the diagnosis of S-SNHL are idiopathic hearing loss of at least 30 dB over at least three serial test frequencies. This study estimated whether S-SNHL increases the risk of stroke using Korean National Health Insurance Service National Sample Cohort (NHIS-NSC 2002-2013) data. SUBJECTS AND METHOD: Among NHIS-NSC 2002-2013, we excluded the patients diagnosed as S-SNHL or stroke in 2002. The patients who were diagnosed and treated as S-SNHL (n=2510) and the comparison group (n=12550) extracted using propensity score matching were enrolled. During an 11-year follow-up period until December 2013, the incidence of stroke among two groups was analyzed and the result was adjusted for the impact of comorbidities such as hypertension, diabetes, and chronic kidney disease with Cox proportional hazard regression. RESULTS: According to our data, 10.8% of S-SNHL patients (among 2510) and 7.8% of the comparison group (among 12550) had strokes. Stroke incidence was reported higher in patients with history of S-SNHL compared to the comparison group [hazard (HR), 1.15; 95% confidence interval (CI), 1.01-1.32] followed by patients with hypertension (HR, 2.51; 95% CI, 2.22-2.84), diabetes mellitus (HR, 1.62; 95% CI, 1.43-1.85). In terms of the type of strokes, S-SNHL increased the risk of ischemic stroke (HR, 1.18; 95% CI, 1.02-1.37). CONCLUSION: S-SNHL appeared to be associated with an increased risk of developing stroke after adjusting for other risk factors.

Clinical significance of mismatch repair genes immunohistochemical expression of complex endometrial hyperplasia

OBJECTIVE: Women with Lynch syndrome have an increased risk of developing colorectal and gynecologic malignancies such as endometrial cancer. Complex hyperplasia has about a 30% risk of developing into endometrial cancer. The aim of this study was to determine the genetic risk for developing endometrial cancer by immunohistochemical staining of premalignant lesions for mutL homolog 1, mutS homolog 2, mutS homolog 6, and postmeiotic segregation increased 2. METHODS: Twenty cases (n=20) were selected from among patients with available sample blocks for analysis. Clinical information was obtained from medical chart review. Immunohistochemical staining was performed for all of the tumor blocks. Staining was scored based on the intensity (intensity score 0-3) . RESULTS: Among the 20 cases of complex endometrial hyperplasia, 11 (55%) patients showed loss of expression of at least one of the following proteins: mutL homolog 1, mutS homolog 2, mutS homolog 6, or postmeiotic segregation increased 2. Seven (35%) patients were negative for the expression of two or more proteins, and one patient (5%) was negative for the expression of all four proteins. CONCLUSION: More than half of the patients showed loss of expression of at least one mismatch repair protein in our study population. Genetic risk counseling and further tests are recommended for these patients.

A Case of Sudden Deafness with Intralabyrinthine Hemorrhage Intralabyrinthine Hemorrhage and Sudden Deafness

Sudden hearing deterioration may occur in our population, but it is difficult to explain the exact pathophysiology and the cause. Magnetic resonance imaging (MRI) in sudden sensorineural hearing loss (SSNHL) is usually useful to evaluate neural lesions such as acoustic schwannoma and hemorrhage in labyrinth. Recently some cases of SSNHL caused by intralabyrintine hemorrhage were reported by the advance of MRI. In the case of intralabyrintine hemorrhage, MRI showed a hyperintense signal in the labyrinth on the pre-contrast and contrast enhanced T1-weighted image and relatively weak intensity on T2-weighted image. The prognosis SSNHL by intralabyrintine hemorrhage is generally known to be poor. We report a case of sudden deafness with intralabyrintine hemorrhage who has a history of anticoagulant administration, with a review of literature.

Hearing Outcome According to the Timing of Intratympanic Dexamethasone Injection in Idiopathic Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Oral systemic steroids are the most commonly accepted treatment for idiopathic sudden sensorineural hearing loss (SSNHL) despite pathophysiological uncertainty. Recently, intratympanic dexamethasone (ITD) has been proposed as an effective, alternative method for patients in whom oral steroids either fail to respond or are contraindicated. The authors compared the efficacy of ITD according to the duration of hearing loss prior to first dose of ITD. SUBJECTS AND METHOD: We retrospectively reviewed the medical records and audiologic data of 86 SSNHL patients who received ITD from May 2009 to April 2012. Injections were repeated 5 times for 2 weeks and the favorable recovery was defined as complete or partial recovery using Siegel's criteria. We compared the hearing outcomes between pre-ITD and post-ITD with respect to the duration of hearing loss. RESULTS: The mean pure-tone audiograms before and after ITD were 57.91+/-25.52 dB and 50.81+/-24.28 dB (p<0.01), respectively. According to Siegel's criteria, the overall rate of hearing improvement after ITD was 22.1% (19/86). Favorable hearing recovery was observed in 8 of 18 (44.4%) patients within 10 days, 7 out of 41 (17.1%) between 10 days and 20 days, 2 of 18 (11.1%) between 20 days and 30 days, 2 of 7 (28.6%) over 30 days. CONCLUSION: ITD is a useful method as primary or salvage treatment of SSNHL. The results of this study suggest that early ITD after hearing loss increase the probability of hearing recovery.

Otogenic Pneumocephalus Associated with a Ventriculoperitoneal Shunt

Otogenic pneumocephalus is a condition of intracranial air originating from the middle ear or mastoid air cells. This communication between the intracranial cavity and the pneumatic cavities is usually associated with trauma after cranial fractures or iatrogenic trauma. We present a rare case of otogenic pneumocephalus arising in the left posterior fossa from wellpneumatized mastoid air cells. The patient complained of roaring tinnitus that developed 29 months after ventriculoperitoneal shunt insertion due to brain tumor surgery. High resolution computed tomography scan of the temporal bones revealed a large pneumocephalus below the left tentorium, and a bony dehiscent route was clearly identified in a sagittal view. A left mastoidectomy with preservation of the posterior wall of the external auditory canal was performed, and the expected bony dehiscent site was identified in the posterior fossa dura plate, just posterior to the posterior semicircular canal, below the Donaldson's line. This communication was sealed with a temporalis muscle plug from the deep temporalis muscle fascia and bone dust. Pneumocephalus may be caused by negative intracranial pressure in a patient with very well-pneumatized mastoid bone, and it can be a possible cause of 'wind-like' sound in the ear.

Bilateral Anterior Ischemic Optic Neuropathy with Sudden Sensorineural Hearing Loss in a Long term Hemodialysis Patient / 대한신장학회지

Anterior ischemic optic neuropathy (AION) is rarely reported in end stage renal disease. In particular, AION combined with sudden sensorineural hearing loss (SNHL) has not been reported in domestic and international journals. Here we report the first case of this combined condition. A 58-year-old male patient in end-stage renal disease presented on painless bilateral visual and hearing deterioration. Clinical findings and imaging studies were compatible with a diagnosis of AION and SNHL. Despite of high-dose steroid therapy, vision and hearing were not significantly recovered. Uremic patients often have coexisting pathology such as hypotension during dialysis, atherosclerosis and anemia, predisposing to AION and SNHL. We describe a patient of dialysis for 10 years who presented with bilateral visual and hearing loss due to complications of long-term dialysis. Our case suggests that nephrologists have to know and treat more carefully this rare but emergent complications of dialysis.

Surgical Management of Facial Paralysis Following Temporal Bone Fractures / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Controversy persists in regard to the management of traumatic facial paralysis. We reviewed the cases of decompression of traumatic facial nerve according to the type of fracture, injury site of nerve, injured state of nerve, surgical timing, surgical approach and opening of epineurium to determine good prognostic factors and propose in this article a rationale of management. SUBJECTS AND METHOD: The authors reviewed retrospectively 35 cases of the decompression of traumatic facial paralysis at the Department of Otorhinolaryngology, Yonsei University College of Medicine from January 1991 to December 2002. RESULTS: The most common site of the injury was perigeniculate area. The most common fracture type was longitudinal fracture. The results of immediate facial nerve decompression were excellent in functional recovery. The surgical findings of injured facial nerve were, in order, edematous swelling, bony impingement, fibrosis and partial transection, traumatic neuroma. Decompression with nerve sheath slitting appeared to provide better outcomes. The approach for decompression according to the injured sites was sufficiently adequate. CONCLUSION: According to our surgical experiences of traumatic facial paralysis, the important prognostic factors are timing of surgical intervention, injured state of the nerve and the slitting of the nerve sheath.

Mucosal Melanoma Arising in the Eustachian Tube: A Case Report / 대한이비인후과학회지

Mucosal melanoma is a very rare disease. Most cases of mucosal melanoma have their origins in the head and neck region. To date, only three cases of melanoma originating from the eustachian tube have been reported. We present a case of mucosal melanoma of eustachian tube origin in which a complete excision was performed. The treatment of mucosal melanoma is not well established, but surgical excision is considered to be the treatment of choice. Radiotherapy is controversial but given consideration in the present case because of the anatomic complexity and difficulty in performing a complete excision. In this case, the patient underwent adjuvant radiotherapy and the mass size was greatly decreased which aided the subsequent surgical excision. Systemic chemotherapy was not utilized in this case. However, it is often used for palliative purposes. A literature review was conducted in the presentation of this case.

Hearing Results of Ossiculoplasty Using Polycel(R) Prosthesis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: During the last decade, the surgical use of alloplasts has become more and more widespread among otologists. In this study, we evaluated the hearing results of ossiculoplasty using Polycel(R) prosthesis. SUBJECTS AND METHOD: One hundred eighty eight cases who underwent ossicular chain reconstruction using Polycel(R) prosthesis and had been followed up postoperatively for more than 12 months at Severance Eye-ENT Hospital from 1998 to 2002 were reviewed retrospectively. Postoperative hearing results were assessed by measuring the postoperative air-bone gap (ABG) and closure in air-bone gap. Successful postoperative ABG criteria were defined as the following three groups ; ABG of < or =10 dB, ABG of < or =20 dB, and ABG of < or =30 dB. Several prognostic factors such as the condition of middle ear mucosa and ossicles, presence or absence of cholesteatoma, surgical method, staging and revision surgery were analyzed. RESULTS: Of the total of 188 cases, 22 cases (11.7%) were < or =10 dB ABG, 96 (51.1%) cases were < or =20 dB ABG, and 158 (84.0%) cases were < or =30 dB ABG. The hearing results were good for healthy middle ear mucosa and cases which contained stapes superstructure, the hearing results were Good. CONCLUSION: Polycel(R) is a good material to be used in ossiculoplasty as a hydroxyapatite and autologous bone. In ossiculoplasty, good prognostic factors of the middle ear condition were healthy middle ear mucosa and the presence of stapes superstructure.

Clinical Review of Primary Hyperparathyroidism / 대한내분비외과학회지

PURPOSE: The increased detection of hypercalcemia during health screening has been increased the diagnosis of hyperparathyroidism. The surgical treatment of primary hyperparathyroidism has been changing from standard exploration for all 4 parathyroid glands to minimally invasive surgery focused to abnormal gland. For the latter, exact preoperative localization is necessary. The aims of this study were to evaluate clinical features of patients with primary hyperparathyroidism and the preoperative localization methods. METHODS: A retrospective study was performed for 61 patients with primary hyperparathyroidism in Samsung Medical Center. RESULTS: There were 19 males and 42 females whose ages ranged from 12 to 76 years. Among 61 patients with primary hyperparathyroidism, there were 51 adenomas, 7 hyperplasias and 3 adenocarcinomas. Preoperative parathyroid hormone (PTH) level was increased in all patients except in a MEN IIA associated patient. Among the methods for preoperative localization, ultrasonography detected 47 of 55 cases (85.5%), (99m)Tc-sestamibi scan 40 of 49 cases (81.6%), MRI 3 of 5 cases (60.0%), CT 9 of 18 cases (50.0%) and Tl-Tc subtraction scan 6 of 9 cases (66.7%). In 26 patients who have been diagnosed as single nodular lesion in the same area by the parathyroid scan and ultrasonography, we could find a single parathyroid adenoma in that area during exploration. Postoperative PTH level of all patients but one were normalized. CONCLUSION: Single gland disease detected by both parathyroid scan and ultrasonography was mostly due to adenoma which can be treated safely by unilateral exploration or minimally invasive surgery.

Combination of Mutated Herpes Simplex Virus (G207) with Radiation for the Treatment of Squamous Cell Carcinoma of the Head and Neck / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: G207 virus is an ideal candidate of oncolytic viral therapy. It is a multi-gene mutant of HSV-1 with a deletion at the gamma34.5 loci and a LacZ gene insertion in the ICP6 gene, encoding the HSV ribonucleotide reductase. Ionizing radiation induces the growth arrest-inducible gene, Gadd34, a protein that correlates with apoptosis following radiation and has homology with the G207 gamma34.5 gene. It is hypothesized that the combination of radiotherapy with G207 virus may have a synergic effect on viral replication and efficacy. The purpose of this study is to evaluate the combination of the cytotoxic G207 virus with radiation therapy to treat head and neck tumors. MATERIALS AND METHOD: Five human SCCHN cell lines and one murine SCC cell line were utilized in this study. There were two groups of cells: control cells received no irradiation while the second group was irradiated with 400 cGy. Cells were infected with G207 vectors at a multiplicity of infection (MOI) of 0.1. Cytotoxicity assay was performed for 5 days. Cells and culture medium supernatant were collected and viral titers determined by plaque forming units on Vero cells. To evaluate infection efficiency, X-gal staining was performed at 24hr post infection. RESULTS: All head and neck squamous cancer cell lines tested demonstrated an increased susceptibility to the combination of G207 virus with radiation therapy when compared with each single modality (more than additive effect, p<0.05). Even though cell lines such as SCC25, MSKQLL2, or SCCVII were radioresistant, the combination of G207 with radiation therapy showed significantly increased cytotoxic effect. X-gal staining and viral growth curve studies demonstrated that G207 replications in radiated cell lines were not decreased as compared with non-radiated ones. CONCLUSION: The results provide preliminary support for the use of G207 oncolytic virus as a radiation adjuvant in treatment of head and neck cancer. The combination of radiation and oncolytic viral gene therapy may eventually be useful in treating patients with radio-resistant, non-resectable disease, and patients with a high probability of contracting postoperative microscopic residual diseases.

The Change of Nasal Blood Flow after a Total Laryngectomy Determined by Laser Doppler Blood Flowmetry / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The effects of airflow cessation on the human nasal mucosa can be conveniently studied in laryngectomees and the blood flow to nasal mucosa is an important factor in maintaining normal nasal function. Therefore, we investigated the changes in nasal mucosa blood flow after a total laryngectomy with Laser Doppler flowmetry. MATERIALS AND METHOD: Twenty-four laryngectomees were studied and compared with 35 normal volunteers. Among 24 total laryngectomees, 9 were esophageal speakers. The Laser Doppler flowmetry was performed using a Periflux 4001 (Perimed, Jrtlla, Sweden) and Perfusion unit (PU), Velocity unit (VU), and Concentration Unit (CU) were measured. The laser Doppler flowmetry data in the laryngectomees were compared with those of the normal subjects, and between the esophageal and non-esophageal speakers. RESULTS: The difference between laryngectomees and normal subjects was statistically significant with the exception of the CU (p<0.05). Furthermore, no correlations were found between blood flow and age, and between blood flow and postoperative duration. The difference between esophageal speakers and non-esophageal speakers was statistically significant with the exception of the level of concentration (p<0.05). CONCLUSION: The nasal blood flow decreased after a total laryngectomy. When airflow improved, an increase in the level of blood flow was recorded. And the change of the nasal blood flow most likely occured within the first year after a total laryngectomy.

Surgical Treatment of Primary and Metastatic Malignant Tumors of the Accessory Parotid Gland / 대한이비인후과학회지

Abstract Tumor of the accessory parotid gland is frequently mistaken as a cheek subcutaneous tumor because of its location and rarity. Preoperative tissue diagnosis is imperative for proper treatment of this rare tumor. In technical point of view, the parotidectomy approach with wide facial nerve dissection and careful elevation of cheek flap is the key to safe resection of the tumor without complication of facial nerve injury. We report one case each of primary and metastatic cancer of accessory parotid gland with a brief review of literature.