Clinical Manifestations and Prognosis of Benign Paroxysmal Positional Vertigo according to Etiology / 대한이비인후과학회지

Background and Objectives@#This work investigates the clinical characteristics of benign paroxysmal positional vertigo (BPPV) according to etiology by comparing idiopathic BPPV (iBPPV), BPPV occurring after head trauma (tBPPV) and BPPV associated with idiopathic sudden sensory neural hearing loss (sBPPV).Subjects and Method A total of 869 patients who were diagnosed and treated for BPPV were reviewed retrospectively. Patients were divided into three groups according to the probable etiology of BPPV: iBPPV vs. tBPPV vs. sBPPV. We investigated and compared demographics, the affected sides and canals, the number of canalith repositioning procedure (CRP) performed to achieve successful reposition, canal conversion and recurrence among the three groups. Among the three groups, BPPV patients who performed caloric test and/or video head impulse test (vHIT) were additionally evaluated and compared. @*Results@#The iBPPV group (n=787) had greater female preponderance (72%, 567/787) than the tBPPV (n=51) and sBPPV groups (n=31, p<0.001). The mean number of CRPs needed for successful repositioning in the iBPPV group (1.40±0.03) was significantly (p<0.001) lower than that in the tBPPV and sBPPV groups (2.04±0.24 and 2.45±0.36). There was no difference between the tBPPV and sBPPV groups. Recurrence rate was not significantly different among three groups (14.6% vs. 17.7% vs. 16.2%) statistically. The presence of canal paresis and abnormal results of vHIT test were not related with a greater number of CRPs required and recurrence. @*Conclusion@#More CRPs were required for successful repositioning in the tBPPV and sBPPV patients than in the iBPPV patients and there was no difference between tBPPV and sBPPV patients. Recurrence rate was not different among the three groups. This information may be helpful for clinicians in counselling and managing BPPV patients.

Effects of Amniotic Membrane Extract on the Hyperplastic Response of the Middle Ear Mucosa in a Bacterially-Induced Otitis Media Rat Model: A Preliminary Study

Objectives@#. Human amniotic membrane extract (AME) is known to contain numerous bioactive factors and anti-inflammatory substances. However, the anti-inflammatory effects of AME on the middle ear (ME) mucosa are unclear. This study assessed the effects of AME on the growth of the ME mucosa in response to bacterially-induced otitis media (OM). @*Methods@#. OM was induced by inoculating nontypeable Haemophilus influenzae (NTHi) into the ME cavity of rats. ME mucosal explants were cultured in AME concentrations of 0, 5, 10, or 50 μg/mL. The area of explant outgrowth was measured in culture and analyzed at 1, 3, 5, and 7 days after explantation. The expression of Ki-67, mucin 5AC (MUC5AC), tumor necrosis factor-α (TNF-α), and interleukin-10 (IL-10) in the explants was also evaluated using quantitative polymerase chain reaction (PCR) and immunocytochemistry (ICC). @*Results@#. The NTHi-induced ME mucosa growth increased gradually over the 7-day culture period in all explants at different AME concentrations. There was a trend for mucosal growth inhibition at higher concentrations of AME, although the growth was not significantly different among the groups until day 5. The ME mucosal explants treated with the 50 μg/mL concentration of AME showed significantly suppressed growth on postexplantation day 7 compared with other explants on the same day. PCR and ICC staining revealed that the expression of Ki-67, MUC5AC, TNF-α, and IL-10 further decreased in the explants with higher concentrations of AME than in those with lower concentrations of AME. @*Conclusion@#. Our results showed that higher concentrations of AME reduced the mucosal proliferative response in bacterial OM in rats. These findings provide evidence that AME has an influence on the inflammatory and proliferative responses to NTHi infection in ME mucosa.

Influence of Vitamin D Deficiency on Progression of Experimental Otitis Media in Rats

BACKGROUND: Vitamin D plays an important role in the immune response against infection. The purpose of the present study was to investigate the influence of vitamin D deficiency on the progression of otitis media (OM) using an experimental rat model. METHODS: Four-week-old male Sprague-Dawley rats (n=72) were divided into two groups based on their diet: a control diet group (n=36) and a vitamin D-deficient diet group (n=36). After 8 weeks of diet, experimental OM was induced by inoculation of non-typeable Haemophilus influenzae in the middle ear cavity. The rats were evaluated with otomicroscopy to determine the inflammation in the middle ear mucosa on days 1, 2, 4, 7, and 14 post-inoculation. Bullae from sacrificed rats were collected and analyzed histologically. RESULTS: The middle ear mucosa from rats with vitamin D deficiency showed a significantly higher thickness than that of controls during the course of OM. The maximum mucosal thickness was 56.0±9.1 µm in the vitamin D deficiency group, and 43.9±9.8 µm in the control group, although there was no significant difference in the tympanic membrane score between the two groups evaluated with otomicroscopy. An immunohistochemical study showed increased expression of interleukin 6 (IL-6) and tumor necrosis factor α in rats manifesting vitamin D deficiency and decreased expression of IL-10 compared with controls. CONCLUSION: Our results showed that vitamin D deficiency may exacerbate the pathophysiological changes of OM via altered cytokine production. Therefore, maintaining vitamin D status in the optimal range may be beneficial for proper management of OM.

The Value of Cardiovascular Risk Factors in Predicting Hearing Recovery of Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Several prognostic factors are known to be related to the recovery of sudden sensorineural hearing loss (SSNHL). Recent studies have suggested that cardiovascular risk factors (CVRFs) are associated with the occurrence of SSNHL. However, the value of CVRFs as a predictor of recovery in patients with SSNHL has been rarely evaluated. We aim to evaluate the prognostic value of CVRFs in relation to hearing recovery of SSNHL. SUBJECTS AND METHOD: A total of 278 patients who were diagnosed and treated for SSNHL and who underwent blood sampling and follow-ups for more than 3 months were reviewed retrospectively. We reviewed CVRFs such as age, body mass index, blood pressure, cholesterol, smoking history, the presence of diabetes mellitus and other related underlying diseases. Patients were divided into three groups (low, medium, and high CVRF groups) according to the CVRF grades. Hearing thresholds were repeatedly measured on the initial visit, 1 week, 1 month and 3 months after treatment. Treatment outcome was analyzed by comparing hearing recovery rate and post-treatment audiometric changes among the three CVRF groups. RESULTS: Seventy (25.2%), 129 (46.4%) and 79 (28.4%) patients were included into the low, medium and high CVRF groups, respectively. The hearing threshold was significantly reduced at 3 months after treatment in all three groups (p<0.001). The hearing recovery rate of the low CVRF group was significantly higher than that of the medium and high CVRF group (p=0.011). On the last visit, the high CVRF group significantly showed more poor hearing improvement than the low CVRF group did (p=0.045). CONCLUSION: Our findings suggest that the presence of CVRFs may be a poor prognostic sign for hearing recovery in patients with SSNHL.

Animal Models of Otitis Media / 대한이비인후과학회지

Otitis media (OM) is one of the most common inflammatory illnesses in the pediatric population. OM is a multifactorial disease that develops as a result of complex interactions between bacterial infection, environmental risk factors, and host genetic factors. The high prevalence and recurrence of OM, coupled with the risk of developing hearing loss have meant that research to understand the mechanisms of OM and identify new therapeutic measures is urgent. Various experimental animals such as chinchilla, guinea pig, gerbil, rat and mouse have been used to investigate the pathogenesis and treatment of OM. Also, a lot of methods have been introduced to induce OM in animals including obstruction of E tube and direct injection of otopathogens into the middle ear. Recently there has been an increase in the use of the mouse for OM research due to the ability to easily manipulate their genetic components. The use of animal models has enabled researchers to identify a number of molecular mechanisms involved in the development of OM. Despite the real progresses obtained from animal models of OM, however, there are still several limitations to using them for OM research. In this review article, various animal models that have been introduced to investigate the pathogenesis of OM will be discussed briefly.

Selective Delivery of a Therapeutic Gene for Treatment of Head and Neck Squamous Cell Carcinoma Using Human Neural Stem Cells

OBJECTIVES: Based on studies of the extensive tropism of neural stem cells (NSCs) toward malignant brain tumor, we hypothesized that NSCs could also target head and neck squamous cell carcinoma (HNSCC) and could be used as a cellular therapeutic delivery system. METHODS: To apply this strategy to the treatment of HNSCC, we used a human NSC line expressing cytosine deaminase (HB1.F3-CD), an enzyme that converts 5-fluorocytosine (5-FC) into 5-fluorouracil (5-FU), an anticancer agent. HB1. F3-CD in combination with 5-FC were cocultured with the HNSCC (SNU-1041) to examine the cytotoxicity on target tumor cells in vitro. For in vivo studies, an HNSCC mouse model was created by subcutaneous implantation of human HNSCC cells into athymic nude mice. HB1.F3-CD cells were injected into mice using tumoral, peritumoral, or intravenous injections, followed by systemic 5-FC administration. RESULTS: In vitro, the HB1.F3-CD cells significantly inhibited the growth of an HNSCC cell line in the presence of the 5-FC. Independent of the method of injection, the HB1.F3-CD cells migrated to the HNSCC tumor, causing a significant reduction in tumor volume. In comparison to 5-FU administration, HB1.F3-CD cell injection followed by 5-FC administration reduced systemic toxicity, but achieved the same level of therapeutic efficacy. CONCLUSION: Transplantation of human NSCs that express the suicide enzyme cytosine deaminase combined with systemic administration of the prodrug 5-FC may be an effective regimen for the treatment of HNSCC.

Evaluation of Anxiety and Depressive Levels in Tinnitus Patients

BACKGROUND AND OBJECTIVES: The aims of this study were to evaluate the relationship between tinnitus and the level of anxiety and depression experienced by subjective tinnitus patients, and to determine the effect of the level of anxiety and depression to the results of tinnitus treatment. SUBJECTS AND METHODS: A total of 104 patients were included in this study. All the patients conducted Tinnitus Handicap Inventory (THI), Beck Depression Inventory (BDI), State Trait Anxiety Inventory 1, 2 (STAI 1, 2) to evaluate their psychometric properties. The subjective patterns of tinnitus before and after treatment were assessed through questionnaires. RESULTS: Significant correlation between THI scores and BDI, STAI 1, 2 scores were observed in the moderate and severe tinnitus group. The patients were classified into two groups depending on their THI scores, and also classified into two groups according to BDI, STAI 1, 2 results. Analysis of differences after treatment indicated significantly improved VAS scores after treatment in all groups. CONCLUSIONS: The subjective level of tinnitus is significantly related with depression and anxiety symptoms when inconvenience caused by tinnitus was moderate or over. Assessments on tinnitus after treatment appeared to have improved significantly regardless of the severity of tinnitus, level of depression or anxiety disorder.

A Case of Bilateral Bell's Palsy with Uncontrolled Diabetes Mellitus / 대한이비인후과학회지

Bilateral facial palsy is uncommon and it accounts for 0.3-2.0% of the facial palsy cases. In contrast to unilateral facial palsy, bilateral facial palsy may occur in association with a variety of neurological, infectious, neoplastic, traumatic, metabolic or degenerative disorders. Diabetes has been associated with bilateral facial palsy. Diabetes is more common among patients with bilateral facial palsy. But the correlation between diabetics and bilateral facial palsy is unclear. Herein, we report a case of a 66 year-old woman with bilateral Bell's palsy associated with uncontrolled diabetes mellitus.

Correlation between Pressure Sensitivity of Nasal Mucosa and Experimentally Induced Nasal Stuffiness in Healthy Adults / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The correlation between subjective nasal obstruction symptom and minimal cross-sectional area (MCA) of nasal cavity is uncertain. Some chemicals change subjective nasal obstruction symptoms without changing MCA. The aim of this study is to evaluate the correlation between the tactile pressure sense of nasal mucosa and the nasal obstruction symptom. SUBJECTS AND METHOD: From 30 healthy adult volunteers, sensitivity to pressure change (P-sensitivity) and sensitivity to MCA change (A-sensitivity) were measured for each side of the nose, respectively. P-sensitivity was obtained as the slope of the regression line which was defined as the change of visual analog scale (VAS) score of the subjective nasal pressure sense divided by the change of inflated intranasal balloon pressure. A-sensitivity was obtained as the slope of the regression line which was defined as the change of VAS score of nasal obstruction divided by the change of MCA measured with acoustic rhinometry in experimentally narrowed or blocked nose using pieces of sponge. RESULTS: There was a strong correlation between P-sensitivity and A-sensitivity. In each volunteer, P-sensitivity or A-sensitivity of one side nose was well correlated with those of the opposite side, respectively. CONCLUSION: Both P-sensitivity and A-sensitivity of human nose vary from person to person, but they have a strong correlation with each other. Nasal obstruction symptom can be influenced by change of general somatic sense of nasal mucosa.

Delayed Facial Paralysis After Middle Ear and Mastoid Surgery due to Reactivation of Herpes-Zoster Virus / 대한이비인후과학회지

Herpes viral reactivation is thought to be an important etiologic factor in the development of post-operative delayed onset of facial paralysis. The authors present a case of herpes zoster oticus that occurred as a consequence of middle ear and mastoid surgery. The patient was initially misdiagnosed as iatrogenic facial paralysis and treated with oral steroid only. The final diagnosis of herpes zoster oticus was made by the development of herpetic auricular eruption with severe otalgia and the results of positive serological tests. Clinical features, diagnosis and management of this rare case are presented and discussed.

Association of the GSTP1 and NQO1 Polymorphisms and Head and Neck Squamous Cell Carcinoma Risk

The GSTP1 and NQO1 have been reported to be associated with an increased risk for smoking related head and neck squamous cell carcinoma (HNSCC). The purpose of this study was to determine the effect of these metabolic gene polymorphisms on the risk of HNSCC. The study population included 294 histologically confirmed HNSCC cases and 333 controls without cancer. Genotyping analysis of the GSTP1 Ile105Val and NQO1 Trp139Arg genes was performed by polymerase chain reaction-based techniques on DNA prepared from peripheral blood. The Mantel-Haenszel chi-square test was used for statistical analysis. The allele frequencies of the GSTP1 and NQO1 polymorphisms were not statistically significant between cases and controls. In analyzing the association between smoking amounts and genetic polymorphisms, GSTP1 and NQO1 polymorphisms were associated with cigarette smoking amounts in cases. G allele containing genotypes in GSTP1 and T allele containing genotypes in NQO1 were associated with a tobacco dose-dependent increase in risk of HNSCC and these genotype distributions were statistically significant (p<0.05). We found that the GSTP1 105Val allele and NQO1 139Arg allele were associated with tobacco dose-dependent increase in risk of HNSCC. GSTP1 and NQO1 genotype polymorphisms may play an important role in the development of smoking related HNSCC.

A Case of Cholesterol Granuloma of the Frontal and Ethmoid Sinus / 대한이비인후과학회지

Cholesterol granuloma of the paranasal sinus is a rare condition. It is rarely diagnosed preoperatively, as correct diagnosis depends on its characteristic histological picture. It is currently thought that impaired drainage, hemorrhage and inadequate ventilation play significant roles in its pathogenesis. We have experienced a case of cholesterol granuloma that had developed in the frontal and the ethmoid sinuses, which was managed successfully by transnasal endoscopic marsupialization. We report this case with a literature review.

Short Term Follow-up of Hearing Changes according to Insertion Site of Temporalis Muscle Fascia in Type I Tympanoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There are two types of methods in the underlay technique that are employed according to the graft insertion site. The purpose of this study is to evaluate the short term follow-up results of air-bone conduction threshold changes according to the insertion of temporalis muscle fascia to medial and lateral side of malleus in type I tympanoplsty with simple mastoidectomy. MATERIALS AND METHOD: 72 patients with perforated tympanic membrane over the half size in pars tensa were operated in type I tympanoplasty with simple mastoidectomy. Patients were divided into two groups according to the insertion of fascia of temporalis muscle to either i) lateral side of the malleus (group A, 32 cases) or ii) medial side of the malleus (group B, 40 cases). Each group was divided into three subgroups according to size of perforation in the tympanic membranes, ranging from moderate, large, to total. Difference in the air-borne conduction threshold changes between the first preoperative and postoperative year was analyzed for each group. RESULTS: The differences in the pre and postoperative air-bone conduction gap (ABG) between the group A and B were 14.4+/-7.1 dB, 10.4+/-6.2 dB, respectively. There was no statistical difference between the two groups (p>0.05). The pre and postoperative ABG differences for different sizes of perforation in the tympanic membrane in group A were 17.5+/-12.2 dB (moderate), 14.1+/-7.4 dB (large), 14.5+/-8.5 dB (total), and in group B were 9.5+/-4.8, dB (moderate), and 9.3+/-7.2 dB (large), and 12.0+/-7.1 dB (total). There was no statistical difference between the subgroups of the same group (p>0.05). The pre and postoperative bone conduction threshold of group A decreased at 250, 500, 1000, and 2000 Hz but increased at 3000, 4000 Hz. The threshold of group B decreased at all frequency. Postoperative reperforations were observed in just 2 cases of the group B. One case was observed at 5 postoperative months in the large perforation group, and the other case was observed at 15 months in the total perforation group, with the former case healing spontaneously at 6 months. CONCLUSION: The results suggest that the two methods of underlay technique could be selected properly by location of perforation, middle ear anatomy and its pathological state, and continuity of ossicles, as well as per operator's preference. When the perforation is located at the anterior, anterosuperior and anteroposterior portion of tympanic membrane, the tympanic membrane is thickened severely so the boundary becomes uncertain between the middlear mucosa and the tympanic membrane. The insertion of fascia to lateral side of malleus is therefore recommended.

A Case of Inflammatory Pseudotumor in the Retroperitoneum / 대한비뇨기과학회지

Inflammatory pseudotumor is a rare, benign lesion of various organ and tissue that usually occurs in children and young adults. We report on a 35-year-old male patient with retroperitoneal inflammatory pseudotumor who was completely cured by surgical resection and steroid therapy.

A Case of Angiolymphoid Hyperplasia with Eosinophilia of the Tongue / 대한이비인후과학회지

Angiolymphoid hyperplasia with eosinophilia(ALHE) is an uncommon disorder manifested as solitary or multiple nodules mainly in the dermis and subcutaneous tissue of head and neck region. Histological characteristics of ALHE is proliferation of endothelial cells in the small to medium sized vessels and infiltration of lymphocytes, plasma cells and eosinophils. ALHE affecting the tongue is very rare. We report a case of ALHE of the tongue in an 56 year old man with the review of literatures.

Otologic Manifestations in Down's Syndrome / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Infants and children with Down's syndrome have been frequently suspected to have associated otologic disorders and hearing imparment as well as mental retardation. For such children with Down's syndrom, development of speech is seriously delayed due to high incidence of otitis media and hearing loss. The purpose of this study was to elucidate the otologic problems in Down's syndrome children, such as incidence, degree, and types of hearing loss. MATERIALS AND METHODS: 43 subjects aged between 4 months and 5 years who were previously diagnosed with Down's syndrome in the pediatric department were investigated for the otologic manifestations. All the patients were evaluated audiologically. RESULTS: Clinical examination revealed the histories of otitis media in 12 subjects (27.9%) and mild auricular anomaly in 2 subjects. A clinical and audiological examination were performed for 43 cases. Auditory brainstem responses, which was employed in all cases, revealed normal hearing in 12 cases (27.9%), unilateral hearing loss in 7 cases (15.9%) and bilateral hearing loss in 24 cases (56.2%). Types of the hearing loss were etiher conductive as in 40 ears (46.5%) or sensorineural as in 15 ears (17.4%). Degree of hearing loss was mild for 14 subjects (16.3%), moderate for 29 subjects (33.7%), severe for 6 subjects (7.0%), and profound for 6 subjects (7.0%). CONCLUSION: Our results demonstrated that the otitis media and hearing loss were common for the cases of Down's syndrome. It is believed that even mild to moderate hearing loss in children can greatly affect cognitive learning and receptive language acquisition, so that early otologic evaluation and follow-up is essential in diaognosis and treatment of otologic diseases.

Organotypic Culture of Organ of Corti with Floating Drop Method from Newborn Rat / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Organotypic culture of organ of Corti maintains the basic organization of the spiral lamina and can conserve several factors responsible for the neuronal growth of the nervous components. The explant culture technique has been widely used in organ culture system, however, the floating drop method using collagen gel was also developed as a simple and reliable method. In order to study the effect of growth factors on the regenerative and protective ability of cochlear hair cells, we first had to establish an in vitro model of the inner ear. MATERIALS AND METHODS: Organ of Corti was obtained from newborn rats and cultured with the floating drop method using collagen gel. Immunohistochemical staining was used to visualize the stereocilia and scanning electron microscopic study was also carried out. RESULTS: Explants were maintained up to 10 days without contamination. Morphologically, immunofluorescent staining with phalloidin showed well preserved outer and inner hair cells with stereocilia on the second day of culture. On the tenth day of culture, the staining result showed inner and outer hair cells, although the stereocilia were poorly stained. In scanning electron microscopic examination, an explant on the tenth day of culture showed preserved outer and inner hair cells and stereocilia, although damaged hair cells and stereocilia were also observed. CONCLUSION: The floating drop method was an appropriate method for maintaining the organ of Corti in vitro with the advantage being the easiness in its manual manipulation.

Analysis on Outcomes and Predict of Laser Uvulopalatopharyngoplasty / 대한이비인후과학회지

BACKGROUND: Laser uvulopalatopharyngoplasty(Laser UPPP) is a modified operative procedure of UPPP using laser for the patient of obstructive sleep apnea syndrome. It is based on the progressive enlargement of the airspace in the oropharynx, to eliminate or reduce obstruction that occurs during sleep, by successive vaporization of the soft palate, wide posterior tonsil pillars and redundant posterior mucosa and resection of hypertrophied palatal tonsils. OBJECTIVES: The objectives of this study were to evaluate the success rate of the operation and to access the value of predictors of outcome in patients with obstructive sleep apnea syndrome. MATERIALS AND METHODS: Laser UPPP was performed in 23 patients with obstructive sleep apnea syndrome based on preoperative polysomnography and preoperative and postoperative polysomnography were compared to evaluate the success rate of operation. Each patient underwent preoperative fiberoptic nasopharyngoscopy with Mueller maneuver. RESULTS: 73.9% of patients had greater than 50% reduction in apnea index and the improvement of snoring was obtained in 69.5% of patients. No polysomnography parameter could accurately predict the changes in sleep after laser UPPP. There was no significant difference between responder and nonresponder group concerning the body mass index(BMI). But there was a significant difference between two groups in severity of obstruction during Mueller maneuver. CONCLUSION: The results of this study suggest that laser UPPP may be effective treatment for the obstructive sleep apnea syndrome with a high success rate and Mueller maneuver would be beneficial in selecting the candidates for laser UPPP by its high predictive efficacy.