A Study on Prognostic Factors of Primary and Revision Myringoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There is no consensus on the prognostic factors regarding pos-toperative recurrence after myringoplasty. In this study, we investigated the preoperative clinical findings and postoperative results after primary myringoplasty and compared them with those of revision myringoplasty. SUBJECTS AND METHOD: Computerized database of 861 clinical records of last 20 years were analyzed retrospectively for the subjects who underwent myringoplasty at the Department of Otolaryngology, University of Korea. All the surgeries were done under general or local anesthesia by senior surgeons. Primary and revision cases of myringoplasty or type 1 tympanoplasty followed up at least for longer than 3 months were only included in the study. Those other cases of tympanoplasty types, concomitant ossiculoplasty and/or mastoidectomy, or those with the presence of cholesteatoma and those that required repair during exploratory tympanotomy were excluded. RESULTS: 535 primary and 101 revision cases have met our inclusion criteria. Overall, in this study, the failure rates of primary and revision myringoplasty were 11.02% and 5.94%, respectively. Significantly different among the prognostic factors were such as sex, age, anesthesia, surgical approach, the presence of otorreha, size of eardrum perforation, external auditory canal narrowing, valsalva test, degree of pneumatization, graft materials, tympanoplasty type, previous mastoidectomy, the presence of bilateral otitis media influencing on myringoplasty revision, and the presence of otorrhea and sclerotic type of mastoid pneumatization. CONCLUSION: Among various prognostic factors of myringoplasty, poor prognostic factors were preoperative otorrhea and poor pneumatization.

Quantitative Analysis of Fixation Index of Caloric Induced Nystagmus and Its Clinical Implication / 대한평형의학회지

BACKGROUND AND OBJECTIVES: There is no general consensus as to the normal limit or recommended procedure for visual fixation index (VFI) during caloric test because fixation suppression (FS) could be influenced by different variables. In this study, we present our mathematical modeling according to different variables to establish a clinical implication of VFI in patients with vertigo. MATERIALS AND METHODS: Data were analyzed from a retrospective record of patients who underwent caloric testing. Three subgroups were classified (normal caloric response, unilateral vestibular hypofunction and central vertigo). VFI distribution and mathematical modeling to estimate an associated probability were performed from each group. A receiver operation characteristics (ROC) curve was plotted to determine its diagnostic value. RESULTS: Four hundred eighteen, 67 and 14 patients met our inclusion criteria for normal caloric response, unilateral vestibular hypofunction and cerebellar infarction respectively. VFIs on warm irrigation showed more consistent distribution than cold irrigation in normal caloric response group. In contrast, there was significant inconsistency of VFIs between each side in unilateral vestibular hypofunction group (p>0.05). FS ability was inversely propositional with increase in age on all caloric (p<0.05). The area under the ROC curve of VFIs on warm caloric irrigation was 0.821 and that on cold irrigation was 0.785 for detecting central vertigo. CONCLUSION: Calibrated normal limit for VFI according to age is needed to ensure its clinical implication. Diagnostic value of VFI and its reliability on warm stimulation was superior to that of cold, which indicates VFI on warm stimulation seems to be a more reliable parameter.

Intramural Esophageal Abscess and Dissection due to Retropharygeal Abscess / 대한이비인후과학회지

Intramural esophageal dissection is a rare esophageal disorder characterized by sudden severe retro-sternal pain, hematemesis, odynophagia and dysphagia due to longitudinal separation of submucosa from muscle layer of the esophagus. Even though the etiology of this disorder still remains uncertain, it is usually associated with a rapid increase of intra-esophageal pressure in addition to coagulation disorder. We treated a patient who initially presented with retropharyngeal abscess, but finally progressed to an intramural esophageal dissection, which was successfully treated by endoscopic procedure. This is the first case that recorded disease progression and treatment from a retropharyngeal abscess to esophageal dissection.