Bilateral Sequential Pneumolabyrinth Resulting from Nose Blowing

Pneumolabyrinth describes a condition with entrapped air in the labyrinth and usually occurs in temporal bone fractures that involve the otic capsule. While sporadic cases of bilateral pneumolabyrinth have been reported, cases lacking head trauma are very rare. We report the case of a 43-year-old man who had sudden hearing loss bilaterally after blowing his nose at an interval of 1 year. Although conservative management for the right ear and exploratory tympanotomy with sealing of the possible site of perilymphatic leakage in the left ear were performed, hearing outcome was poor in both ears. To our knowledge, this is the first case of bilateral pneumolabyrinth occurring as a result of nose blowing.

Risk Factors of Post-Operative Recidivism in Congenital Cholesteatoma of the Middle Ear / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There is no general consensus on the risk factors affecting the recurrence or residual disease (recidivism) after surgery of congenital cholesteatoma of the middle ear. In this study, we analyzed clinical characteristics of recidivistic cases after the surgery and compared those of non-recurrent cases to investigate the risk factors regarding the post-operative recidivism of the disease. SUBJECTS AND METHOD: Data were collected from retrospective chart reviews and computerized database of patients who have underwent surgeries at Kangdong and Hallym University Sacred Heart Hospital during the last 24 years. All surgeries, consisting of 95 primary cases and 24 revision cases, were performed by the same surgeon. RESULTS: Recurrence was detected in 24 cases of the 95 patients (including 4 cases, of which primary surgeries were done at other hospitals). Among the risk factors affecting post-operative recidivism such as sex, age, symptom, disease duration, type of cholesteatoma, mastoid pneumatization, ossicle status, and stage of disease, factors of longer symptom duration, poor mastoid pneumatization, older age, poor mastoid pneumatization, advanced or recurrent cholesteatoma were significantly related to the recidivism of disease. CONCLUSION: Longer symptom duration, poor mastoid pneumatization, and advanced or recurrent cholesteatoma were revealed as high risk factors for post-operative recidivism in this study.

Comparisons of Three Indicators for Frey's Syndrome: Subjective Symptoms, Minor's Starch Iodine Test, and Infrared Thermography

OBJECTIVES: To correlate Frey's syndrome with subjective symptoms, Minor's starch iodine test results, and infrared thermography measurements, and to discuss the utility of thermography as a quantitative diagnostic method. METHODS: This study included 59 patients who underwent unilateral parotidectomy. A subjective clinical questionnaire and an objective Minor's starch iodine test were performed to evaluate the incidence of Frey's syndrome. Infrared thermography was performed, and the subjects were divided into seven groups according to the temperature differences between operated and unoperated sites. The thermal differences were correlated with the results from Minor's starch iodine test and the subjective symptoms questionnaire. RESULTS: Of the 59 patients, 20 patients (33.9%) reported subjective symptoms after eating; 30 patients (50.8%) tested positive for Minor's starch iodine test, 19 patients (63.3%) of which reported subjective symptoms. Of the 29 patients who were negative for the iodine test, 2 patients (6.9%) reported subjective symptoms. Thus, subjective symptoms were well correlated with Minor's starch iodine test (r=0.589, P<0.001). As the thermal differences with infrared thermography increased, the number of patients with subjective symptoms increased (chi2=22.5, P<0.001). Using infrared thermography, the mean temperature difference in the positive group for the iodine test was 0.82degrees C+/-0.26degrees C, and that in the negative group was 0.10degrees C+/-0.47degrees C. With increased thermal differences, more patients showed positivity in the iodine test (chi2=29.9, P<0.001). CONCLUSION: Subjective symptoms, Minor's starch iodine test, and infrared thermography are well correlated with one another. Quantitative thermography provides clues for the wide variation in the incidence of Frey's syndrome, and could be a useful method for diagnosing and studying Frey's syndrome.

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.

Surgical Treatment of Spontaneous Meningocele of the Temporal Bone Causing a Pulsatile Tinnitus / 대한이비인후과학회지

A meningocele is a protrusion of meninges through a defect in the skull base. It is a rare but potentially life-threatening condition requiring surgery. It can present with conductive hearing loss, persistent middle ear effusion, cerebrospinal fluid otorrhea, recurrent meningitis, and epilepsy. We report a patient who presented with a three-year history of intermittent pulsatile tinnitus in her left ear. She had clear middle ear effusion and radiological evaluations suggesting an attic cholesteatoma. She underwent a tympanomastoidectomy and we discovered a meningocele in the epitympanum and a bony defect of the tegmen tympani. We easily restored the meningocele using a microelevator and bolstered the bone with temporalis fascia, conchal cartilage and musculoperiosteal flap. There was no evidence of cerebrospinal fluid leakage and the patient's tinnitus disappeared six months after the operation.