A Case of Medullary Infarction Presented Initial Symptoms Similar to Meniere's Disease.

Fluctuating hearing loss and vertigo are the typical presentations of Meniere's disease. However, it is unusual that fluctuating hearing loss and vertigo are caused by vertebral artery occlusion or cerebral infarction. Here, we described the case of a 54-year-old male patient with hypertension and diabetes mellitus who presented with fluctuating hearing loss in his left ear and severe whirling-type dizziness without associated neurological signs or symptoms. Temporal magnetic resonance imaging (MRI) was normal. He was diagnosed with a possible Meniere's disease and started conservative treatment. Eight years later, the patient developed dysarthria and left-side weakness. Brain MRI revealed right anterior medullary infarction, and cerebral angiography showed occlusion of the right vertebral artery. In this case, we attempted to review the initial imaging study and reported the characteristics of the case.

The Changing Pattern of Published Articles in the Field of Otology: 1818 to Today.

To examine and identify the changing pattern of published articles in the otology literature over the past several decades. We used a variety of search engines available through PubMed.gov based on key words in the following categories: diagnosis, diagnostic tools, and therapeutic tools. The number of searchable key words increased from 1945 to the present. Overall, there has been a major shift in topics cover in the otological literature. Most recently, there has been significant increases in the following categories: age-related hearing loss, speech discrimination, and cochlear implantation. Based on this analysis, we believe these represent the areas of major research in the field of otology today. The present study is a bibliometric analysis of the changing pattern of published articles using a new analytic approach. The results identify the shifting topics of research in otology and might be helpful for future studies in Otorhinolaryngology Head and Neck Surgery.

Clinical Characteristics of Epidermoid Cysts of the External Auditory Canal.

BACKGROUND AND OBJECTIVES: The epidermoid cyst is a common benign disease of the skin caused by inflammation of hair cortex follicles and proliferation of epidermal cells within the dermis or superficial subcutaneous tissue. The purpose of this study was to investigate the characteristics of epidermoid cysts of the external auditory canal (EAC) by analyzing the clinical and radiologic features. SUBJECTS AND METHODS: The clinical records were retrospectively reviewed for patients diagnosed with epidermoid cyst of the EAC from March 2004 to December 2013. The epidermoid cysts were diagnosed clinically by endoscopy and microscopy examinations and by temporal bone CT images, and were confirmed by histopathologic examination. Characteristics of epidermoid cysts in bony EAC and cartilaginous EAC were compared. RESULTS: Eight patients had an epidermoid cyst in the bony EAC and nine patients had one in the cartilaginous EAC. Swelling and otalgia were common symptoms, but 47% of cysts were found incidentally. The mean age of patients was 49.6 years (age range, 26-67 years) in the bony EAC cases and 26.1 years (age range, 6-57 years) in the cartilaginous EAC cases. The mean size of the epidermoid cyst was 3.50 mm (size range, 2-7 mm) in the bony EAC cases and 9.55 mm (size range, 2-20 mm) in the cartilaginous EAC cases. CONCLUSIONS: Comparison of epidermoid cysts of the bony EAC and the cartilaginous EAC revealed that epidermoid cysts of the bony EAC is usually found incidentally, arose in older patients and had smaller size.

Posterior tympanotomy is a riskier procedure in chronic otitis media than in a normal mastoid: a high-resolution computed tomography study.

PURPOSE: The aim of our study was to compare the difficulty in performing a posterior tympanotomy in chronic otitis media (COM) versus the same procedure in a normal mastoid. MATERIALS AND METHODS: The study included 122 patients who underwent tympanomastoidectomy for unilateral chronic otitis media with contralateral normal mastoid pneumatization. We evaluated the anatomical relationships between the mastoid segment and neighboring structures by analyzing axial temporal bone computed tomography scans. A vertical line (line A) was drawn tangential to the most lateral end of the posterior semicircular canal (point A). Three distances were measured: the distance (D1) between the point A and the most lateral end of the mastoid segment of the facial nerve (point B), the distance (D2) between the line A and the point B, and the distance (D3) between the point B and the posterior end of the bony annulus of the external auditory canal. RESULTS: The average measurements of D1 and D3 were 3.79 ± 0.55 and 2.63 ± 0.51 mm, respectively, in the normal mastoid ears and 3.47 ± 0.59 and 2.35 ± 0.44 mm, respectively, in the COM ears. The measurements of D1 and D3 were statistically shorter in the COM ears than in the normal ears. CONCLUSIONS: These findings suggest that the facial recess in COM may be narrower than in a normal mastoid and that performing a posterior tympanotomy may be riskier in COM than in a normal mastoid due to the potential for injury to the neighboring structures and the facial nerve.

[A school-level longitudinal study of clinical performance examination scores].

PURPOSE: This school-level longitudinal study examined 7 years of clinical performance data to determine differences (effects) in students and annual changes within a school and between schools; examine how much their predictors (characteristics) influenced the variation in student performance; and calculate estimates of the schools' initial status and growth. METHODS: A school-level longitudinal model was tested: level 1 (between students), level 2 (annual change within a school), and level 3 (between schools). The study sample comprised students who belonged to the CPX Consortium (n=5,283 for 2005~2008 and n=4,337 for 2009~2011). RESULTS: Despite a difference between evaluation domains, the performance outcomes were related to individual large-effect differences and small-effect school-level differences. Physical examination, clinical courtesy, and patient education were strongly influenced by the school effect, whereas patient-physician interaction was not affected much. CONCLUSION: Student scores are influenced by the school effect (differences), and the predictors explain the variation in differences, depending on the evaluation domain.

Ganglion cyst of the spinoglenoid notch: comparison between SLAP repair alone and SLAP repair with cyst decompression.

BACKGROUND: Some authors have described the ganglion cyst of the spinoglenoidal notch as related to repetitive overhead activities and labral tear caused by trauma, while others have explained lesions of the capsulolabral complex and ganglion cysts to have separate pathologies. The purpose of this study is to compare clinical and radiological outcomes between 2 groups: 1 with superior labrum anterior and posterior (SLAP) repair only and the other with SLAP repair and cyst decompression prospectively. MATERIALS AND METHODS: From August 2000 to March 2007, 28 patients matching the inclusion criteria were selected for the study. They were divided into 2 groups: 1 who received SLAP repair and the other with concomitant SLAP repair and cyst decompression. A visual analogue scale (VAS) and Rowe and Constant scores were used to make evaluation. Preoperative magnetic resonance images (MRIs) of 2 patient groups were compared with 2 follow-up MRIs taken 3 months after the operation and at final follow-up. RESULTS: Mean VAS and Constant and Rowe scores in groups I and II improved significantly from mean preoperative score compared to last follow-up score; however, there was no statistically significant difference between the 2 groups (P > .05). Preoperative MRI and arthroscopy revealed type II SLAP lesions and a type V lesion, respectively, as accompanying lesions in 24 cases. CONCLUSION: The hypothesis stating 1-way valve mechanism of SLAP lesion as an initial cause of ganglion cysts has been proved indirectly in this study. Furthermore, direct decompression of the cyst does not lead to different results.

Setting school-level educational goal and objectives with the modified delphi method.

PURPOSE: The aim of this study was to set the school-level educational goals and objectives, based on the needs analysis, by modified Delphi method. METHODS: A needs analysis and workshops were performed to establish educational goals and objectives. The needs analysis comprised 3 rounds of questionnaires and a panel and reference group that compared the results. Various workshops were held to set, outline, develop, and promote the educational goals and objectives and perform a satisfaction survey. RESULTS: In the needs analysis, we identified 8 keywords for 'ends' and 12 for 'means' with regard to educational goals and 25 keywords for educational objectives, which were summarized in 5 factors (categories). There were significant differences between the panel and reference groups. Through the workshops, we established new educational goal and objectives that met with high satisfaction among members. CONCLUSION: The developmental process with which the educational goals and objectives were established through a needs analysis and workshops was effective, efficient, and supportive in medical education.