The Efficiency of Simultaneous Binaural Ocular Vestibular Evoked Myogenic Potentials: A Comparative Study with Monaural Acoustic Stimulation in Healthy Subjects

김민범,반재호 대한이비인후과학회 2012 Clinical and Experimental Otorhinolaryngology Vol.5 No.4

Objectives. To evaluate the test-retest reliability and convenience of simultaneous binaural acoustic-evoked ocular vestibular evoked myogenic potentials (oVEMP). Methods. Thirteen healthy subjects with no history of ear diseases participated in this study. All subjects underwent oVEMP test with both separated monaural acoustic stimulation and simultaneous binaural acoustic stimulation. For evaluating test-retest reliability, three repetitive sessions were performed in each ear for calculating the intraclass correlation coefficient (ICC) for both monaural and binaural tests. We analyzed data from the biphasic n1-p1 complex, such as latency of peak, inter-peak amplitude, and asymmetric ratio of amplitude in both ears. Finally, we checked the total time required to complete each test for evaluating test convenience. Results. No significant difference was observed in amplitude and asymmetric ratio in comparison between monaural and binaural oVEMP. However, latency was slightly delayed in binaural oVEMP. In test-retest reliability analysis, binaural oVEMP showed excellent ICC values ranging from 0.68 to 0.98 in latency, asymmetric ratio, and inter-peak amplitude. Additionally, the test time was shorter in binaural than monaural oVEMP. Conclusion. oVEMP elicited from binaural acoustic stimulation yields similar satisfactory results as monaural stimulation. Further, excellent test-retest reliability and shorter test time were achieved in binaural than in monaural oVEMP. Objectives. To evaluate the test-retest reliability and convenience of simultaneous binaural acoustic-evoked ocular vestibular evoked myogenic potentials (oVEMP). Methods. Thirteen healthy subjects with no history of ear diseases participated in this study. All subjects underwent oVEMP test with both separated monaural acoustic stimulation and simultaneous binaural acoustic stimulation. For evaluating test-retest reliability, three repetitive sessions were performed in each ear for calculating the intraclass correlation coefficient (ICC) for both monaural and binaural tests. We analyzed data from the biphasic n1-p1 complex, such as latency of peak, inter-peak amplitude, and asymmetric ratio of amplitude in both ears. Finally, we checked the total time required to complete each test for evaluating test convenience. Results. No significant difference was observed in amplitude and asymmetric ratio in comparison between monaural and binaural oVEMP. However, latency was slightly delayed in binaural oVEMP. In test-retest reliability analysis, binaural oVEMP showed excellent ICC values ranging from 0.68 to 0.98 in latency, asymmetric ratio, and inter-peak amplitude. Additionally, the test time was shorter in binaural than monaural oVEMP. Conclusion. oVEMP elicited from binaural acoustic stimulation yields similar satisfactory results as monaural stimulation. Further, excellent test-retest reliability and shorter test time were achieved in binaural than in monaural oVEMP.

만성 신부전환자의 혈청 갑상선홀몬 농도의 변화

김민범,이정호,신영태,김삼용,노흥규 충남대학교 의과대학 지역사회의학연구소 1989 충남의대잡지 Vol.16 No.1

To investigate the thyroid hormonal changes and their mechanisms in patients with chronic renal failure (CRF), the author measured serum levels of the thyroid hormones using radioimmu-noassay and calculated each ratio of serum thyroid hormones in 17 patients with CRF. Ten patients were on hemodialysis therapy and seven patients had not undergone hemodialysis. The following results were obtained. 1) The serum T3 and T4 concentrations were significantly lower in patients with CRF(0.7±0.47㎍/1 and 5.53±2.95㎍/dl, respectively) than in normal subjects(1.21±0.18㎍/1 and 9.46±1.92㎍/dl, respectively. 2) The serum FT4(free T4) concentration was significantly lower in patients with CRF(1.20±0.50μu/dl) than in normal subjects(1.01±0.48μu/dl). 4) The serum rT3(reverse T3) concentration in patients with CRF(285.7±148.1pg/ml) tends to be greater than normal subjects(204.6±43.3pg/ml). But is was not significant statistically. 5) The calculated serum concentration ratio of T3/T4 in patients with CRF(0.17±0.04: presented as Mean±SEM) did not differ significantly from that of normal subjects(0.13±0.01). But the serum concentration ratio of rT3/T4 in patients with CRF(78.78±18.98) was significantly greater than in normal subjects(21.90±1.04). 6) There was no significant difference in thyroid functions between male and female patients with CRF, and also between patients on hemodialysis and non-dialyzed uremic patients. It was concluded that the serum T3, T4, FT4 concentration were significantly decreased in patients with CRF, while the serum TSH concentration was significantly increased. The calculated serum concentration ratio of rT3/T4 was also significantly increased in patients with CRF. Thus is appears that abnormalities found in patients with CRF may reflect both the possible intrathyroidal abnormalities and alteration of serum rT3 metabolism with increased peripheral generation of rT3 from T4.

Hearing Outcomes According to the Types of Mastoidectomy: A Comparison between Canal Wall Up and Canal Wall Down Mastoidectomy

김민범,최지선,이재권,박주연,추호석,조양선,홍성화,장원호 대한이비인후과학회 2010 Clinical and Experimental Otorhinolaryngology Vol.3 No.4

Objectives. The aim of this study was to compare the hearing outcomes between canal wall up mastoidectmy (CWUM)and canal wall down mastoidectmy (CWDM). Methods. One hundred seventy one chronic suppurative otitis media (CSOM) patients were enrolled in this retrospective study. The patients who underwent the second staged ossiculoplasty at least 6 months after mastoidectomy and who had an intact, well aerated tympanic cavity as well as intact mobile stapes at the time of operation were selected from the medical record. Based on the type of mastoid surgery, the patients were categorized into two groups: the CWUM (n=38) and CWDM groups (n=133). The hearing results of the CWUM and CWDM groups were compared using the pre- and post-operative air-bone gap (ABG) at 3 months after ossiculoplasty. Results. The preoperative ABG in both groups (CWUM and CWDM) were 28.4±15.6 dB and 31.8±14.5 dB, respectively (P=0.18). Both groups didn’t show any significant difference (10.9 dB vs. 13.5 dB, respectively) (P=0.21) for the postoperative ABG closure. The proportion of patients with an ABG less than 20 dB was 58.6% of the CWDM patients and 68.4% of the CWUM patients (P=0.25). Conclusion. The type of mastoid surgery (CWUM and CWDM) did not affect the hearing results of CSOM patients. When choosing the type of mastoidectomy procedure for CSOM surgery, the hearing outcomes are basically the same for both types of procedure.

동시 및 순차적 양측 인공와우 이식술의 시간 및 비용 비교

김민범,김환,최재영 대한이비인후과학회 2013 대한이비인후과학회지 두경부외과학 Vol.56 No.10

Background and Objectives Purpose of this study is to compare the cost-effectiveness between sequential (SeqBCI) and simultaneous bilateral cochlear implantations (SimBCI). Subjects and Method This is a retrospective study of 15 patients who underwent bilateral cochlear implantations at a tertiary care facility. Nine patients with SimBCI and six with SeqBCI were included. Operation time, anesthesia time, expenses for preoperative evaluation, hospitalization time, hospital expenses and postoperative expenses were investigated. Results The 1st, 2nd and cumulative operation time for the SeqBCI group were 181, 120 and 301 minutes, respectively, on the average. The 1st, 2nd and cumulative anesthesia time were 212, 162 and 373 minutes, respectively. The 1st, 2nd and cumulative expenses for preoperative evaluation were 1074754, 280118 and 1354872 won, respectively. The 1st, 2nd and total hospitalization time were 6.2, 4.2 and 10.4 days, respectively. The 1st, 2nd and cumulative hospital expenses were 24082713, 24158366 and 48176734 won, respectively. The 1st, 2nd and cumulative postoperative expenses were 447830, 551778 and 999608 won, respectively. For the SimBCI group, the operation time, anesthesia time, expenses for evaluation, hospitalization time, hospital expenses and postoperative expenses were 246, 280 minutes, 1396793 won, 6.2 days, 46073011 and 816121 won, respectively. On the whole, anesthesia time, hospitalization time and postoperative expenses of the SimBCI group were less than those of the SeqBCI group (p=0.01, 0.02 and 0.02, respectively). The postoperative expenses of SeqBCI were the highest during the first 4 months whereas those of SimBCI were less during the same period (p=0.03). Conclusion Cumulative anesthesia time, hospitalization time and postoperative cost of SimBCI were less than those of SeqBCI. Our results may be useful for counseling the timing of second CI.

급성 중추성 현훈

김민범,반재호 대한이비인후과학회 2014 대한이비인후과학회지 두경부외과학 Vol.57 No.8

Acute vertigo is a common symptom at the otolaryngology clinics or the Emergency Department. Also, many otolaryngologists see these patients first or they are referred from the Emergency Department. Although the stroke incidence in all dizzy patients is relatively low, the misdiagnosis of central vertigo may lead to serious morbidity and even mortality. Nevertheless, it is difficult to diagnose in vertigo patients whether the origin is central or not, especially at the initial visit. The purpose of this clinical review was to investigate clinical findings of acute central vertigo and to suggest the recent advance of differential diagnosis in these patients from peripheral vestibulopathy. We also suggest an appropriate practice for the radiologic investigation in these patients. Korean J Otorhinolaryngol-Head Neck Surg 2014;57(8):504-10

상반고리관 양성 돌발성 두위현훈의 임상양상

김민범 대한평형의학회 2013 Research in Vestibular Science Vol.12 No.2

The aim of this study is to investigate the characteristics of anterior semicircular canal benign paroxysmal positional vertigo (BPPV). Materials and Methods: This is a retrospective chart review of 1,150patients who were diagnosed with BPPV at an ENT special hospital. We investigated a number of canalith repositioning procedure (CRP), canal switch and a history of recurrence or head trauma. Results: Anterior semicircular canal BPPV was observed in 41 (3.5%) patients. The average number of CRPs in patients with anterior semicircular canal BPPV was 2.19, which was higher than 1.60in those with posterior semicircular canal BPPV (p<0.0001). Canal conversion from anterior to posterior semicircular canal was found in 5 (12.1%) patients during treatment. The average number of CRPs in conversion cases was 4,which was higher than 1.94 in non‐conversion cases (p=0.001). Conclusion:More CRPs were necessary for the treatment of anterior semicircular canal BPPV than posterior semicircular canal BPPV. Canal switch could be considered as a factor to prevent a successful treatment.

Clinical Value of Vestibular Evoked Myogenic Potential in Assessing the Stage and Predicting the Hearing Results in Ménière’s Disease

김민범,최지선,박가영,조양선,홍성화,정원호 대한이비인후과학회 2013 Clinical and Experimental Otorhinolaryngology Vol.6 No.2

Objectives. Our goal was to find the clinical value of cervical vestibular evoked myogenic potential (VEMP) in Ménière’s disease (MD) and to evaluate whether the VEMP results can be useful in assessing the stage of MD. Furthermore, we tried to evaluate the clinical effectiveness of VEMP in predicting hearing outcomes. Methods. The amplitude, peak latency and interaural amplitude difference (IAD) ratio were obtained using cervical VEMP. The VEMP results of MD were compared with those of normal subjects, and the MD stages were compared with the IAD ratio. Finally, the hearing changes were analyzed according to their VEMP results. Results. In clinically definite unilateral MD (n=41), the prevalence of cervical VEMP abnormality in the IAD ratio was 34.1%. When compared with normal subjects (n=33), the VEMP profile of MD patients showed a low amplitude and a similar latency. The mean IAD ratio in MD was 23%, which was significantly different from that of normal subjects (P=0.01). As the stage increased, the IAD ratio significantly increased (P=0.09). After stratification by initial hearing level,stage I and II subjects (hearing threshold, 0-40 dB) with an abnormal IAD ratio showed a decrease in hearing over time compared to those with a normal IAD ratio (P=0.08). Conclusion. VEMP parameters have an important clinical role in MD. Especially, the IAD ratio can be used to assess the stage of MD. An abnormal IAD ratio may be used as a predictor of poor hearing outcomes in subjects with early stage MD.

Isosorbide Concentration in Perilymph of the Guinea Pig After Oral Administration Versus That After Round Window Perfusion

김민범,도경희,김규성 대한이비인후과학회 2014 Clinical and Experimental Otorhinolaryngology Vol.7 No.4

Objectives. The aims of this study were to investigate the feasibility of isosorbide delivery into perilymph through the round window membrane (RWM), and to compare the intracochlear isosorbide concentration in perilymph after oral administration (PO) versus that after round window perfusion (RWP). Methods. Sixteen male guinea pigs (32 ears) were used. Isosorbide, an osmotic diuretic, was administered via RWP or PO. First, to investigate the optimal perfusion time, perilymph sampling of scala tympani from the RWM was performed after RWP for 15, 30, or 60 minutes. Second, to compare the drug concentration after RWP versus that after PO, perilymph was aspirated at 3 and 6 hours after administration. Intracochlear concentration of isosorbide was ana- lyzed by high-performance liquid chromatography coupled to refractive index detection. Results. Isosorbide passed through the RWM into perilymph after RWP. After RWP for 15, 30, and 60 minutes, mean iso- sorbide concentrations in perilymph were 116.27±44.65, 245.48±112.84, and 279.78±186.32 mM, respectively. The intracochlear concentration after RWP for 30 minutes was higher than that after RWP for 15 minutes (P=0.043). At 3 and 6 hours after PO, isosorbide concentrations in perilymph were 28.88±4.69 and 12.67±2.28 mM, respec- tively. In contrast, the corresponding concentrations after RWP were 117.91±17.70 and 75.03±14.82 mM at 3 and 6 hours, respectively. Isosorbide concentrations in perilymph following RWP were significantly higher than those fol- lowing PO at both 3 and 6 hours (P=0.025 and P=0.034, respectively). Conclusion. Isosorbide can rapidly pass through the RWM after RWP in guinea pigs, and 30 minutes of perfusion is con- sidered to be appropriate. In addition, over a 6-hour period, RWP can deliver higher concentrations of isosorbide into perilymph than those achieved with PO.

고실내 덱사메타손(Dexamethasone) 주입술로 호전된 난치성 이루를 동반한 호산구성 중이염 : 사례 연구

김민범,현창림,김세형 대한이비인후과학회 부산,울산,경남 지부회 2016 임상이비인후과 Vol.27 No.2

Eosinophilic otitis media (EOM) is a newly recognized intractable middle ear disease, characterized by a highly viscous otorrhea and an accumulation of eosinophils in middle ear effusion and middle ear mucosa. Since EOM can cause gradual or sudden deterioration of hearing, it is important to properly diagnose EOM. Systemic or topical steroid administration is known as the most effective treatment for patients with EOM ; however, oral steroid therapy has the potential to cause adverse drug effects. Recently, we experienced two cases of EOM that were given intratympanic dexamethasone injection had improvement in otologic symptoms including otorrhea and hearing loss. The instillation of dexamethasone into the middle ear cavity is noninvasive and effective treatment for controlling eosinophilic inflammation in this report. Identification of the characteristic manifestations of EOM, and the consequent definite diagnosis and an adequate treatment for EOM can help prevent sensorineural hearing loss in early stage.

양측성 전정장애

김민범,김규성 대한이비인후과학회 2013 대한이비인후과학회지 두경부외과학 Vol.56 No.3

Bilateral vestibulopathy (BV) is a clinical entity with impaired function of bilateral peripheral vestibular system, which is characterized by movement-induced postural vertigo, oscillopsia and unsteadiness of gait. The possible causes are reported including aminoglycosides, Meniere’s disease and meningitis, however, cause of BV remains unclear in up to half. The diagnosis is confirmed by a combination of the vestibulo-ocular reflex tests such as a bilateral head-impulse test, the rotatory chair test and the caloric test. The treatment consists of prophylaxis of progressive vestibular loss, recovery of impaired vestibular function and promotion of central compensation or substitution with rehabilitation therapy.