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Results of Air Caloric and Other Vestibular Tests in Patients with Chronic Otitis Media
이인식,신정은,이여진,박홍주,정용수,곽희붕 대한이비인후과학회 2009 Clinical and Experimental Otorhinolaryngology Vol.2 No.3
Objectives. Air caloric results are supposed to be influenced by anatomic changes of the middle ear. The aims of our study were to evaluate the incidence and characteristics of abnormal air caloric results in patients with unilateral chronic otitis media and without any history of vertigo, and to compare caloric results with there of other vestibular function tests (VFTs). Methods. Twenty five patients with unilateral chronic otitis media (COM) who were scheduled for surgery underwent VFTs preoperatively. Hearing was assessed using pure-tone audiometry and vestibular function was assessed using a set of VFTs: air caloric, head-shaking nystagmus (HSN), vibration-induced nystagmus (VIN), and subjective visual vertical (SVV) tests. Results. Six patients (24%) showed pathologic canal paresis (CP) on COM-sided ears. Two patients showed pathologic CP on the contralateral side. However, both of the two showed inverted nystagmus to warm air stimulation on the COM-side and hyperactive nystagmus to cold air stimulation on the COM-side, which means that the COM-sided ear was stimulated too much. There was pathologic HSN in 12 patients (48%), pathologic VIN in 7 (28%), and pathologic SVV in 5 (20%). Overall, 20 (80%) patients showed abnormal findings through a set of VFTs. Patients with an interaural difference of bone-conduction hearing thresholds ≥10 dB tended to show more abnormal VFT results than those for whom the interaural difference of bone-conduction hearing thresholds was <10 dB. Conclusion. Our data show that one-fourth of patients with unilateral COM show abnormal caloric results on the COM side. However, subclinical latent vestibular imbalances were found to be common, which might be related to the gradual vestibular involvement in inflammatory processes, regardless of the caloric results. Results of a set of VFTs should be referred to when determining vestibular imbalance in patients with COM. Objectives. Air caloric results are supposed to be influenced by anatomic changes of the middle ear. The aims of our study were to evaluate the incidence and characteristics of abnormal air caloric results in patients with unilateral chronic otitis media and without any history of vertigo, and to compare caloric results with there of other vestibular function tests (VFTs). Methods. Twenty five patients with unilateral chronic otitis media (COM) who were scheduled for surgery underwent VFTs preoperatively. Hearing was assessed using pure-tone audiometry and vestibular function was assessed using a set of VFTs: air caloric, head-shaking nystagmus (HSN), vibration-induced nystagmus (VIN), and subjective visual vertical (SVV) tests. Results. Six patients (24%) showed pathologic canal paresis (CP) on COM-sided ears. Two patients showed pathologic CP on the contralateral side. However, both of the two showed inverted nystagmus to warm air stimulation on the COM-side and hyperactive nystagmus to cold air stimulation on the COM-side, which means that the COM-sided ear was stimulated too much. There was pathologic HSN in 12 patients (48%), pathologic VIN in 7 (28%), and pathologic SVV in 5 (20%). Overall, 20 (80%) patients showed abnormal findings through a set of VFTs. Patients with an interaural difference of bone-conduction hearing thresholds ≥10 dB tended to show more abnormal VFT results than those for whom the interaural difference of bone-conduction hearing thresholds was <10 dB. Conclusion. Our data show that one-fourth of patients with unilateral COM show abnormal caloric results on the COM side. However, subclinical latent vestibular imbalances were found to be common, which might be related to the gradual vestibular involvement in inflammatory processes, regardless of the caloric results. Results of a set of VFTs should be referred to when determining vestibular imbalance in patients with COM.
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편마비 환자에서 비복근의 선택적 운동신경 차단 후 보행 시 족저압 지표의 변화
이인식 대한뇌졸중학회 2003 Journal of stroke Vol.5 No.2
Department of Rehabilitation Medicine, Seoul National University College of Medicine, Department of Rehabilitation Medicine, National rehabilitation Hospital*Background: The effect of motor point block of hyperactive gastrocnemius (GCM) muscles has been shown to produce a spasticity relief and improvement of gait patterns. However, few studies have been reported on objective evidence for these effects. The aim of present study was to find out an objective and quantitative parameter to assess the effectiveness of the selective motor branch block of GCM muscles on gait and foot problems in hemiplegic gait. Methods: Twelve chronic ambulatory stroke patients who had spastic equinus feet were selected. Motor branches of medial and lateral GCM muscles were blocked with 5% aqueous phenol solution under electromyographic monitoring. The measurements of foot pressure using F-scan pressure sensitive insole system were performed before and one week after block. Foot contact and center of pressure (COP) parameters were measured and compared between before and after block. Results: Maximum peak contact pressures of affected feet were 95.7¡¾25.6% of unaffected feet before block and their pressures were reduced to 79.0¡¾18.4% of unaffected side. Ther were not significant changes in gait cycles and other contact pressure parameters. The X-coordinate of initial contact and mean COP moved to medial side after block. The differences of mediolateral displacement of COP between both feet were significantly decreased after block, but anteroposterior displacement and velocities of COP were not changed definitely. Conclusions: It is suggested that the main effect of motor branch block on GCM muscles is foot pressure relief and increased ankle stability. We suggest that the quantitative measurement of foot pressure can be useful for assessing the detailed biomechanical alteration in patients with hemiplegic gait.
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이인식,김세원,임정훈,이종민,노홍기,김선유,김보람,고성은 대한재활의학회 2009 Annals of Rehabilitation Medicine Vol.33 No.6
Acute retropharyngeal calcific tendinitis is a rare benign condition which is characterized by acute neck pain and stiffness, and dysphagia. In this report, we present 2 cases of retropharyngeal calcific tendinitis patients. The first patient complained of neck pain and stiffness. The second patient had neck pain and hypophonia. In both cases, CT and MRI of the cervical spine demonstrated prevertebral effusion of the upper cervical spine with calcification at C1-C2 level. Acute neck pain and stiffness improved with oral administration of nonsteroidal anti-inflammatory drug. Follow-up radiologic findings revealed the disappearance of prevertebral effusion and calcification.
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