추골 고정의 임상 양상 및 치료결과에 대한 고찰

나윤찬,장정훈,송재진,이준호,오승하,장선오 대한이비인후과학회 2009 대한이비인후과학회지 두경부외과학 Vol.52 No.10

Background and ObjectivesZZMalleus fixation is one of the important causes of persistent conductive hearing loss. This study was designed to evaluate the clinical manifestation and the treatment outcome of malleus fixation. Subjects and MethodZZThis study was a retrospective review of medical records between 1989 and 2008. Patients diagnosed as malleus fixation by intraoperative findings at the Department of Otorhinolaryngology, Seoul National University Hospital were included. Those cases with chronic otitis media and congenital ossicular anomaly involving the incus or stapes were excluded. A total of 13 patients were included (M:F=4:9, Mean age: 24.4 years old). ResultsZZAll patients (100%) complained of hearing loss. Preoperative mean air-bone conduction gap was 34.4 dB and 5 (83.3%) out of 6 patients had A-type in impedence audiometry and 3 (75%) out of 4 patients had negative results in Gelle test. In the temporal bone computed tomography (TBCT) findings, we could identify bony spicules (2 cases), sclerosis of ligament (3 cases) and epitympanic contraction (2 cases). According to the different causes of conductive hearing loss, corrective surgery was performed: the release of bony ankylosis (2 cases), lysis of ligament (6 cases) and ossiculoplasty (5 cases) were performed. There was a statistically significant improvement in air-bone conduction gap (34.4 dB vs. 20.3 dB, p=0.009) after surgery. ConclusionZZConsidering the improvement of air-bone conduction gap after the corrective surgery, clinical suspicion of malleus fixation is important in cases of unknown conductive hearing loss.

The efficacy of sevolflurane inhalation alone or its combination with intravenous remifentanil against withdrawal movements on rocuronium injection in children

나윤찬,이형곤,이성헌,장은아,윤명하 대한마취통증의학회 2014 Korean Journal of Anesthesiology Vol.67 No.6

Background: The aims of this study were to compare the efficacy of sevoflurane inhalation alone, intravenous remifentanilalone, and the combination of sevoflurane inhalation and remifentanil as pretreatment for the prevention ofrocuronium-induced withdrawal movement in pediatric patients. Methods: In this prospective, randomized study, 90 American Society of Anesthesiologists physical status I or II pediatricpatients aged 3 to 10 years were randomly allocated to one of three treatment groups: The Group S comprising the patientsreceiving sevoflurane inhalation, the Group R comprising those doing intravenous remifentanil 0.5 μg/kg and theGroup C comprising those doing sevoflurane inhalation+intravenous remifentanil 0.5 μg/kg. The response of the patientswas graded based on a 4-point scale. Results: The overall incidence of withdrawal movement on rocuronium injection was 54% (16/30) in the Group S, 57%(17/30) in the Group R and 17% (5/30) in the Group C. There was no significant difference in the incidence of withdrawalmovements on rocuronium injection between the Group S and Group R. In addition, the incidence of withdrawalmovements and generalized movement on rocuronium injection was significantly lower in the Group C as comparedwith the Group S and R (P < 0.05). Conclusions: Our results indicate not only that there was no significant difference in the degree of the effect in loweringthe incidence of withdrawal movements on rocuronium injection between sevoflurane inhalation and intravenousremifentanil but also that it was significantly higher when combined with intravenous remifentanil as compared with thesingle use of sevoflurane inhalation or intravenous remifentanil.

The Need to Consider Vestibular Function in Cochlear Implantation

나윤찬 대한이비인후과학회 2021 Clinical and Experimental Otorhinolaryngology Vol.14 No.1

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메니에르병 환자의 치료경과 및 고실 내 겐타마이신 주입술에 대한 고찰

나윤찬,김봉직,송재진,홍성광,김지수,구자원 대한이비인후과학회 2009 대한이비인후과학회지 두경부외과학 Vol.52 No.12

Background and Objectives Several treatment options have been introduced to control Meniere’s disease (MD). Among them, intratympanic injection of gentamicin (ITGM) is now accepted as a standard treatment method for intractable vertigo in patients with hearing impaired MD. The purpose of this study was to analyze the clinical course and treatment flow in patients with MD and to analyze the efficacy and problems after ITGM. Subjects and Method A retrospective study was performed on 458 patients who were diagnosed as definite MD from May 2003 to October 2007 and were followed up at least 1 year. The authors investigated the course of disease and the results in our patients according to the treatment options. Several clinical parameters including frequency of vertigo, audiometry, caloric and rotation test were reviewed and analyzed according to the guideline of the AAO-HNS (1995), if necessary. Efficacy and problems after ITGM were reviewed. Results Among 458 patients, vertigo was resolved or improved in 399 patients (87.1%) with medical management. Fifty-nine patients needed further treatment (endolymphatic sac decompression: 4, Meniette: 2, ITGM: 53). Among 53 patients who got ITGM, 40 patients were followed up for more than 1 year after injection. Thirty-six patients (87.5%) showed successful control of vertigo. The average pure-tone threshold was changed from 54.1 dB to 56.9 dB after treatment. Three patients (7.5%) revealed more than 20 dB aggravation. Conclusion Vertigo was controlled by supportive treatments or medication in 87% of definite MD patients. And ITGM could effectively and reasonably control vertigo for intractable MD patients.

두경부의 점막연관 림프조직에서 발생한 림프절외 변연부 B세포 림프종의 임상 양상 및 치료 결과에 대한 고찰

나윤찬(Yoon Chan Rah),한규희(Kyu-Hee Han),안수연(Soo-Youn An),권택균(Tack-Kyun Kwon),성명훈(Myung-Whun Sung),김광현(Kwang Hyun Kim),하정훈(J. Hun Hah) 대한두경부종양학회 2009 대한두경부 종양학회지 Vol.25 No.2

Objectives :Mucosa-associated lymphoid tissue(MALT) lymphoma of the head and neck region is relatively rare, but it has variable clinical and biological characteristics. Although there were few studies on this topic, there is still controversy regarding the best treatment. The authors retrospectively investigated the clinical courses and treatment results in 10 patients presenting with MALT-lymphoma in head and neck region except ocular adnexa. Material and Methods :Ten patients with a histologically verified diagnosis of the extranodal mar-ginal zone B cell lymphoma arising in thyroid glands(3), larynx(3), oral cavity(2), oropharynx(1), salivary glands(1) were analyzed. Results :Four patients were allocated to stage IE and another six patients to stage IIE according to the Ann Arbor staging system. Treatment consisted of local therapy(surgical resection and/or radiotherapy) in four patients and systemic chemotherapy with/without local therapy in six patients. Complete remission and partial remission were achieved in seven patients(70%) and two patients(20%), respectively. No recurrence or mortality was observed with a mean follow-up of 40.5 months. Conclusion :Patients with MALT-lymphomas of the head and neck region were potentially treated by local modality in localized disease state. However systemic chemotherapy was also effective even in localized disease state and was well tolerated by pa-tients. And strict staging and close long-term monitoring were recommended considering its indolent progression.

Impact of Nicotine Exposure on Hair Cell Toxicity and Embryotoxicity During Zebrafish Development

유명훈,나윤찬,박세미,권순일,임기정,채성원,정학현,최준 대한이비인후과학회 2018 Clinical and Experimental Otorhinolaryngology Vol.11 No.2

Objectives. Nicotine has various adverse effects including negative impacts associated with maternal exposure. In the current study, we examined nicotine-induced damage of hair cells and embryotoxicity during zebrafish development. Methods. Zebrafish embryos were exposed to nicotine at several concentrations (5, 10, 20, and 40 μM) and embryotoxicity were evaluated at 72 hours, including hatching rate, mortality, teratogenicity rate, and heart rate. Hair cells within the supraorbital (SO1 and SO2), otic (O1), and occipital (OC1) neuromasts were identified at 120 hours. Apoptosis and mitochondrial damage of hair cells were analyzed using TUNEL (terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling) and DASPEI (2-[4-(dimethylamino)styryl]-N-ethylpyridinium iodide) assays, respectively, and changes of ultrastructure were observed by scanning electron microscopy. Results. The control group without nicotine appeared normal with overall mortality and teratogenicity rate <5%. The hatching rate and mortality rate was not significantly different according to nicotine concentration (n=400 each). The abnormal morphology rate (n=400) increased and heart rate (n=150) decreased with increasing nicotine concentration (P<0.05). Nicotine-induced hair cell damage significantly increased as nicotine concentration increased. A significantly greater number of TUNEL-positive cells (P<0.01) and markedly smaller DASPEI area (P<0.01) were shown as nicotine concentration increased. Conclusion. The current results suggest that nicotine induces dose-dependent hair cell toxicity in embryos by promoting apoptosis and mitochondrial and structural damage.

Analysis of Eustachian Tube Dysfunction by Dynamic Slow Motion Video Endoscopy and Eustachian Tube Dysfunction Questionnaire in Chronic Otitis Media

한원규,유준,나윤찬,장지원,임기정,송재준,채성원,정학현,최준 대한이비인후과학회 2017 Clinical and Experimental Otorhinolaryngology Vol.10 No.4

Objectives. Eustachian tube dysfunction has been associated with most cases of middle-ear disease. We aimed to assess the effectiveness of dynamic slow motion video endoscopy (DSVE) as a test of eustachian tube dysfunction. Furthermore, we assessed the correlation of the test with the Valsalva maneuver, the seven-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7), and intraoperative findings of the eustachian tube. Methods. We retrospectively reviewed medical records from April to September 2014 to identify patients who were diagnosed with chronic otitis media (COM) at Korea University Ansan Hospital. They all underwent surgery because of COM without cholesteatoma and were assessed via the DSVE and ETDQ-7 to determine eustachian tube function. Results. We reviewed 46 COM patients and examined 46 ears with COM and 46 ears on the contralateral side to COM that were thought to be normal. The mean DSVE grade in COM ears was 1.57±0.96, while the mean DSVE grade in contralateral ears was 1.15±0.94. The difference in DSVE between COM ears and normal ears was statistically significant (P=0.006). In the ETDQ-7, a higher score was related to intraoperative obstruction of the eustachian tube (P=0.012). Conclusion. DSVE and ETDQ-7 can provide information regarding preoperative status of eustachian tube dysfunction by measuring dynamic structural changes of the eustachian tube in combination with other diagnostic tests.

아미노글리코사이드 전신투여 환자에서 나타난 비대칭적 청각전정장애

박재홍,구자원,나윤찬,김지수 대한평형의학회 2013 Research in Vestibular Science Vol.12 No.2

Since the characteristics of aminoglycoside ototoxicity is typically bilaterally symmetric progression of cochlea-vestibular dysfunction, a unilateral involvement has rarely been reported. However, ototoxicity can be asymmetric or focal after systemic aminoglycoside treatment. The authors report 2 cases of asymmetric or focal audiovestibular deficits in patients treated with systemic aminoglycoside. In such cases, further investigations are also necessary to rule out other possible causes of unilateral sensorineural hearing loss such as cerebellopontine angle tumors.

Clinical Correlation between Perverted Nystagmus and Brain MRI Abnormal Findings

한원구,윤희철,김태민,나윤찬,최준 대한청각학회 2016 Journal of Audiology & Otology Vol.20 No.2

Background and Objectives: To analyze the clinical correlation between perverted nystagmus and brain magnetic resonance imaging (MRI) abnormal findings and to evaluate whether perverted nystagmus is clinically significant results of brain abnormal lesions or not. Subjects and Methods: We performed medical charts review from January 2008 to July 2014, retrospectively. Patients who were suspected central originated vertigo at Frenzel goggles test were included among patients who visited our hospital. To investigate the correlation with nystagmus suspected central originated vertigo and brain MRI abnormal findings, we confirmed whether performing brain MRI or not. Then we exclude that patients not performed brain MRI. Results: The number of patients with perverted nystagmus was 15, upbeating was 1 and down-beating was 14. Among these patients, 5 patients have brain MRI abnormal findings. However, 2 patients with MRI abnormal findings were not associated correctly with perverted nystagmus and only 3 patients with perverted nystagmus were considered central originated vertigo and further evaluation and treatment was performed by the department of neurology. Conclusions: Perverted nystagmus was considered to the abnormalities at brain lesions, especially cerebellum, but neurologic symptoms and further evaluation were needed for exact diagnosis of central originated vertigo.

Short-Term Outcomes of Acute Low-Tone Sensorineural Hearing Loss According to Treatment Modality

장진경,엄건휘,임하영,정종윤,나윤찬,최준 대한청각학회 2016 Journal of Audiology & Otology Vol.20 No.1

Background and Objectives: We compared improvements in hearing thresholds in acute low-tone sensorineural hearing loss (ALHL) patients after two different treatments: steroid alone and steroid and diuretic combined. We analyzed how the duration between the onset of symptoms and the initiation of treatment affected hearing loss improvement and investigated the relation between presence of vertigo in ALHL patients and ALHL progression to Ménière's disease (MD). Subjects and Methods: We retrospectively analyzed the medical records of 47 ALHL patients aged 21 to 76 years. Patients received either orally administered steroid alone (n=12) or steroid and diuretic combined (n=35). We compared improvements in the two groups’ hearing thresholds at three lower frequencies (125, 250, and 500 Hz) after participants had received one month of each respective treatment. Results: Our two treatments did not show any statistical difference in hearing loss improvement after one month. Forty percent of ALHL patients with vertigo developed MD, which was a significantly higher rate than the 12.5% of ALHL patients without vertigo who developed MD. The shorter duration between the onset of symptoms and the initiation of treatment significantly increased improvement in the sum of lower frequency hearing threshold after one month. Conclusions: The current study suggests that steroid and diuretic administered together and steroid alone similarly improve the hearing threshold in ALHL patients after one month. We concluded that patients should initiate ALHL treatment as soon as they experience symptoms. ALHL patients should also be notified of their higher risk of developing MD.