Clinical Approaches for Understanding the Expression Levels of Pattern Recognition Receptors in Otitis Media with Effusion

이소윤,류은웅,김종빈,여승근 대한이비인후과학회 2011 Clinical and Experimental Otorhinolaryngology Vol.4 No.4

Objectives. Bacterial infections in the normally sterile environment of the middle ear cavity usually trigger host immune response, whereby the innate immune system plays a dominant role as the host’s first line of defense. We evaluated the expression levels of Toll-like receptors (TLRs) -2, -4, -5, -9, and nucleotide-binding oligomerization domain-containing proteins (NODs) -1 and -2, all of which are related to bacterial infection in pediatric patients with otitis media with effusion (OME). Methods. The study sample consisted of 46 pediatric patients with OME, all of whom had ventilation tubes inserted. The expression levels of TLR-2, -4, -5, -9, NOD-1 and -2 mRNA in middle ear effusion were assessed by polymerase chain reaction (PCR). Difference of pattern recognition receptors (PRRs) expression level by presence of bacteria, ventilation tube insertion rate, and effusion fluid character was assessed. Results. All effusion fluid samples collected from patients with OME showed expression of TLR-2, -4, -5, -9, NOD-1, and -2mRNA by PCR. However, we found no differences among expression levels of PRRs in relation to characteristics of exudates, presence of bacteria, or frequencies of ventilation tube insertion (P>0.05). Conclusion. Our findings suggest that exudates of OME patients show PRR expressions that are related to the innate immune response regardless of the characteristics of effusion fluid, presence of bacteria in exudates, or frequency of ventilation tube insertion.

양성돌발성두위현훈의 진단과 치료

변재용,류은웅 대한평형의학회 2010 Research in Vestibular Science Vol.9 No.-

Short Term Effects of Repetitive Transcranial Magnetic Stimulation in Patients with Catastrophic Intractable Tinnitus: Preliminary Report

이호윤,류은웅,변재용,여승근,박문서,유승돈 대한이비인후과학회 2013 Clinical and Experimental Otorhinolaryngology Vol.6 No.2

Objectives. The short-term effects of low-frequency repetitive transcranial magnetic stimulation (rTMS) in the patients withcatastrophic and intractable tinnitus were investigated. Methods. Fifteen participants were recruited among patients with catastrophic intractable tinnitus to receive 1 Hz rTMStreatment. Tinnitus severity was assessed before rTMS and directly after sham or real rTMS using the tinnitus handicapinventory (THI) and visual analog scale (VAS). Results. There was no statistical difference in the THI score before and after sham stimulation. However, after 5 replicationsof real rTMS there was statistically significant reduction in THI score. Eight patients showed a decrease of more than10 in THI score. Patients who showed a vast change in THI score after rTMS also showed a large decrease in their VASscore (r=0.879, P<0.001). Duration of tinnitus and change of THI score showed statistically significant moderatenegative correlation (r=-0.637, P=0.011). But in case of VAS, there was no significant difference between VAS andduration of tinnitus. Conclusion. Among total 15 patients with catastrophic intractable chronic tinnitus, eight patients showed some improvementin symptoms after 1 Hz rTMS. rTMS can be considered management modality for intractable tinnitus evenwith distress as severe as catastrophic stage.

벨마비 환자의 동반 증상 분석

이호윤,류은웅,박수완,김수진,여승근,박문서 대한이비인후과학회 2011 대한이비인후과학회지 두경부외과학 Vol.54 No.10

Background and Objectives We aimed to evaluate associated symptoms in patients with Bell’s palsy and prognosis according to associated symptoms. Subjects and Method Seventy-four patients with Bell’s palsy were enrolled in this study. We evaluated the degree of facial palsy with Facial Nerve Grading System 2.0. The grade of facial palsy was determined as initial facial palsy at admission and as final facial palsy at visit after 3 months. Afterwards, we examined symptoms (such as otalgia, facial numbness, taste disturbance, eye problems, hyperacusis, and tinnitus) and co-morbid diseases (such as diabetes mellitus and hypertension) associated with facial palsy. After 3 months of the onset of facial palsy, we examined the changes in the associated symptoms. Results At admission, 71.6 percent of all patients had symptoms associated with facial palsy. Of the associated symptoms, facial numbness and taste disturbance were the most common, which were still found in 23% of the patients after 3 months of the onset of facial palsy. Patients with a high initial grade of facial palsy were accompanied by taste disturbance and hyperacusis more than by other symptoms. Also patients who had auricular pain during the recovery period of Bell’s palsy showed poor prognosis. Compared to non-hypertension patients, for patients with hypertension, taste disturbance was more common during the early period whereas eye problems were more common during the recovery period. Conclusion Patients with Bell’s palsy had diverse symptoms associated with facial palsy. During the early period of Bell’s palsy, we concluded that there was no correlation between the symptoms and the prognosis. However, patients with pain around the ear during the recovery period showed poor recovery of facial palsy.

어지럼 및 말초성 안면마비를 동반한 인체 면역결핍 바이러스 양성 환자 1예

변재용,류은웅,정훈,박문서 대한평형의학회 2010 Research in Vestibular Science Vol.9 No.1

Various neurological complications occur in association with human immunodifiencyvirus (HIV) infection. These complications occur at all stages of infection and any level of central and peripheral nervous system. Neurological complications, such as aseptic meningitis, encephalopathy, neuropathy, myelopathy, and brachial neuritis, develop in association with primary HIV infection. We here in report a case of peripheral facial palsy with suspicious peripheral vertigo manifested as initial symptoms of primary HIV infection.

갑상선 결절에서 세침흡인검사: Bethesda Classification의 임상적 적용

은영규,류은웅,신일호,권기환 대한이비인후과학회 2010 대한이비인후과학회지 두경부외과학 Vol.53 No.7

Background and Objectives To evaluate the usefulness of fine needle aspiration (FNA) for thyroid nodule using the new Bethesda classification. Subjects and Method Patient cytology data were reviewed by retrospective search of thyroid FNA. Cytologic diagnoses were classified as unsatisfactory, benign/negative for malignancy,indeterminate (ID), follicular neoplasm (FN), suspicious for malignancy (SM), and positive for malignancy (PM) according to the proposing of The National Cancer Institute. We analyzed the follow-up FNA diagnoses and the cytologic-histologic correlations. Results Of 1983 patients, 16.8% was classified as unsatisfactory, 73.6% as benign, 1.1% as ID,0.4% as FN, 1.4% as SM, and 6.8% as PM. After the cytologic follow-up, the groups designated as unsatisafactory (80.2%) and ID (50%) mainly showed significant change in diagnosis. Two hundred fifty patients had surgical follow-up. Sensitivity, specificity, and accuracy, positive predictive values and negative predictive values for malignancy of thyroid were 87.6%, 97.2%, 91%,98.3% and 81.2%, respectively. The cytologic-histologic diagnostic discrepancy rate was 13.6%. Conclusion FNA for thyroid nodule using the new Bethesda classification was an accurate and sensitive method for the diagnosis of thyroid nodule, and can provide useful information for the management of thyroid nodule. Korean J Otorhinolaryngol-Head Neck Surg 2010;53:436-40

가상 유양동삭개술 모델에서 유양동 기체 생리의 변화

정대한,정훈,류은웅,박철언,변재용,여승근,박문서 대한이비인후과학회 2010 대한이비인후과학회지 두경부외과학 Vol.53 No.5

Background and ObjectivesZZIt is essential to understand gas physiology of mastoid cavity to study the pathophysiology of middle ear diseases, and the surface area and volume of mastoid mucosa are important parameters for evaluating gas physiology. However, the surface area and mastoid volume of the mastoid cavity have not been practically measured yet. Therefore, we measured and compared surface area and volume of the mastoid cavity before and after mastoidectomy using a virtual mastoidectomy model. Subjects and MethodZZWe performed a virtual mastoidectomy using 10 cases of temporal bone CT indicating pneumatic mastoid. First, we removed all air cells after outlining with irregular AOI function after loading axial CT images to Image-Pro Plus 4.0. Then we filled the removed area with equal planes using local equalization filter. Finally, we calculated and compared the total surface area, volume and area to volume (A/V) ratio by estimating their circumference and area. ResultsZZThe mean surface area of pneumatized mastoid cavity was 127.8 cm2 (range: 94.2-165.3 cm2), and the mean volume was 7.1 cm3 (range: 5.2-11.0 cm3). The mean surface area and volume were altered to 42.8 cm2 (range: 35.9-55.0 cm2) and 12.6 cm3 (range: 10.3-18.7cm3), respectively, after virtual mastoidectomy. As a result, the A/V ratio decreased from 18 to 3.4 after a virtual mastoidectomy in the pneumatic mastoid cavity. ConclusionZZWhen a complete mastoidectomy is performed in the pneumatic mastoid, the surface area is decreased by one third compared to a relatively minor increase in volume. Therefore,the surface area per unit volume is expected to greatly decrease after mastoidectomy. Some physiologic problems occurring after mastoidectomy could be more accurately explained using a virtual mastoidectomy model. Korean J Otorhinolaryngol-Head Neck Surg 2010;53:284-9

Clinical Manifestations of Aural Fullness

박문서,여승근,이호윤,강호민,류은웅,이선규 연세대학교의과대학 2012 Yonsei medical journal Vol.53 No.5

Purpose: Even though aural fullness is ubiquitous among patients presenting to otolaryngology clinics, the association between aural fullness and disease development has not yet been clearly determined. Materials and Methods: Our study was performed on outpatients from June 2006 to February 2010 whose major complaint was “ear fullness”, “aural fullness”, or “ear pressure”. We assessed their demographic and clinical characteristics, including sex, associated diseases, symptoms, otoscopic findings, audiology test results, and final diagnoses. Results: Among 432 patients, 165 (38.2%) were males and 267 (61.8%) were females, with mean ages of 42±19 years and 47±17 years, respectively. Tinnitus, hearing disturbance, autophony (p<0.01) as well as nasal obstruction and sore throat (p<0.05) showed a statistically significant correlation with aural fullness. Among patients who complained of hearing fullness, tests and measures such as impedance audiometry, speech reception threshold, and pure tone audiometry generated statistically significant results (p<0.05). Ear fullness was most frequently diagnosed as Eustachian tube dysfunction (28.9%), followed by otitis media with effusion (13.4%) and chronic otitis media (7.2%). However, 13.4% of patients could not be definitively diagnosed. Conclusion: Among patients complaining of ear fullness, Eustachian tube dysfunction, otitis media with effusion, chronic otitis media were most commonly observed. Performance of otoscopy, nasal endoscopy, the Valsalva maneuver,and additional audiological tests is necessary to exclude other diseases.

Possibility of Discriminating the Presence of Tinnitus through Repeated Tinnitograms

Moon Suh Park,류은웅,Chul Kwon,Cheol Eon Park,Jae Yong Byun,Seung Geun Yeo 대한청각학회 2011 Journal of Audiology & Otology Vol.15 No.3

Background and Objectives: The evaluation of tinnitus is becoming increasingly important in assessing the degree of disability. However, until now, there are no tools to verify the presence of tinnitus. The aim of this study was to identify the possibilities in discriminating the presence of tinnitus through tinnitus test, pitch match test and loudness balance test. Materials and Methods: Typically, 50 patients who have suffered from continuous tinnitus and 20 subjects with normal hearing ability who did not suffer from tinnitus were selected for the present investigation. All the patients underwent the tests for pitch match and loudness balance, which were replicated thrice with 1-minute intervals with a TDH 49 headphone and an oribiter model 922, GN otometrics in a soundproof room. Non-tinnitus group that didn't have tinnitus chose virtual tinnitus based on their own discretion. Results: The most similar sounds mimicking tinnitus were of pure tone in both the groups. However, subjects of the tinnitus group were exposed to a greater variety of sounds than those of the non-tinnitus group. Moreover, the most common frequency of tinnitus was 4 and 8 kHz in the tinnitus group, but 1 kHz in the non-tinnitus group. The mean loudness of tinnitus was 7.28 dBSL in the tinnitus group and 13.6 dBSL in the non-tinnitus group. The loudness of tinnitus in the tinnitus group was less than that in the non-tinnitus group in a statistically significant manner (p<0.05). Loudness in each repeated tinnitus tests was identical in tinnitus group, but significantly different in non-tinnitus group (p<0.05). Conclusions: We concluded that repeated tinnitus tests for loudness matching were helpful in identifying the presence of tinnitus. Introduction Tinnitus is an abnormal sound, which is felt with no stimulation, and about 8-10% of people suffer from this condition. Most of the people amongst 8-10% have become as well as being habituated to tinnitus, and about 1% of them are seriously suffering from the inconvenience caused by the condition.1) Tinnitus is usually a subjective symptom, which could also be expressed by duration and frequency components. Clinically, patients can express tinnitus by using the method to speak similar voices like tinnitus or indicate similar sounds around themselves. However, such a strategy might cause differences between the individuals and it is not easy to evaluate psychoacoustic characteristics because of ones' own diverse auditory experiences. Therefore, the recent methods to evaluate tinnitus have definite limitations, although a number of methods have been developed, which express tinnitus in a more objective way as per the feelings of the patients. Meanwhile, the presence of tinnitus has been recently considered as a criterion for determining the degree of the disability caused by various industrial, but there is no way to objectively prove the presence of tinnitus. However, we can objectively employ the auditory brainstem response test to evaluate the degree of hearing loss. Therefore, in the present study, our aim was to find the usefulness of the repeated tinnitogram in diagnosing the presence of tinnitus. Materials and Methods The study was conducted in 50 patients, who have been suffering from continuous tinnitus for more than 6 months since 2006, and in 20 virtual tinnitus patients (non-tinnitus group) who were assumed to be complaining of tinnitus (actually they do not have any symptoms of tinnitus). Moreover, we excluded the patients who had problems in communicating due to severe hearing loss on both ears, while there were no restrictions with respect to gender, age, cause of tinnitus, duration, direction of progress, and degree of disability. In case of virtual tinnitus patients, volunteers with normal hearing and no experience of tinnitus were also selected for the present study. The average age for the tinnitus patient group was 55 years (14-80 years) and 27 years (23-33 years) for the non-tinnitus patient group (Table 1). Otologic (hearing) evaluation For hearing evaluation, an audiometer (GN otometrics, Orbiter model 922, Chicago, IL, USA) was used to measure individual thresholds for pure tones of 125, 250, 500, 1,000, 2,000, 3,000, 4,000, 6,000, and 8,000 Hz frequencies for more than twice. If any threshold for the respective frequencies was found to be above 26 dB, the condition was diagnosed as hearing loss. For non-tinnitus group, there was no hearing loss on both ears. Measurement of tinnitus Fixed frequency-pitch match test Pure tone and narrow band noise were used according to the range of loudness and frequency. As pure tone, sounds generated in the audiometer (GN otometrics, Orbiter model 922, Chicago, IL, USA) were used, and, as for frequencies, 11 kinds of frequencies were used: 125, 250, 500, 750, 1,000, 1,500, 2,000, 3,000, 4,000, 6,000, and 8,000 Hz. Loudness of tinnitus had the range from 0 to 110 dB, which were adjustable at intervals of 1 dB. The most similar frequency was found by asking the patients about the frequency, which was most similar to their tinnitus, and then moving the dissimilar side to the similar side scale by scale. In the beginning, when it was not possible to find the similar tone through the pure tone test, the test was conducted with narrowband noise. When no similar tone was found even through narrowband noise, white noise and voice signal noise were used in order to figure out the kinds of sounds. However, white noise and voice signal noise are not specific with respect to the frequency, and thus those who selected white noises or voice signals amongst the tinnitus and non-tinnitus groups, were excluded from the statistical analysis of the frequency...