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진주종성 중이염 수술 후 정원창에 발생한 재발성 외림프 누공의 Hydroxyapatite Cement를 이용한 폐쇄술 1예
한치성,오재규,정을현,박성현 대한이비인후과학회 2008 대한이비인후과학회지 두경부외과학 Vol.51 No.8
Perilymphatic fistula (PLF) is a rare condition characterized by abnormal leakage of perilymph from the inner ear into the middle ear via a defect in the oval or round windows. PLF needs special attention concerning early diagnosis and treatment, because it can cause dizziness, hearing loss, tinnitus, meningitis, and other symptoms. The diagnosis of PLF usually cannot be confirmed before exploratory tympanotomy. Fascia, perichondrium, loose areolar tissue, fat and gelfoam can be used effectively in the PLF repair. Fibrin glue was used to aid in securing the graft material. However, recurrence is not rare and revision is sometimes needed to relieve the symptoms associated with the leakage of perilymph. So otologic surgeons should keep in mind that PLF has a great tendency to recur. Careful surgical procedures together with strict postoperative management are important to prevent recurrence and hydroxyapatite cement (HAC) can be used to cover the fistula area as a alternative graft material in recurrent perilymphatic fistula. We report on one recurrent case of postoperative PLF occurring at the round window that was repaired with HAC. (Korean J Otorhinolaryngol-Head Neck Surg 2008;51:742-6)
당뇨환자에서 발생한 돌발성 난청에 대한 스테로이드 전신 투여와 고실내 주입의 치료효과 비교
한치성,박종률,김현범,안중기,박정홍,강명구,이원용,김종애 대한이비인후과학회 2008 대한이비인후과학회지 두경부외과학 Vol.51 No.3
High dose systemic steroid therapy is currently the mainstay of the treatment for sudden sensorineural hearing loss (SSNHL). However, it makes a glycemic control worse in patients with diabetes. Intratympanic steroid injection (ITSI) can result in reduced systemic steroid toxicity and higher perilymph steroid level selectively. The purpose of this study is to compare the efficacy of ITSI (IT group) with that of systemic steroid (IV group) on SSNHL with diabetes. Subjects and Method:Thirty eight SSNHL patients who were diagnosed with diabetes were divided into the IV group (19 patients) and the IT group (19 patients). In the IV group, prednisolone was administrated intravenously for 7 days followed by tapered doses orally for 7 days. In the IT group, dexamethasone was administrated 4 times within a 2 week-period. Hearing outcome was assessed before and after treatment. Results:In the IV group, 10 patients (58.8%) showed an improvement in the pure tone audiogram (PTA), with a mean improvement of 17.6 dB (p=0.023). In the IT group, 16 patients (84.2%) showed improvement in the PTA, with the mean improvement of 25.1 dB (p=0.000). But there was no significant difference in hearing gain and the recovery rate between the two groups. And it is more difficult to control blood sugar in the IV group rather than in the IT group. Conclusion:ITSI treatment is as effective as the systemic steroid treatment for SSNHL patients with diabetes and it can avoid a significant side effect of systemic steroids. So it could be considered as an initial treatment for the SSNHL patient with diabetes. (Korean J Otorhinolaryngol-Head Neck Surg 2008;51:227-33)
한치성,박경원,조준만,정상환 대한이비인후과학회 2010 대한이비인후과학회지 두경부외과학 Vol.53 No.2
Neurofibroma is a relatively common neurogenic tumor originating from schwann cells or fibroblasts in peripheral nerve sheaths. It is classified as solitary or multiple. Solitary lesions are not usually associated with neurofibromatosis or von Recklinghausen’s disease. We report a case of solitary neurofibroma occurred in the right external auditory canal (EAC) in a 30-year-old male who complained of progressive hearing loss and earfullness for 5 years. This diffuse painless mass displaced the auricle laterally and obstructed EAC completely. The lesion was partially excised by retroauricular approach and diagnosed as neurofibroma. This patient does not have any other evidences of neurofibromatosis. A complete excision in this case was not mandatory as malignant change is rare; moreover, it would require extensive resection of periauricular skin, subcutaneous tissue, cartilaginous ear canal and temporalis muscle, followed by reconstruction. We present the clinical characteristics and therapeutic methods of a solitary neurofibroma originating from EAC. Korean J Otorhinolaryngol-Head Neck Surg 2010;53:126-9
개방동 유양돌기절제술 후 시행한 외이도후벽 재건술과 유양동폐쇄술
한치성,김현범,박종률,정을현,오재규,이원용,김종애,안중기,구태우,강명구 대한이비인후과학회 2008 대한이비인후과학회지 두경부외과학 Vol.51 No.1
There have been heated controversies over the choice of the canal wall down mastoidectomy (CWD) and canal wall up mastoidectomy (CWU), which are operational methods used to eliminate the lesion of cholesteatoma. Combining the advantages of both methods, we reconstructed the posterior canal wall with conchal cartilage plate and obliterated mastoid cavity with bone chips (group I), or hydroxyapatite mixed with bone chips (group II) since 2001. This study was designed to evaluate the surgical outcomes of posterior canal wall reconstruction with mastoid obliteration in the treatment of cholesteatoma. Subjects and Method:From January of 2001 to March of 2007, the posterior canal wall reconstruction with mastoid obliteration was conducted on 66 patients. There were 30 cases of cholesteatoma and 36 cases of old radical cavity. The postoperative observation period ranged from 5 to 74 months, with the average period of 34.7 months. We analyzed the postoperative complications, and hearing results of the 33 ossicular reconstruction cases. Results:There was 1 case of residual cholesteatoma in the middle ear cavity, but no recurrent cholesteatoma. In most cases, reconstructed canal wall was maintained well, but partial canal wall resorption and postauricular dimpling occurred in 5 cases of group I. On the other hand, the epithelization of posterior canal wall was incomplete in 4 cases of group II. After surgery, no patients complained any cavity problems at all. Conclusion:The present study suggests that this procedure can prevent cavity problems and reduce the recurrence of cholesteatoma with destructed canal wall. (Korean J Otorhinolaryngol-Head Neck Surg 2008;51:33-40)
부성현,박동진,한치성 대한이비인후과학회 2008 대한이비인후과학회지 두경부외과학 Vol.51 No.9
The Usher syndrome is an autosomal recessive disorder that cause bilateral sensorineural hearing loss and progressive loss of vision. It is genetically heterogeneous and is the most frequent cause of hereditary deafness and blindness in human. There are three types of Usher syndrome that can be distinguished clinically and into different subtypes. Type 2 Usher syndrome is the most common form and less severe than Type 1. It is characterized by congenital, moderate to severe, high frequency sloping hearing loss, retinitis pigmentosa which is typically diagnosed in late adolescence, and normal vestibular function. Recently, we have experienced a case of clinically diagnosed Type 2 Usher syndrome in a 34 years old female. We report this case with a brief review of literature. This is the first Type 2 Usher Syndrome to be reported in the otolaryngologic field in Korea. (Korean J Otorhinolaryngol-Head Neck Surg 2008;51:833-7)