Beom-Cho Jun

The analysis of maxillary sinus aeration according to aging process; volume assessment by 3-dimensional reconstruction by high-resolutional CT scanning:

OBJECTIVE: To evaluate change of the maxillary sinus volume according to patient age and gender by using a 3-dimensional (3-D) reconstruction of computed tomography images. STUDY DESIGN AND SETTING: One hundred seventy-three people (totaling 238 maxillary sinuses) who had undergone paranasal sinus CT scan between December 2000 and November 2003 and had no evidence of inflammation or hypoplasia in the CT finding and had no specific history of paranasal sinus surgery or maxillofacial trauma were retrospectively analyzed. The 3-D reconstruction images were obtained by using a surface-rendering technique (Vworks; CybeMed, Seoul, Korea) on a personal computer. The mean volume of maxillary sinus was evaluated according to patient chronologic age and gender. The ratio of the maximum horizontal and half-horizontal extension for the estimation of the morphological change of maxillary sinus and the degree of descent of the sinus below the nasal floor were evaluated in the 3-D image. RESULTS: The development of the maxillary sinus continued until the 3rd decade in males and until the 2nd decade in females. The mean maxillary sinus volume in early adults was 24,043 mm 3 (males) and 15,859.5 mm 3 (females). There was a significance difference in the sinus volume (P < 0.05) according to gender, and there was a significant difference in the maxillary sinus volume according to age before it reached maximum. After its maximum growth period, however, there was no significant difference in the volume change of maxillary sinus and the descent below the nasal floor between two adjacent groups. CONCLUSIONS: The growth of the maxillary sinus continues until the 3rd decade in males and the 2nd decade in females. Therefore, a maxillary sinus operation affecting the bony structures before these ages might affect the development of the sinus and needs to be performed carefully

Hearing outcome of sudden sensorineural hearing loss: long-term follow-up.

Objective To evaluate the time-dependent progress and delayed improvement in patients who were treated with combination therapy including oral corticosteroid for idiopathic sudden sensorineural hearing loss. Study Design and Setting This retrospective study at a secondary referral and university-based center included 156 patients who were treated by 10-day course of admission therapy and followed for at least three months. Results Of 121 patients who recovered over three months of follow-up, 45.5% showed a delayed recovery after the end of 10-day course of therapy. Of these 55 patients, 78.2% recovered within one month, 5.5% recovered within one to two months, 12.7% recovered in two to three months, and 3.6% recovered later than three months after discharge. Conclusions This study describes the long-term results for a three-month retrospective series of 156 patients diagnosed with idiopathic sudden sensorineural hearing loss, although this result should be further studied by additional research.

Three-dimensional reconstruction based on images from spiral high-resolution computed tomography of the temporal bone : anatomy and clinical application

The aim of this study was to investigate the usefulness of a three-dimensional (3D) reconstruction of computed tomography (CT) images in determining the anatomy and topographic relationship between various important structures. Using 40 ears from 20 patients with various otological diseases, a 3D reconstruction based on the image data from spiral high-resolution CT was performed by segmentation, volume-rendering and surface-rendering algorithms on a personal computer. The 3D display of the middle and inner ear structures was demonstrated in detail. Computer-assisted measurements, many of which could not be easily measured in vivo, of the reconstructed structures provided accurate anatomic details that improved the surgeons understanding of spatial relationships. A 3D reconstruction of temporal bone CT might be useful for education and increasing understanding of the anatomical structures of the temporal bone. However, it will be necessary to confirm the correlation between the 3D reconstructed images and histological sections through a validation study.

Efficacy of intratympanic steroid therapy for idiopathic sudden sensorineural hearing loss: comparison with systemic steroid therapy and combined therapy

Abstract Conclusion: Intratympanic steroid therapy (IT-S) was as effective as systemic steroid therapy (SST) or combined therapy (CT) and could be considered a first-line therapeutic modality for idiopathic sudden sensorineural hearing loss (SSNHL). Due to its known safety and efficacy, IT-S will be particularly suitable for patients with SSNHL who have chronic diseases such as diabetes mellitus, hypertension, or chronic renal failure. Objectives: Systemic high dose steroid therapy is the main therapeutic modality for SSNHL. Comparable therapeutic efficacies for IT-S and CT with SST and IT-S for SSNHL have been reported recently. We compared the efficacy of IT-S, SST, and CT for treating SSNHL. Methods: A retrospective, multicenter study investigating the therapeutic efficacy of SST, IT-S, and CT for SSNHL was designed and involved 735 patients with idiopathic SSNHL who were diagnosed and treated at seven tertiary referral medical centers of the Catholic University of Korea between 2007 and 2011. Patients were divided into three groups according to the treatment methods they received: IT-S group, SST group, and CT group (SS plus IT-S). Hearing was evaluated by pure tone audiogram performed before initial treatment and at 4 weeks following the final treatment. More than a 10 dB HL decrease in average air conduction threshold of hearing at 500, 1000, 2000, and 3000 Hz was defined as improved hearing. Results: Among 735 patients with SSNHL, 94 were included in the IT-S group, 444 in the SST, and 197 in the CT group. Age, gender, interval from disease onset to start of treatment, and initial hearing level were not different among the three groups. Patients who had concomitant medical disorders such as diabetes mellitus, hypertension, or chronic renal failure were more frequently treated with IT-S. No difference in the level of hearing gain or ratio of hearing improvement was observed among the three groups (p = 0.147 and p = 0.067, respectively).

Temporal bone myeloid sarcoma.

Myeloid sarcoma is a rare condition thats caused by the aggregation of immature myeloid cells in leukemic patients. Myeloid sarcoma occurring in the temporal bone more frequently involves the mastoid bone than is the case for metastatic lesions arising from non-systemic malignancies. The disease is difficult to diagnose when it presents with symptoms that mimic otomastoiditis. However, an early diagnosis is important in order to achieve complete remission of the disease. Magnetic resonance imaging of the temporal bone is useful for making the diagnosis of myeloid sarcoma, and especially to evaluate the extent of disease. High-dose radio- or chemotherapies are the first-line approaches and possibly the only approaches to achieve complete remission and to cure the disease. With the aim of improving our understanding of myeloid sarcoma in the temporal bone, the present report describes our experience with 5 such cases and we compare the clinical features of these 5 patients with those clinical features of patients who have metastatic lesions.

Functional evaluation of paratubal muscles using electromyography in patients with chronic unilateral tubal dysfunction.

Eustachian tube dysfunction is closely related to the development of otitis media and result from several factors including inflammation within the nasal cavity and nasopharynx, adenoid hypertrophy, cleft palate and nasopharyngeal carcinoma. To some extent, eustachian tube dysfunction may be related to weakness of the paratubal muscles, such as the tensor veli palatini and levator veli palatini muscles. The aim of the study is to find out myogenic factors in eustachian tube dysfunction using electromyography (EMG), and to evaluate the clinical feasibility of EMG. Ten patients with unilateral eustachian tube dysfunction were included in this study. The healthy side of each patient was used as a control. EMG tests on paratubal muscles were conducted under the view of a 30° endoscope or fiberoptic laryngoscope. EMG on the tensor veli palatini showed decreased amplitudes on the affected side in one patient during phonation. EMG on the levator veli palatini showed decreased amplitudes on the affected side in two patients during both deglutition and phonation, one patient during phonation only, and two patients during deglutition only. The only patient who had decreased amplitude on EMG of the tensor veli palatini also had decreased amplitude on EMG of the levator veli palatini. In conclusion, although it is generally accepted that the tensor veli palatini plays a major role in opening the eustachian tube, reduced activity of the levator veli palatini may be related to eustachian tube dysfunction. When assessing eustachian tube function, EMG is useful for evaluating myogenic factors.

Clinical feasibility of the new technique of functional 3D laryngeal CT

Conclusions. Functional 3D laryngeal CT (F3DLxCT) is an informative tool for visualizing the active changes in length, tension and mass of the vocal folds for pitch control. Furthermore, volume defects and level differences of paralyzed vocal folds are easily detectable with this new technique. Objective. To evaluate the clinical feasibility of F3DLxCT images, which can provide clear coronal images of the vocal fold in each anteroposterior direction during phonation and in the resting state. Material and methods. FLxCT images were reconstructed to three dimensions to visualize laryngeal motion. FLxCT was performed in four normal controls and in four patients with unilateral vocal fold paralysis in the resting state and during phonation with three vowel sounds of different pitch. 3D images were reconstructed with segmentation and a surface-rendering algorithm on a PC, using the DICOM file of axial images. Results. The dynamic vocal fold 3D image during phonation could visualize that the thickness and volume were decreased in relatively to the pitch increase. Typical subglottic shoulder-like image formation and ventricular widening were noted with the high-pitch tone.

Deep temporal fascial-periosteal flap for canal wall down mastoidectomy

It is very important to make a safe, dry, trouble‐free ear for the canal wall down mastoidectomy. Although fascia graft is the most common material used for the repair of the perforated tympanic membrane, it is usually too small to cover the whole mastoid cavity in canal wall down mastoidectomy. The presence of exposed bone delays the epithelialization and results in prolonged otorrhea. We present a new simple technique that uses a postauricular, inferiorly based pedicled flap. Although our deep temporalis fascial–periosteal flap is not bulky, it is large enough to obliterate a sclerotic mastoid cavity without the need for additional flaps. It shrinks much less than a muscular flap during the healing period. In addition to reducing the cavity volume, this flap promotes the epithelialization over the bone and the shortening of the healing time. Although only a small number of patients were included in this study, coverage of a canal wall down mastoid cavity by a deep temporalis fascial–periosteal flap is expected to be a reliable and effective technique that results in a dry, trouble‐free mastoid cavity.

Magnetic resonance imaging of the mastoid cavity and middle ear : Prevalence and clinical significance of incidental abnormal findings in a nonotolaryngologic adult and pediatric population

OBJECTIVE The purposes of this study were to determine the prevalence of abnormalities in the mastoid cavity and middle ear in a nonotolaryngologic population and to correlate the results with clinical data. DESIGN Prospective, cross-sectional study. SETTING An academic tertiary care centre. METHODS We evaluated 100 adults and 30 children from May to July 2003. Patients who had a history of mastoid or middle ear surgery or were presently suffering from otitis media were excluded. Magnetic resonance imaging (MRI) was conducted for the suspected intracranial pathology. MAIN OUTCOME MEASURES The T2-weighted image was reviewed. The abnormality detected by MRI was divided into (1) mastoid cavity abnormality and (2) middle ear abnormality. All patients were asked to complete a questionnaire pertaining to the symptoms of the mastoid or middle ear pathology and the history of the otitis media. Also, their ears were examined carefully by an otoscope or otomicroscope. RESULTS In both groups, most of the abnormalities were found in the mastoid cavity. Analysis of the clinical data revealed that abnormal MRI findings of the mastoid cavity were significantly correlated to clinically significant mastoid or middle ear disease in adults. CONCLUSIONS Incidental MRI abnormalities in the mastoid cavity and middle ear detected in a nonotolaryngologic population were relatively uncommon compared with incidental paranasal sinus abnormalities. However, clinicians should remember the possibility of the pathologies that demand active treatment among these abnormalities, especially when a high signal abnormality is found in the mastoid cavity of an adult.

Clinical feasibility of temporal bone magnetic resonance imaging as a prognostic tool in idiopathic acute facial palsy.

OBJECTIVE To assess the feasibility of temporal bone magnetic resonance imaging for evaluating the severity and prognosis of idiopathic acute facial nerve palsy. METHODS Forty-four patients with idiopathic acute facial nerve palsy who had undergone gadolinium-enhanced magnetic resonance imaging were selected retrospectively. The degree of radiological facial nerve enhancement was determined using quantitative analysis (with region-of-interest measurements for separate facial nerve segments) and using subjective visual analysis. The clinical severity of facial nerve palsy was then correlated with the degree of facial nerve enhancement. RESULTS The visually determined degree of facial nerve enhancement did not correlate significantly with the House-Brackmann grade at either the early or late stages (p > 0.05). Results using the region-of-interest system were similar (p > 0.05). CONCLUSION Temporal bone magnetic resonance imaging is not essential for patients with acute facial nerve palsy.