Byung Don Lee

Repair of large traumatic tympanic membrane perforation with a Steri-Strips patch.

Objective. To investigate the effects of the Steri-Strips patch (3M) on the treatment of large traumatic tympanic membrane perforations (TMP). Study Design. Prospective, randomized, controlled. Setting. Tertiary university hospital. Subjects and Methods. A randomized prospective analysis was performed between February 2009 and January 2011 for the treatment of traumatic TMP larger than 50% of the entire tympanic membrane. The results of closure rate, closure time, hearing gain, and rate of otorrhea between conservative observation, paper patching, and Steri-Strips patching groups were compared. Results. In total, 87 patients were analyzed in this study. The closure rates of the perforations in the Steri-Strips patching, paper patching, and observation groups were 93.3%, 84.2%, and 78.9%, respectively. There was no statistically significant difference in tympanic membrane closure rate between the 3 groups. The Steri-Strips technique decreased the need for repeat procedures. Overall, the Steri-Strips and paper patching groups showed shorter healing times compared with the observation group. However, there was an increased rate of otorrhea in the Steri-Strips group compared with the observation group. Conclusion. Steri-Strips patching reduced the healing time and need for repeat procedures in patients with large traumatic TMPs. However, the occurrence of otorrhea was significantly more common in patients treated with the Steri-Strips technique.

Abnormality of cervical vestibular-evoked myogenic potentials and ocular vestibular-evoked myogenic potentials in patients with recurrent benign paroxysmal postitional vertigo.

Abstract Conclusion: Our results show that cervical vestibular-evoked myogenic potential (cVEMP) or ocular VEMP (oVEMP) abnormalities in the recurrent benign paroxysmal positional vertigo (BPPV) group were significantly higher than those in the non-recurrent BPPV group. Therefore, we can infer that VEMP abnormality is one of risk factors for BPPV recurrence. Objective: This prospective study aimed to test the hypothesis that otolith dysfunction using the VEMP test is a cause of recurrence of BPPV. Methods: cVEMP and oVEMP tests using 500 Hz tone-burst stimuli were performed on 16 patients with recurrent BPPV between March 2010 and December 2011. Both VEMP tests were performed in 20 patients with non-recurrent BPPV. Results: The differences in age, sex, and involved canal between the recurrent and non-recurrent BPPV groups were not significant. Abnormal cVEMP responses were detected in 5 of 16 (31.3%) subjects in the recurrent BPPV group and abnormal oVMEP responses were detected in 4 of 16 (25%) subjects in the recurrent BPPV group. When we defined VEMP abnormality as an abnormal cVEMP or abnormal oVEMP, VEMP abnormalities were detected in eight (50%) subjects in the recurrent BPPV group and in three (15%) subjects in the non-recurrent BPPV group; the difference between groups was significant.

Effect of diesel exhaust particles on human middle ear epithelial cells

OBJECTIVE In the present study, we investigate whether diesel exhaust particles (DEPs) cause cytotoxicity and induce inflammation or increase the expression of mucin in immortalized human middle ear epithelial cell lines (HMEECs). Several publications have shown an association between traffic-related air pollutants and otitis media. Additionally, DEP have been shown to cause inflammation and an allergic response in the airways. METHODS Cell viability following DEP treatment was investigated in HMEECs using the MTT assay. We measured the expression of the inflammatory cytokines TNF-α and COX-2 and the mucin genes MUC5AC and MUC5B using semiquantitative real-time reverse transcriptase-polymerase chain reaction (RT-PCR) and Western blotting. RESULTS Cell viability tests showed that exposure to more than 80 μg/mL of DEP caused a decrease in cell viability. DEP exposure also increased the expression of MUC5AC, but did not induce the expression of MUC5B in HMEECs. CONCLUSION DEP decreased cell viability, induced an inflammatory response, and increased mucin gene expression in HMEECs. These findings support the hypothesis that environmental diesel exposure is a risk factor for otitis media.

Intratympanic Steroids in Severe to Profound Sudden Sensorineural Hearing Loss as Salvage Treatment

OBJECTIVES Intratympanic steroids are being increasingly used in the treatment of sudden sensorineural hearing loss (SSNHL) after the failure of systemic therapy. This study evaluated the efficacy of administering intratympanic dexamethasone (ITD) as a salvage treatment for severe to profound SSNHL. METHODS We reviewed the medical records of patients who presented with severe to profound SSNHL between January 2007 and December 2009. ITD was given about 14 days after the initial systemic treatment. Successful recovery was defined as complete or partial recovery using Sigels criteria. We compared the results of treatment between the severe SSNHL (S-SSNHL) and profound SSNHL (P-SSNHL) groups. RESULTS All the patients in the S-SSNHL group showed significant improvement, as compared to the P-SSNHL group (P=0.017). The recovery rate after the initial systemic treatment was 36% (9/25) in the S-SSNHL group and 18.1% (4/22) in the P-SSNHL group (P=0.207). In comparison, the recovery rate of ITD as a salvage treatment was 37.5% (6/16) in the S-SSNHL group and 5.5% (1/18) in the P-SSNHL group (P=0.03). CONCLUSION Our comparative study dose not support the efficacy of ITD as salvage treatment for patients with P-SSNHL as compared with that for S-SSNHL. We recommend that patients with P-SSNHL be informed about the low efficacy of ITD as a salvage treatment.

Effect of acrolein, a hazardous air pollutant in smoke, on human middle ear epithelial cells

OBJECTIVE Acrolein is a hazardous air pollutant. Tobacco smoke and indoor air pollution are the main causes of human exposure. Acrolein has been shown to cause cytotoxicity in the airways and induce inflammation and mucin production in pulmonary cells. We investigated whether acrolein caused cytotoxicity, induced inflammation or increased expression of mucin in immortalized human middle ear epithelial cell lines (HMEECs). METHODS Cytotoxicity following acrolein treatment was investigated using the MTT assay, flow cytometry, and Hoechst 33342 staining of HMEECs. We measured expression of inflammatory cytokines tumor necrosis factor (TNF)-α and cyclo-oxygenase (COX)-2 and the mucin gene MUC5AC using semi-quantitative real-time reverse transcriptase polymerase chain reaction (RT-PCR) and Western blotting. RESULTS Exposure to >50 μg/mL acrolein caused a decrease in cell viability. Acrolein induced apoptosis and necrosis at 50 μg/mL. Acrolein at 5-50 μg/mL increased expression of TNF-α and COX-2, as shown by RT-PCR and Western blotting. Acrolein exposure at 5-50 μg/mL for 2-24h increased MUC5AC expression, as determined by RT-PCR. CONCLUSION Acrolein decreased cell viability, induced an inflammatory response, and increased mucin gene expression in HMEECs. These findings support the hypothesis that acrolein, a hazardous air pollutant in tobacco smoke and ambient air, is a risk factor for otitis media.

Protective effect of NecroX, a novel necroptosis inhibitor, on gentamicin-induced ototoxicity

INTRODUCTION NecroX is a novel necrosis and necroptosis inhibitor that shows scavenger activity against mitochondrial reactive oxygen species (ROS) and cytoprotective activity against various insults. These findings raise the possibility of its protective effect in ototoxicity. This study was performed to investigate the protective effect of NecroX on gentamicin (GM)-induced hair cell loss in neonatal mouse cochlea cultures. MATERIALS AND METHODS The protective effects of NecroX were measured by phalloidin staining of cultures from postnatal day 2-3 mice with GM-induced hair cell loss. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining was used to detect apoptosis. The radical-scavenging activity of NecroX was assessed using the 1,1-diphenyl-2-picrylhydrazyl (DPPH) assay. RESULTS NecroX showed a significant and concentration-dependent protective effect against GM-induced hair cell loss, and hair cells retained their stereocilia well. NecroX decreased GM-induced apoptosis of hair cells as assessed by TUNEL staining. Additionally, NecroX showed direct radical scavenging activity in the DPPH assay. CONCLUSIONS In this study, we demonstrated the protective effect of NecroX on GM-induced hair cell loss in neonatal cochlea cultures, and suggest that it may be of therapeutic use in the treatment of drug-induced ototoxicity.

Comparison of Conventional Excision via a Sublabial Approach and Transnasal Marsupialization for the Treatment of Nasolabial Cysts: A Prospective Randomized Study

Objectives Surgical excision via a sublabial approach is considered the standard treatment for nasolabial cysts. Although transnasal marsupialization has been proposed as an alternative method, no prospective study has compared the effectiveness of these techniques. We thus compared the surgical procedure, operating time, postoperative pain, complications, and recurrence rate between the two surgical methods. Methods Twenty patients diagnosed with nasolabial cysts were allocated randomly into two groups according to the surgical technique. In the sublabial approach group, the cysts were excised completely using a sublabial approach, while in the transnasal marsupialization group, the cysts were marsupialized transnasally under the guidance of nasal endoscopes. The pure operating time was measured and postoperative pain was evaluated using a visual analog scale. Complications after the procedure were assessed and recurrence was determined according to the clinical symptoms and postoperative radiologic findings. Results The transnasal marsupialization group had significantly shorter operating times, less postoperative pain, lower complication rates, and shorter duration of side effects than the sublabial approach group. No recurrence occurred in either group after a 1-yr follow-up period. Conclusion Although both methods are effective for treating nasolabial cysts, the transnasal marsupialization of nasolabial cysts has many benefits over the conventional sublabial approach. Therefore, we propose that transnasal marsupialization be the treatment of choice for nasolabial cysts.

A Clinical Analysis of Sudden Sensorineural Hearing Loss Cases

Background and Objectives High-dose systemic steroid therapy is the mainstay treatment for sudden sensorineural hearing loss (SSNHL). Recovery rates from SSNHL range are about 47-63% and are influenced by various prognostic factors. To evaluate the prognostic value of specific clinical parameters, we reviewed 289 cases by clinical and statistical analysis. Subjects and Methods This study included 289 patients with SSNHL who visited the Department of Otolaryngology at Soonchunhyang University Hospital from January 2005 to December 2012. The cases were reviewed retrospectively based on clinical charts. Hearing improvement was evaluated in relation to pure-tone audiogram results, duration between SSNHL onset and time of initial treatment, seasonal incidence, dizziness, patient age, degree of hearing loss, patterns of initial pure-tone audiogram and presence of underlying disease. Results Hearing improvement was observed in 196 of 289 (67.8%) patients; such improvement began within 7 days in most patients, followed by rapid hearing recovery. Cases that failed to show improvement within 14 days were unlikely to achieve hearing recovery. The more severe the hearing loss during the early stage, the lower the hearing recovery rates. Patients aged less than 60 years appear to have better prognosis of hearing improvement compared to those who are over 60 years. Conclusions Important prognostic factors for recovery in patients with SSNHL include the time of initiating treatment after symptom onset, the degree of early-stage hearing loss, and the age of the affected patient.

Simultaneous versus Subsequent Intratympanic Dexamethasone for Idiopathic Sudden Sensorineural Hearing Loss

Objective. The authors compared the efficacy of simultaneous and subsequent intratympanic dexamethasone injections for the treatment of idiopathic sudden sensorineural hearing loss. Study Design. Prospective randomized controlled multicenter study. Setting. Three tertiary university hospitals. Subjects and Methods. In the simultaneous intratympanic dexamethasone group, intratympanic dexamethasone was given initially with systemic steroids. In the subsequent intratympanic dexamethasone group, intratympanic dexamethasone was given 7 days after systemic treatment. The authors compared hearing outcomes between the groups according to Siegel’s criteria and frequency (0.25, 0.5, 1, 2, 3, 4, 6, and 8 kHz). Results. A total of 88 patients were analyzed in this study. There was no difference between the groups in hearing recovery according to Siegel’s criteria or frequencies. Neither recovery time nor early recovery differed between the groups. In the subsequent intratympanic dexamethasone group, 15 patients showed hearing recovery within 7 days and did not need intratympanic dexamethasone treatment. After intratympanic dexamethasone treatment, >28% (25/88) of the patients complained of otalgia, transient dizziness, ear fullness, and headache. Five percent of the patients showed small, transient perforations and otorrhea during intratympanic dexamethasone treatment. Conclusions. Simultaneous intratympanic dexamethasone did not confer an additional hearing gain or earlier recovery rate compared with subsequent intratympanic dexamethasone. A considerable number of patients did not need intratympanic dexamethasone for idiopathic sudden sensorineural hearing loss, and some patients experienced unnecessary side effects due to intratympanic dexamethasone. Therefore, the use of intratympanic dexamethasone is recommended only for subsequent or salvage treatment of idiopathic sudden sensorineural hearing loss after systemic steroid treatment.

The inhibitory effect of honokiol, a natural plant product, on vestibular schwannoma cells.

As the molecular biology of vestibular schwannoma (VS) is better understood, new means of targeting the pathways involved for intervention in schwannoma cells are being developed. Honokiol, a bioactive constituent of Magnolia officinalis, has attracted attention due to its diverse biological effects. This study was conducted to determine the inhibitory effect of honokiol on schwannoma cell proliferation.