Dong Choon Park

Age-related differences in parameters of vestibular evoked myogenic potentials

Conclusions. The statistically significant correlations between vestibular evoked myogenic potential (VEMP) parameters and age may be due to hair cell loss of the otolith organ and/or to degenerative changes of the vestibular neural pathway. These findings indicate that age should be taken into account when interpreting VEMP results. It is also important to determine a standard method for performing VEMP and a universal index for comparison among laboratories. Objectives. VEMP, which measures the surface electric potential from the cervical muscle evoked by sufficiently loud sounds, is a useful tool to evaluate vestibule-colic reflex function. We have assayed the effect of age on VEMP results. Subjects and methods. After excluding subjects with a previous history of dizziness, middle ear pathology, or other inner ear symptoms, a total of 97 healthy volunteers (194ears) were included. All VEMP parameters were analyzed to find differences related to side and gender, as well as the relationship between age and each VEMP parameter. Results. Age was correlated with all VEMP parameters. Latency of p13, n23 showed a negative correlation and amplitude of p13-n23 showed a positive correlation with age. Differences between the right and left sides were not significant.

Acyclovir plus steroid vs steroid alone in the treatment of Bell's palsy

PURPOSE The pathogenetic mechanism of Bells palsy is thought to involve herpes simplex virus reactivation within the geniculate ganglion, followed by inflammation and entrapment of the nerve at the meatal foramen. We therefore compared the therapeutic effect of acyclovir plus steroid vs steroid alone, in combination with physical therapy, in patients with Bells palsy. MATERIALS AND METHODS In a double-blind, randomized, prospective trial, 91 patients were randomized to treatment with acyclovir and prednisone (44 patients) or prednisone alone (47 patients). All patients underwent physical therapy. The follow-up period was greater than 6 months or encompassed the period of complete recovery from paralysis. House-Brackmann grade was evaluated 2 and 6 months after onset, with complete and satisfactory recovery defined as House-Brackmann grades I and II, respectively. RESULTS The overall recovery rate of patients treated with steroid and acyclovir (93.1%) was greater than that of patients treated with steroid alone (85.1%), but the difference was not statistically significant. CONCLUSION The benefit of acyclovir in Bells palsy has not been definitively established.

Bacteriology of chronic suppurative otitis media – a multicenter study

Conclusions. Bacterial predominance and antibiotic sensitivity have changed over time, making continuous and periodic surveillance necessary in guiding appropriate antibacterial therapy. Objectives. With the development and widespread use of antibiotics, the types of pathogenic microorganisms and their resistance to antibiotics have changed. Knowledge of the species and resistance rates of current pathogens is important for determining the appropriate antibiotics for patients with chronic suppurative otitis media. We investigated the current bacteriology of chronic suppurative otitis media. Subjects and methods. This was a retrospective study of 1102 patients with chronic suppurative otitis media seen at six hospitals in Korea from January 2001 to December 2005. Results. The most commonly identified pathogenic bacterial species was Pseudomonas, with the next most prevalent being methicillin-resistant Staphylococcus aureus (MRSA).

Vestibular evoked myogenic potentials in patients with benign paroxysmal positional vertigo involving each semicircular canal

PURPOSE We have investigated vestibular evoked myogenic potentials (VEMPs) as a function of age and the involvement of each of the 3 semicircular canals in patients with benign paroxysmal positional vertigo (BPPV). MATERIALS AND METHODS We performed prospective assessment from January 2005 to September 2006. Vestibular evoked myogenic potential was measured in 53 patients with BPPV and 84 healthy subjects, with the latter subdivided by patient age. RESULTS The subgroup of healthy subjects older than 60 years showed significantly more prolonged p13 and n23 latencies and lower amplitude than the other 2 subgroups. Of the 53 patients with BPPV, 13 (24.5%) showed abnormal VEMP responses on the affected side when compared with their age-related control subgroup. There was no correlation between VEMP findings and the affected semicircular canal. CONCLUSION Patients with BPPV may show abnormal VEMP findings, irrespective of the involved semicircular canal, and age was associated with VEMP results suggesting degeneration of the maculae of the saccule.

TLR-9, NOD-1, NOD-2, RIG-I and immunoglobulins in recurrent otitis media with effusion☆

OBJECTIVES Pattern recognition receptors (PRRs) induce appropriate immune responses after recognizing certain molecular characteristics of pathogens. It is not known, however, whether PRRs are expressed in middle ear infections and whether the expression of PRRs and immunoglobulins is correlated in recurrent otitis media with effusion (OME). We therefore investigated the expression of PRRs and immunoglobulins in children with OME. MATERIALS AND METHODS The study population consisted of 66 children with OME, of whom 27 had more than 4 episodes in 12 months or more than 3 episodes in 6 months (otitis-prone group), and 39 had fewer than 4 episodes in 12 months or 3 episodes in 6 months (non-otitis-prone group). The expression in middle ear effusion of Toll-like receptor (TLR)-9, nucleotide-binding oligomerization domain (NOD)-1, NOD-2, and retinoic acid-inducible gene (RIG)-I mRNA, as determined by real-time PCR, and the concentrations of IgG, IgA, and IgM, as determined by ELISA, were compared between the two groups. RESULTS The levels of TLR-9, NOD-1 and RIG I mRNAs were significantly lower in the otitis-prone than in the non-otitis-prone group (p<0.05 each). The concentrations of IgG, IgA and IgM in effusion fluid did not differ significantly between the two groups (p>0.05), and there were no correlations between immunoglobulin concentration and the expression of PRPs (p>0.05). CONCLUSIONS Decreased expression of PRRs may be associated with increased susceptibility to OME.

Relationship between effusion bacteria and concentrations of immunoglobulin in serum and effusion fluid in otitis media with effusion patients

OBJECTIVE Bacterial infection and immunity are important in the development of otitis media with effusion (OME) in children who have not developed Eustachian tube function. We evaluated the relationship between the presence of bacteria in effusion fluid and immunoglobulin (Ig) concentrations in effusion fluid and serum. METHODS Middle ear effusion and blood samples were collected from 58 OME patients who had undergone ventilation tube insertion. Bacteria in effusion fluid were detected by standard bacterial culture and polymerase chain reaction (PCR). Serum and middle ear fluid Ig concentrations in OME patients and serum Ig concentrations in 64 control children were evaluated. RESULTS Bacteria were detected in 24/58 (41.4%) effusion fluid samples by PCR and in 12/58 (20.6%) by standard culture. There was no correlation between effusion Ig concentration and the presence of bacteria or between serum and effusion Ig concentrations, but serum Ig concentration was related to the presence of effusion bacteria (p<0.05). Serum IgG, IgA and IgM in patients with OME were lower than in control patients (p<0.05). CONCLUSIONS These results suggest that the presence of effusion bacteria in OME may be related to systemic immunity, but that the concentration of Ig in effusion fluid may not be affected by the presence of effusion bacteria.

Zoster sine herpete causing facial palsy

OBJECTIVES The aims of this study were to verify the characteristics of zoster sine herpete (ZSH) causing facial palsy and the effects of different treatments and to confirm the difference from other etiologies. METHODS From March 2010 to March 2011, a prospective study was performed on patients with ZSH with facial palsy. Patients were divided into a steroid-treated group and a steroid-antiviral combination group, and then the effects according to regimen of treatment were prospectively analyzed. Last, the difference between the ZSH group and patients diagnosed with Bell palsy and Ramsay Hunt syndrome in the same study period was confirmed retrospectively. RESULTS Forty-five patients were diagnosed as having ZSH. Significant improvement was not observed in the ZSH group regardless of the treatment regimen during a 3-week period (P < .05). In patients with ZSH with accompanying typical pain, significant continuous improvement after 6 weeks was observed in patients with combination therapy (P < .05). Compared with patients with Bell palsy and Ramsay Hunt syndrome, there was a significant difference in recovery rate between patients with ZSH (accompanying pain) and those with Bell palsy (89.9%) (P < .05). CONCLUSION The initiation of recovery in ZSH started later than that in other peripheral palsies, and slower recovery was shown in patients with ZSH with pain compared with those with Bell palsy. Steroid-antiviral combination therapy was a more effective regimen for treatment compared with steroid-only treatment. To improve the accuracy of ZSH diagnosis, confirming the presence of accompanying typical pain is necessary.

Immunoglobulins and transcription factors in adenoids of children with otitis media with effusion and chronic rhinosinusitis.

OBJECTIVE To evaluate the level of immunoglobulins and expression of the transcription factors in the adenoids. METHODS The study population consisted of 30 children with otitis media with effusion (OME), 22 children with chronic rhinosinusitis (CRS) and 27 children with adenoid hyperplasia. IgA, IgG, IgD and IgM concentrations in these three groups were compared immunohistochemically. We also compared the levels of expression of B lymphocyte inducer of maturation program 1 (BLIMP-1), a promoter of plasmacytosis, and B cell leukemia/lymphoma-6 (BCL-6), a repressor of plasmacytosis, in the adenoids of these children. RESULTS The expression of antibody to Ig A in the OME and CRS groups each was significantly lower than the score in the adenoid hyperplasia group. The staining scores of antibodies to IgG, IgD and Ig M did not differ significantly among the three groups. The expression of antibody to BLIMP-1 in the CRS and adenoid hyperplasia groups showed a significant difference. Staining scores of Antibody to BCL-6 did not differ significantly among the three groups. CONCLUSIONS We found that the reduction of IgA in the adenoids was associated with pediatric OME and CRS, and that reduction of expression of the transcription factor BLIMP-1 rather than BCL-6 was associated with CRS.

Evidence for increased NADPH-diaphorase-positive neurons in the central auditory system of the aged rat

Conclusions: The age-related increase in the production of nitric oxide (NO) suggests that this increase was related to neuron aging. Additional studies may provide information regarding aging-related changes in the central auditory system. Objectives: Although NO has been associated with aging, it is unclear whether specific areas of the central auditory system are involved. We therefore assayed aging-related changes in NADPH-diaphorase (NADPH-d), a selective histochemical marker for NO, in the neurons of the central auditory system and other brain regions. Materials and methods: The numbers of NADPH-d-stained neurons and the area and staining density of cell bodies were examined in aged (24 months old) and younger (4 months old) Wistar rats. Results: The number of NADPH-d-positive neurons in the inferior colliculus was significantly increased in aged rats (p<0.05), whereas the area of NADPH-d-positive neurons in all areas did not differ significantly between aged and younger rats (p>0.05). The staining densities of NADPH-d-positive neurons in the inferior colliculus, the auditory cortex, and the visual cortex were significantly greater in aged compared with younger rats (p<0.05).

Expression of GATA3, T-bet, IL-4, and IFN-γ mRNA in the effusion of OME patients

OBJECTIVE The role of allergy in the pathophysiology of otitis media with effusion (OME) remains unclear. We evaluated the role of allergy and the Th1/Th2 balance in OME patients. METHOD Middle ear fluid was collected from 46 OME patients who had a ventilating tube inserted, and expression of GATA3, T-bet, IL-4, and IFN-gamma mRNA was assessed by RT-PCR. Expression of transcription factors and cytokines was compared in patients with and without allergy. RESULTS The levels of GATA3 and T-bet mRNA in effusion fluid correlated positively with the levels of IL-4 and IFN-gamma mRNA, respectively. However, the allergy and non-allergy groups showed no significant differences in expression of any of these transcription factors and cytokines. The T-bet:GATA3 ratio was higher in the non-allergy than in the allergy group, but the difference was not statistically significant. CONCLUSION Although we observed a significant positive correlation between GATA3 and IL-4 mRNA levels, we cannot conclude that OME with allergy is related to a Th-2 driven immune response.