Se-Joon Oh

Calcium hydroxylapatite injection for the patulous Eustachian tube

The function of the E-tube is to adjust the balance of both sides of the ear drum. The patulous Eustachian tube (PET) is a rare disease and a benign condition. So, most of the doctors ignored this disease. But, patients with PET suffer from ear fullness, autophony, hearing their own breathing, and etc. Many treatment methods have been introduced and injection is also one way of treating the disease. We introduce an injection technique for the treatment of PET using calcium hydroxylapatitie (Radiesse®).

Trans-tympanic catheter insertion for treatment of patulous eustachian tube.

OBJECTIVES To evaluate the safety and therapeutic efficacy of trans-tympanic catheter insertion (TCI) in patients with refractory patulous eustachian tube (PET). METHODS TCI was attempted in thirty-six ears of twenty-nine patients with chronic PET refractory to conservative treatment. The catheter was inserted under local anesthesia in an operating room through the bony orifice of the eustachian tube (ET) to occlude the isthmus of the tube via a myringotomy site on the tympanic membrane. Patients were evaluated postoperatively by nasal endoscopy and by interview to document symptoms. Successful treatment was defined as complete relief or significant improvement plus satisfaction with treatment. Patients had no concurrent disease and did not undergo any additional surgical procedure. RESULTS TCI was performed in all except one ear, in which it failed because of an abnormally narrow tympanic ET orifice. Follow-up durations ranged from 6 to 37 months, with an average of 19.3 months. Successful treatment of subjective autophony was achieved in twenty-nine (82.4%) of the thirty-five ears. Ventilation tube (VT) placement was performed in the two ears because of otitis media with effusion (OME) after TCI. In one ear, the inserted catheter was finally removed due to additional unilateral mastoiditis after VT extrusion. CONCLUSION TCI seems to be a minimally invasive and was used successfully to treat PET. The procedure had a good overall success rate and complications were rare in the long-term.

The reversed internal magnet of cochlear implant after magnetic resonance imaging

Cochlear implants (CI) have now become a standard method of treating severe to profound hearing loss. Recently, the number of patients with CI has been rapidly increasing as the big benefits of CI become more widely known. Magnetic resonance imaging (MRI) has also become a routine diagnostic imaging modality, used in the diagnosis of common conditions, including stroke, back pain, and headache. We report our recent experience with a case in which internal magnet of the cochlear implant was reversed after 1.5-T lumbar spine MRI. This complication is managed successfully by reversing the orientation of the external magnet in the head coil.

Endoscopic autologous cartilage injection for the patulous eustachian tube

Patulous eustachian tube (PET) can have a significant negative impact on a patients quality of life. Several methods of surgical management can be an option to treat PET, and our objective is to evaluate the safety and efficacy of autologous cartilage injection in patients with PET. Thirty-three ears of twenty-five patients with chronic PET refractory to conservative treatment were enrolled to this study. Autologous tragal cartilage was harvested, and chopped into fine pieces to allow its injection using a 1 cc Bruening syringe. Endoscopic cartilage injection was performed submucosally into the anterior (0.5 mL) and posterior aspects (0.5 mL) of the nasopharyngeal ET under local anesthesia in an operating room. Patients were evaluated postoperatively by nasal endoscopy and by interview to document symptoms. Successful treatment was defined as complete relief or significant improvement plus satisfaction with treatment. The only complication that occurred was temporary otitis media with effusion in one ear. Inferior turbinate reduction was performed in three ears with accompanying nasal septal deviation or turbinate hypertrophy to allow better nasopharyngeal ET visualization. After autologous cartilage injection, the successful treatment rate, as determined by subjective autophony symptoms, was 69.7% (23/33). The average follow-up period was 25.2 months. Autologous cartilage injection is a minimally invasive technique that has been used by the authors to successfully treat patulous eustachian tube. The described procedure was found to provide a good overall success rate without long-term complications.

Auricular Cartilage Regeneration with Adipose-Derived Stem Cells in Rabbits

Tissue engineering cell-based therapy using induced pluripotent stem cells and adipose-derived stem cells (ASCs) may be promising tools for therapeutic applications in tissue engineering because of their abundance, relatively easy harvesting, and high proliferation potential. The purpose of this study was to investigate whether ASCs can promote the auricular cartilage regeneration in the rabbit. In order to assess their differentiation ability, ASCs were injected into the midportion of a surgically created auricular cartilage defect in the rabbit. Control group was injected with normal saline. After 1 month, the resected auricles were examined histopathologically and immunohistochemically. The expression of collagen type II and transforming growth factor-β1 (TGF-β1) were analyzed by quantitative polymerase chain reaction. Histopathology showed islands of new cartilage formation at the site of the surgically induced defect in the ASC group. Furthermore, Massons trichrome staining and immunohistochemistry for S-100 showed numerous positive chondroblasts. The expression of collagen type II and TGF-β1 were significantly higher in the ASCs than in the control group. In conclusion, ASCs have regenerative effects on the auricular cartilage defect of the rabbit. These effects would be expected to contribute significantly to the regeneration of damaged cartilage tissue in vivo.

Comparison of extrusion and patency of silicon versus thermoplastic elastomer tympanostomy tubes

OBJECTIVES This study aimed to assess the differences in the extrusion rate, patency and incidence of otorrhea according to the material properties of tubes in tympanostomy tube (TT) procedures. SUBJECTS AND METHODS A total of 75 children with bilateral chronic otitis media with effusion were randomized in this prospective trial to receive 1.02-mm-sized TTs (thermoplastic elastomer) in one ear and 1.14-mm-sized TTs (silicone) in the other ear. Data were obtained on ventilation tube type, time to extrusion, comorbidities, tube plugging, incidence of TT otorrhea during following up, and age of the patient. Postoperatively, follow-up by an otologist continued every two months to assess the incidence of otorrhea, plugging, and TT extrusion until all tubes were extruded. RESULTS Out of the 75 children, 7 patients were excluded during surgery and 4 were lost during follow-up. The mean extrusion time of 1.02-mm-sized TTs (thermoplastic elastomer) was 10.28 months, whereas that of 1.14-mm-sized TTs (silicone) was 7.36 months, which showed a significant difference. However, thermoplastic elastomer TTs had more plugging events than silicone TTs. CONCLUSIONS There was a significant increase in the time to extrusion in ears with the 1.02-mm-sized thermoplastic elastomer TT, although, generally, the larger inner diameter of the tube last longer in the eardrum. This contrasting result is thought to be due to the different material properties of both TTs. This information may be helpful for TT selection in clinical practice depending on the patients condition.

Prevalence and incidence of clinically significant patulous Eustachian tube: A population-based study using the Korean National Health Insurance Claims Database

OBJECTIVES The aim of this study is to estimate the entire population-based prevalence and incidence of Patulous Eustachian tube (PET) using the Korean National Health Insurance (NHI) claims database. The annual trends of prevalence and incidence of PET were also investigated. METHODS Retrospective analysis of PET patients was performed between 2010 and 2016, from the NHI claims database. PET patients were defined as those who had at least one service claim with a primary diagnosis under an ICD-10-based PET code (H69.0). RESULTS During the study period, there were 20,533 new PET patients in Korea. In 2016 there were 4482 incident cases, and the standardized annual incidence rate was 8.8 per 100,000 persons. The standardized annual prevalence rate increased significantly from 7.2 per 100,000 persons in 2010 to 10.3 per 100,000 persons in 2016. The prevalence increased significantly on annual basis, whereas the incidence rate fluctuated over time. Interestingly, the incidence and prevalence of PET in women was almost twice as high as that in men, and peaked in their 20s. CONCLUSIONS This study demonstrated the substantial annual increase of the NHI claims with PET code (H69.0) in Korea from 2010 to 2016. Statistical results based on the NHI claims, we confirmed the high prevalence and incidence rates of clinically significant PET in women than in men. This study only covered patient using the medical service for PET and missed PET sufferers not seeking medical service. However, this study can provide basic epidemiological information on clinically significant PET.

Extratympanic imaging of middle and inner ear structures of mouse and rat using optical coherence tomography

Background and Objective: Noninvasive middle and inner ear imaging using optical coherence tomography (OCT) presents some unique challenges for real-time, clinical use in animals and humans. The goal of this study was to investigate whether OCT provides information about the middle and inner ear microstructures by examining extratympanic structures. Materials and Methods: Five mice and rats were included in the experiment, and the swept-source OCT system was tested to identify the middle and inner ear microstructures and to measure the length or thickness of various structures. Results: It was possible to see middle ear structures through the tympanic membrane with the OCT instrument located extratympanically in both rats and mice. We could also obtain the inner ear images through the otic capsule in the mice, but the bulla needed to be removed to visualize the inner ear structures in the rats. The whole apical, middle and basals of the cochlea and the thickness of the otic capsule covering the cochlea could be visualized simultaneously. Conclusions: OCT is a promising technology to assess middle ear and inner ear microanatomy noninvasively in both mice and rats. OCT imaging could provide additional diagnostic information about the diseases of the middle and inner ear.

In Vivo Study of Mastoid Obliteration Using Hydroxyapatite-Chitosan Patch

Many artificial materials have been used for mastoid cavity obliteration in canal wall down tympanomastoidectomy. Among the artificial materials, hydroxyapatite is most popular material for mastoid cavity obliteration. Hydroxyapatite is biostable and osteoconductive, but it has poor mechanical properties, especially brittleness. To overcome the limitation, hydroxyapatite has been combined with natural chitosan polymer, which is biocompatible and flexible, to produce a hydroxyapatite-chitosan patch via a sublimation-assisted compression process. We evaluated this hydroxyapatite-chitosan patch for tympanic cavity obliteration in a rat model by comparing it with sham surgery group, bone cement and homologous cartilage. The cavity obliteration ratio and new bone formation in tympanic bullae were determined by computed tomography, histological analysis, field emission scanning electron microscopy, and energy-dispersive X-ray spectroscopy. Comparing the hydroxyapatite-chitosan patch with homologous cartilage and bone cement, the tympanic cavity obliteration ratio was superior in the patch group (40.96 ± 7.79%) than other groups (32.23 ± 6.93% and 16.07 ± 6.10%). Even the hydroxyapatite-chitosan patch made no difference in new bone formation ratio ranging from 27.92 ± 11.08 to 29.17 ± 10.96% with other groups. In conclusion, hydroxyapatite-chitosan patch for mastoid cavity obliteration showed easy handling, flexibility, favorable osteogenesis and biostability.

Multiple Dural Arteriovenous Fistulas Presenting as Pulsatile Tinnitus Treated with External Manual Compression

Dural arteriovenous fistula (DAVF) have been treated by transarterial or transvenous embolization, surgery, and radiosurgery. Besides these treatment options, the external compression technique is a non-invasive, low-cost form of treatment. This article reports that a 60-year-old man with DAVF between multiple arterial branches and transverse/sigmoid sinus was treated by repeated external manual compression method.