Soo-Keun Kong

Autologous cartilage injection for the patulous eustachian tube

The eustachian tube (ET) is normally closed, but it opens temporarily during swallowing. Patients with a patulous ET (PET) have various aural symptoms such as aural fullness, autophony, and hearing their own breathing. These symptoms are caused by abnormal transmission of sound from the pharynx to the middle ear via an open ET with little attenuation. We introduce a novel injection technique for the treatment of PET using autologous cartilage. This procedure is minimally invasive and has been successfully used to treat PET in 2 patients.

Acute otitis media–induced petrous apicitis presenting as the Gradenigo syndrome: successfully treated by ventilation tube insertion

Petrous apicitis has traditionally been treated with aggressive surgical methods. However, recent reports describe good results with more conservative medical treatment and minimal surgical intervention. We report a case of petrous apicitis presenting as the Gradenigo syndrome treated by ventilation tube insertion. We recommend aggressive surgical intervention for patients who failed to respond to conservative therapy including ventilation tube insertion.

Radiologic analysis of high jugular bulb by computed tomography.

Introduction Many previous studies of high jugular bulb (HJB) have limitations, such as focusing simply on the incidence or having a relatively small number of subjects. The objective of this article was to investigate the overall incidence of HJB and bony dehiscence in HJB on a large scale using high-resolution temporal bone computed tomography. The other purpose was to measure the horizontal distance from the tympanic annulus and the height above the annulus. The next step was to classify HJBs according to relative levels compared with surrounding structures. Materials and Methods Temporal bone computed tomographic images from January 2005 to April 2010 at Pusan National University Hospital, a tertiary care center, were reviewed retrospectively. Exclusion criteria were patients younger than 10 years, a previously operated ear, cholesteatoma with bony destruction, adhesive otitis media with unclear position of tympanic membrane, and congenital anomalies of the ear. We investigated the incidence of HJB, the bony dehiscence of the HJB, horizontal distance, vertical height of HJB, and classified HJB in relation to neighboring structures. We used the cochlear basal turn and the lateral semicircular canal as criteria for classification because they were readily seen in most cases: group A, above the inferior bony annulus of the tympanic membrane and below the cochlear basal turn; group B, above the cochlear basal turn and below the lateral semicircular canal; and group C, above the lateral semicircular canal. Results Total 2,299 cases (4,598 ears) were finally examined. The study group consisted of 1025 male and 1,274 female patients, aged 11 to 90 years (mean, 48.0 yr). Of the 2,299 patients, 298 (13.0%) had HJB. HJB was observed in 435 (9.5%) of 4598 ears. HJB was more prominent on the right (right:left = 1.88:1; p < 0.01). Of the 435 HJB cases, 121 (27.8%) had bony dehiscence. HJB with bony dehiscence also was more prominent on the right (right:left = 2.03:1; p < 0.01). The average horizontal distance between HJB and the inferior bony annulus of the tympanic membrane was 2.2 ± 1.8 mm. HJB in contact with the tympanic membrane was seen in 47 ears (47/435, 10.8%). The average vertical height between the HJB and the inferior bony annulus of the tympanic membrane was 59.1 ± 27.4 mm. In the classification, group B was most common (62.1%). Conclusion A meaningful proportion of HJB ears had bony dehiscence contact with the tympanic membrane. In planning ear surgery and other interventions, physicians should keep in mind the possibility of HJB and its bony dehiscence, which can lead to inadvertent injuries.

Histologic changes in the auditory tube mucosa of rats after long-term exposure to cigarette smoke

PURPOSE The aim of the study was to investigate the effect of cigarette smoke on the auditory tube and middle ear mucosa after long-term exposure (4 and 6 months). MATERIALS AND METHODS Fifteen rats were divided into 3 groups. The experimental groups were exposed to cigarette in a smoking chamber for 4 and 6 months (n = 5 each). A control group (n = 5) was placed in the same chamber without exposure to cigarette smoke. Histologic changes of the auditory tube mucosa were observed through light and electron microscopes. Histologic changes of the middle ear mucosa were also observed through light microscopes. RESULTS The histologic changes consisted of a proliferation of goblet cells and an increase of mucus secretion in auditory tube. Squamous metaplasia was paradoxically decreased according to the duration of exposure in auditory tube. The number of goblet cell was gradually increased according to the duration of exposure in the auditory tube and middle ear. CONCLUSIONS Long-term passive smoke directly affects the auditory tube and middle ear mucosa. Histologic changes of auditory tube mucosa consisted of goblet cell proliferation and excessive mucus secretion.

Management of high jugular bulb with tinnitus: transvenous stent-assisted coil embolization.

A 33-year-old woman presented with a right-sided pulsatile tinnitus correlated with her heartbeat and mild right ear hearing disturbance. At the initial physical examination, a dark-purple, pulsating mass from the right tympanic cavity was observed through the inferoposterior portion of the right tympanic membrane. The tympanic membrane was adherent to the promontory and pulsating mass. The tinnitus was eliminated by digital compression of the right jugular vein. A high-resolution computed tomography of the temporal bone revealed a large high jugular bulb with bony dehiscence in the right middle ear. The transfemoral cerebral angiogram showed hypoplasia of the left transverse sinus. The left venous sinus, therefore, was mainly drained into the occipital sinus and then connected to the right sigmoid sinus (88), just distal to the high jugular bulb (Fig I). Considering the dominance of the right venous sinus, we performed a transvenous stent-assisted coil embolization to avoid the risk of increasing intracranial pressure (IICP). A 7-French shuttle sheath Shuttle (Cook Incorporated, Bloomington, IN) was positioned in the right proximal SS via the right femoral vein for easy navigation of the stent delivery system. A 5-French catheter was placed into the right internal carotid artery (ICA) after left femoral puncture allowed the visualization of the high jugular bulb, construction of a roadmap and angiographic monitoring of the procedure. The patient was given intravenous heparin to maintain an activated clotting time between 200 and 300 seconds. A self-expandable stent (Precise RX, Cordis Corporation, Miami Lakes, FL) was placed into the SS over a O.035-in stiff wire (Radiofocus Guide Wire, Terumo Corporation, Tokyo, Japan) that was positioned in the superior sagittal sinus. To cover the neck portion of the high jugular bulb, the stent was placed from the SS to the internal jugular vein (IJV). The microcatheter (Echelon, ev3, Irvine, CA) was then carefully introduced and advanced to the dilated portion of the bulb through the stent mesh. The embolization was performed with electrically detachable polymercoated (Nexus, ev3) and fibered (NXT, ev3) coils. The tinnitus resolved immediately after the embolization. The

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.

Analysis of hepatitis B virus in the cerumen and otorrhea of chronic HBV-infected patients: is there a hepatitis B virus infectivity?

The object of this study was to find out whether cerumen and otorrhea have any infectivity in the transmission of hepatitis B virus (HBV). Background: The HBV infection is a worldwide health problem. It can be transmitted by infected blood or other body fluids through percutaneous or permucosal exposure. Recently, there have been some reports where cerumen can be a potential source of HBV transmission. Methods: This study was performed on 30 chronic hepatitis B patients who tested positive in hepatitis B surface antigen (HBs Ag). Thirty cerumen and 5 otorrhea samples were analyzed. The cerumen and the serum were examined for (HBs Ag) and hepatitis B e antigen (HBe Ag) by using enzyme immunoassay systems. As for HBV DNA detection, quantitative polymerase chain reaction was performed on the serum, cerumen, and otorrhea. Results: Hepatitis B virus DNA was detected in the 20 samples of cerumen (66.7%) and all 5 otorrhea (100%) from 30 patients. The mean values of HBV DNA in cerumen and otorrhea were significantly lower than serum. Hepatitis B virus DNA and HBs Ag were detected with significantly higher rates in the cerumen of patients who are serum HBe Ag positive than negative. However, positive HBe Ag, which implies that it is associated with the increased risk of disease progression and infectivity, was not detected in any of cerumen samples. Conclusion: The cerumen and otorrhea of chronic hepatitis B patients have a low risk of infectivity.

Epithelial-myoepithelial carcinoma in the external auditory canal

Epithelial-myoepithelial carcinoma (EMC) is a rare glandular epithelial neoplasm of the salivary gland with an incidence of less than 1 percent of all salivary gland tumors. EMC originates primarily in the parotid gland, but isolated cases have been described from the maxillary sinus, nasal cavity, trachea, larynx, and lacrimal gland. EMC originating from the external auditory canal is extremely rare. This report describes the case of an EMC originating from a minor salivary gland of the external auditory canal. A 70-year-old man who had complained of left-sided otalgia for 3 months was referred to our clinic. There was no notable past otological history. Examination revealed a bulging mass at the postero-superior wall of the left external auditory canal. The mass extended to the bony portion of the external auditory canal. However, the skin over the mass in the external auditory canal was intact. The upper half of the left tympanic membrane was invisible because of the mass, but the lower half of left tympanic membrane was intact. The right ear was normal. No masses were palpated in the head or neck. Pure tone audiometry showed moderate sensorineural hearing loss on both sides. Physical examinations of the cranial nerve were normal. CT scans demonstrated a soft tissue mass in the postero-superior wall of the left external auditory canal, and the mass had some calcified foci. The invasion of the bony auditory canal could not be confirmed (Fig 1). The mastoid cavity had a well-established pneumatic pattern. The middle and inner ears appeared normal. An excisional biopsy was performed via the endaural approach. The mass was a well-encapsulated mass and extended to a portion of the bony auditory canal. The mass was removed en bloc uneventfully and measured 10 7 5 mm. Histopathological examination disclosed an EMC. Tumor nests at the surgical margin were present. The tumor was characterized by a double-cell lining of inner epithelial and outer myoepithelial cells. Immunohistochemical studies showed that the inner luminal cells expressed cytokeratin, whereas the outer cells stained positively for S-100 protein and -smooth muscle actin (Fig 2). The patient had a lateral temporal bone resection under general anesthesia. The tu-