Sung Min Jin

A Clinical Analysis of Psychogenic Sudden Deafness

OBJECTIVE: Sudden deafness, in most cases, has no apparent cause. In some cases viral infection, vascular occlusion, or a cochlear membrane rupture may be responsible for the sudden loss of hearing. In this study, we analyzed etiology, audiologic, psychiatric, and clinical aspects of psychogenic sudden deafness through a retrospective chart review. Patients included were thought to have sudden deafness as a result of psychogenic causes and/or stresses. STUDY DESIGN AND SETTING: We reviewed the records of 277 patients who had been admitted to the Department of Otolaryngology, Kangbuk Samsung Hospital, from January 1997 to July 2003, with the initial diagnosis of idiopathic sudden hearing loss. RESULTS: In the medical history of 9 patients, there was an association between sudden onset of hearing loss and psychogenic events. There were 4 patients who had a preexisting mental health condition. A psychiatrist provided the classification of psychogenic sudden deafness for 7 patients (2.5%) who had organic causes ruled out. These patients showed discrepancy between pure tone audiometry and ABR. There were 2 males and 5 females; 4 patients were in their 10s, 1 in his 20s, and 2 in their 40s. Three patients had bilateral hearing loss and 4 had unilateral loss. The hearing test scores revealed: 4 patients with severe to profound hearing loss at 71 dB or higher, 2 patients with moderately severe hearing loss ranging from 56 to 70 dB, and 1 patient with moderate hearing loss from 41 to 56 dB. Hearing was restored in all patients, partially or completely, by treatment with steroid injections and psychotherapy. CONCLUSIONS: A total of 2.5% of sudden onset hearing loss cases in our study were a result of psychogenic causes. We observed distinctive features for audiologic measures, psychiatric findings, and clinical characteristics. The recovery rate and prognosis were better in patients who had accurate audiometry and were under the care of a psychiatrist.

Expression of cell-cycle regulators (cyclin D1, cyclin E, p27kip1, p57kip2) in papillary thyroid carcinoma

Objective: To evaluate the expression of cell-cycle regulators in papillary thyroid carcinoma in relation to lymph node metastatic features, and to determine whether immunohistochemical staining of cell-cycle markers can predict lymph node metastasis. Study Design: Cross-sectional study of prior surgical specimens. Setting: Academic tertiary referral center. Subjects and Methods: We reviewed the clinical records of patients who had undergone surgery for thyroid cancer and follicular adenoma between January 2005 and May 2008 at our clinic. Among these cases, 92 patients, comprising 28 patients with follicular adenoma, 32 with papillary thyroid carcinoma without lymph node metastasis, and 32 with papillary thyroid carcinoma with lymph node metastasis, were selected randomly. Formalin-fixed, paraffin-embedded tissues from the 92 patients were immunohistochemically stained for cyclin D1, cyclin E, p27kip1, and p57kip2, and protein expression levels were quantified and compared among the groups. Results: Tumor specimens from the papillary thyroid carcinoma group had significantly higher expression levels of cyclin D1 and cyclin E, and cytoplasmic expression of p57kip2 than the other two groups (P < 0.05). In particular, all malignant cases expressed cyclin D1, and cytoplasmic p57kip2 was expressed only in malignant cases. Furthermore, differences in the grade of cyclin D1 expression according to lymph node metastasis were statistically significant (P < 0.05). Conclusion: Our results suggest that immunohistochemistry of certain cell-cycle regulators may be helpful in the diagnosis of papillary thyroid carcinoma, and that cyclin D1 in particular may be a useful marker for evaluating lymph node metastasis.

Relationships between Lymph Node Metastasis and Expression of CD31, D2-40, and Vascular Endothelial Growth Factors A and C in Papillary Thyroid Cancer

Objectives To investigate the relationships between lymph node metastasis (LNM) and expression of CD31, D2-40 and vascular endothelial growth factors (VEGF)-A and -C in patients with papillary thyroid cancer (PTC). Methods Paraffin-embedded thyroid tissues of 72 patients were evaluated, which included 25 patients with thyroid nodular hyperplasia (TNH), 24 PTC patients without LNM, and 23 PTC patients with LNM. Three pathologists, who were blinded to the patients clinical information, assessed the immunohistochemical staining results. The amount of expression was scored as high (>25% of cells stained) or low (0-25%). Results A higher level of VEGF-A expression was observed in the PTC groups regardless of LNM when compared to the group with TNH (91.3%, 79.2%, 4.0%, respectively). VEGF-C expression in the PTC with LNM group was significantly higher than the other two groups (P<0.05). No difference in microvessel density (MVD) scores was observed using CD31 among the three groups. The lymphatic vessel density (LVD) score using D2-40 was significantly higher in patients having PTC with LNM than the other groups (P<0.05). Conclusion VEGF-C and D2-40 were more highly expressed in patients having PTC with LNM than in patients having PTC without LNM or in those having TNH. Analysis of VEGF-C level and LVD using D2-40 may be helpful in the diagnosis of PTC and the evaluation of LNM potential in patients with PTC.

Vocal fold wound healing after injection of human adipose-derived stem cells in a rabbit model

Abstract Conclusion: Injection of injured rabbit vocal folds with human adipose-derived stem cells (hADSCs) led to improved wound healing and fewer signs of scarring as demonstrated by a decreased collagen content in the treated folds compared with the untreated folds. hADSCs remained viable for up to 12 weeks in rabbit vocal folds. Objective: The aim of this study was to investigate the morphologic and histologic properties of scarred rabbit vocal folds following injection of hADSCs. Methods: This was a randomized, controlled animal study. Twenty-four vocal folds from 12 New Zealand rabbits were scarred using a CO2 laser and injected with either hADSCs (left vocal fold) or phosphate-buffered saline (right vocal fold). Every 4 weeks for the first 12 weeks after injection, an endoscopic examination was performed to assess the morphology of the vocal folds. Twelve weeks later the animals were euthanized and the tissues were stained for histology. Results: In comparison with the right vocal folds, there was significantly less granulation tissue in the hADSCs-injected left vocal folds (p < 0.05). Histological examination revealed excessive collagen deposition and perichondral fibrosis in the right vocal folds, whereas the left vocal folds exhibited better wound healing and less collagen deposition (p < 0.05). Among the 12 specimens injected with hADSCs, 4 specimens demonstrated viable hADSCs under immunofluorescent cytochemistry.

Anatomical variations of the spinal accessory nerve and its relevance to level IIb lymph nodes

Objective: This study was conducted to identify anatomical variations of the spinal accessory nerve (SAN) in the upper neck, the landmark of the anterior and inferior border of level IIb, and to evaluate the nerves effect on the border and the number of lymph nodes (LNs) in level IIb. Study Design and Setting: Case series with planned data collection. Subjects and Methods: A total of 181 neck dissections (NDs) were prospectively enrolled in this study. The relation between the SAN and adjacent structures (internal jugular vein [IJV], sternocleidomastoid muscle [SCM], cervical plexus) and the number of LNs in level IIb was investigated. Results: The SAN crossed the IJV ventrally in 72 cases (39.8%) and dorsally in 104 cases (57.4%), and passed through the IJV in five cases (2.8%). The SAN ran along the inner surface of the SCM and sent branches to the SCM without penetration of the muscle in 83 cases (45.9%), whereas in 98 cases (54.1%) the nerve sent branches to the SCM by penetration. Cervical plexus contribution to the SAN was seen from C2 in 96 cases (53.1%), C2 and C3 in 69 cases (38.1%), and C3 in 16 cases (8.8%). The mean number of LNs of level IIa and level IIb was 6.5 and 8.2 in cases in which the SAN crossed the IJV ventrally, and 6.8 and 5.4 in dorsally crossing cases. LNs included in the neck level IIb in ventrally crossing SAN cases were significantly larger than the dorsally crossing cases (P < 0.05). Conclusions: Our results may help to minimize the incidence of injuring the SAN in the upper neck during ND. Neck level IIb would contain more LNs if the course of the nerve leans toward the ventral side.

Favorable Vocal Fold Wound Healing Induced by Platelet-Rich Plasma Injection

Objectives To introduce a new injection material for vocal fold diseases, which could be readily translated to clinical practice, we investigated the effectiveness of platelet-rich plasma (PRP) injection on the injured vocal fold in terms of histological recovery. Methods Blood samples were drawn from New Zealand White rabbits and PRP was isolated through centrifugation and separation of the samples. Using a CO2 laser, we made a linear wound in the 24 vocal fold sides of 12 rabbits and injected each wound with PRP on one vocal fold side and normal saline (NS) on the other. Morphologic analyses were conducted at 2, 4, and 12 weeks after injection, and inflammatory response, collagen deposit, and changes in growth factors were assessed using H&E and masson trichrome (MT) staining and western blot assay. Results PRP was prepared in approximately 40 minutes. The mean platelet concentration was 1,315,000 platelets/mm3. In morphological analyses, decreased granulation was observed in the PRP-injected vocal folds (P<0.05). However, the irregular surface and atrophic change were not difference. Histological findings revealed significant inflammation and collagen deposition in NS-injected vocal folds, whereas the PRP-injected vocal folds exhibited less (P<0.05). However, the inflammatory reaction and fibrosis were not difference. In western blot assay, increased amounts of growth factors were observed in PRP-injected vocal folds. Conclusion Injection of injured rabbit vocal folds with PRP led to improved wound healing and fewer signs of scarring as demonstrated by decreased inflammation and collagen deposition. The increased vocal fold regeneration may be due to the growth factors associated with PRP.

Plasma Gel as a New Augmentation Material for Injection Laryngoplasty in Rabbit Model Histologic Analysis

Objectives Currently, a variety of materials are available for the treatment of glottal insufficiency. Ideal injection materials should be inexpensive, easily obtainable, nontoxic, and biocompatible. Plasma gel has recently been developed as an injectable, autologous material used in plastic surgery. The aim of this study was to evaluate the histological changes in rabbit vocal folds (VFs) after an injection of plasma gel, compared with collagen (Artecoll) or hyaluronic acid (Reviderm Intra). Study Design Experimental prospective animal study. Setting Animal laboratory. Subjects and Methods Blood samples were collected from 12 New Zealand rabbits. Plasma collected from each rabbit was centrifuged and processed using a gel heating system. All rabbits received a 0.05 ml injection of plasma gel into the right VF, while an equivalent volume of Artecoll or Reviderm Intra was injected into the left VFs of each 6 rabbits randomly. The larynges were collected 2, 4, and 8 weeks after injection, and the tissues were stained for histological analysis. Results In comparison with left VFs injected with Artecoll or Reviderm Intra, there was significantly less inflammatory response and foreign body reaction in the plasma gel injected right VFs (P < .05). Multinucleated foreign body type giant cells were also more prevalent in the left VFs. There were no quantitative differences in the rates of neovascularization or collagen deposition between groups. Conclusion Plasma gel is a biologically compatible material that may serve as a suitable augmentation material in injection laryngoplasty. Further studies that examine the long-term effects in a larger number of subjects are needed.

Investigation into psychological correlates of patients with vocal nodules using the Symptom Checklist-90-Revision.

OBJECTIVE The purpose of this study was to analyze the psychological characteristics of patients with vocal nodules and to establish the relationship between these characteristics and the development of vocal nodules. SETTING A tertiary medical centre. DESIGN AND METHOD The patient group consisted of 41 housewives with vocal nodules, and the control group consisted of 35 housewives who did not have any vocal pathology. The subjects completed questionnaires related to the voice disorder and the Symptom Checklist-90-Revision. OUTCOME MEASURES The scores of the patient group with less than 1 year of symptom duration (acute) and more than 1 year of symptom duration (chronic) were also compared with those of the controls. RESULTS AND CONCLUSION The total patient group differed statistically from the control group on seven neurotic dimensions (p < .001) and one psychotic dimension (p < .05). The acute group differed on two neurotic dimensions (p < .05). We suggest that the neurotic traits found in the acute group may play a role in the development of vocal nodules. The dimensions in which the total patient group differed significantly from the control group may indicate the changes that occur in the psychological characteristics following voice change. The collective results indicate that psychological characteristics play an important role in the pathogenesis of vocal nodules. Hence, greater attention should be given to the psychological and emotional aspects of patients for the treatment and prevention of vocal nodules.