PURPOSE: The purpose of this study was to evaluate the high-resolution CT features of Swyer-James syndrome with special attention to the airway lesions and to determine the clinical utility of high-resolution CT compared with that of chest radiography. MATERIALS AND METHODS: In seven patients with Swyer-James syndrome, we retrospectively reviewed chest radiographs obtained during inspiration and expiration and high-resolution CT scans obtained in inspiration. The high-resolution CT appearance was evaluated and compared with that of chest radiography. RESULTS: On both chest radiographs and high-resolution CT, the affected lung volume was relatively diminished in four patients and normal in three patients. In all seven patients, chest readiographs showed hyperlucency of the lung which was unilateral in four and bilateral in three patients. Unilateral small hilum was seen in six patients and bronchiectasis was demonstrated in one patient on chest radiographs. The hyperlucent lung volume was not diminished on expiratory radiographs in all seven patients. In all patients, high-resolution CT demonstrated low attenuation regions of the lung either bilaterally(n=5) or unilaterally(n=2). Pulmonary vessels were markedly decreased in size and number in the lung parenchyma with low attenuation. Six patients had bronchiectasis on high-resolution CT, which were cylindrical or varicose in five and cystic in one. Bronchiolectasis was observed in three patients on high-resolution CT. CONCLUSION: The high-resolution CT findings are characteristic of Swyer-James syndrome. High-resolution CT is more sensitive than chest radiography in detecting regions of low attenuation and bronchiectasis and may be useful for the diagnosis of Swyer-James syndrome. Our results suggest that bronchiectasis is a frequently associated airway lesion of Swyer-James syndrome and bronchiolectasis may be associated in some cases.
Bronchiectasis ; Diagnosis ; Humans ; Lung ; Lung, Hyperlucent* ; Radiography ; Radiography, Thoracic ; Retrospective Studies ; Thorax ; Tomography, X-Ray Computed

BACKGROUND AND OBJECTIVES: The long-term effect of tinnitus retraining therapy (TRT) is excellent while its short-term effect is known to be inferior to tinnitus making (TM). In this regard, we mixed TRT (mTRT) by combining TRT and TM to improve the short-term effect of TRT. This study evaluated the short-term effect of the mTRT and also compared the clinical efficacy between mTRT and TM. SUBJECTS AND METHOD: Twenty patients who underwent mTRT due to chronic subjective tinnitus were included in this study. Sound therapy of the mTRT was performed with mixed noise of broadband noise and narrow band noise. The broadband noise was used for TRT and the narrow band noise was used for TM. During the first month of mTRT, sound therapy was mainly composed of narrow band noise. During the second month, the proportion of broadband noise was gradually increased to 2/3. After 3 months, only the broadband noise was applied. Tinnitus Handicap Inventory (THI), Visual Analog Scale (VAS) on annoyance and the tinnitus awareness duration (hr/day) was checked as the outcome measures. The outcome was also compared between mTRT and TM. RESULTS: The THI score decreased significantly from 41.8+/-24.3 to 27.3+/-25.6 after mTRT. The VAS (from 5.9+/-1.4 to 4.7+/-1.8) and the tinnitus awareness duration (from 18.5+/-8.2 to 12.6+/-10.7) also showed a significant improvement after treatment. When the treatment outcome was compared between mTRT and TM, there was no significant difference. CONCLUSION: mTRT seems to be effective in relieving the discomfort of tinnitus. Similar short-term outcomes can be expected from mTRT as they did in TM.
Humans ; Noise ; Outcome Assessment (Health Care) ; Tinnitus ; Treatment Outcome

Bites and Stings ; Bone Screws ; Humans ; Lip ; Mandible ; Mastication ; Orthodontics ; Osteogenesis, Distraction ; Osteotomy ; Tooth ; Tooth Mobility ; Walking

Herpes zoster oticus usually accompanies vestibulopathy on the ipsilateral ear. However we have encountered two herpes zoster oticus patients with bilateral vestibulopathies. Bilateral vestibulopathy was detected on the 2nd month and 19th day of herpes zoster oticus, respectively. While the contralateral vestibulopathy was detected 2 month after the ipsilateral vestibulopathy in the first patient, the vestibular function deteriorated simultaneously on the 19th day in the second patient. It seems that the bilateral vestibulopathy was caused by an autoimmune process in both cases, but the initiating event is different. The ipsilateral vestibular damage may have sensitized the immune system in the first patient resulting in sympathetic vestibulopathy. But in the second patient, the ipsilateral cochlear damage may have sensitized the immune system resulting in simultaneous bilateral vestibulopathy.
Ear ; Herpes Zoster ; Herpes Zoster Oticus ; Humans ; Immune System

BACKGROUND AND OBJECTIVES: Diagnosis and treatment of dizziness after motor vehicle accident (MVA) is not challenging. Psychological factors may be important and patient's quality of life can be underestimated due to nonspecific vague symptoms. The aim of this study is to reveal the clinical characteristics of dizziness after motor vehicle accident. SUBJECTS AND METHOD: Of the patients who have visited Dankook University hospital for traumatic dizziness from Jan. 1994 through Jan. 2008, we enrolled 51 patients who had history of motor vehicle accident and performed vestibular function test (VFT). Patients were divided into groups according to VFT findings. Patients who had unilateral hypo-function in VFT were classified as Group A. Patients who showed typical nystagmus for benign paroxismal positional vertigo (BPPV) were classified as Group B. And the others were classified as Group C who showed fair VFT results. RESULTS: Group C was found with unidentified dizziness, a tendency of late onset and long term recovery. Also they complained different distributions of their symptoms, that is, the rate of patients with headache and visual symptoms were higher in Group C. CONCLUSION: There were no remarkable characteristics in unidentified dizziness after MVA. Although the objective test results were non-specific, their clinical progress was not favorable. They complained of headache and visual symptoms more than other groups.
Dizziness ; Headache ; Humans ; Motor Vehicles ; Quality of Life ; Vertigo ; Vestibular Function Tests

BACKGROUND AND OBJECTIVES: Although the adverse effect of long term steroid usage is well known, the adverse effect of short term high dose steroid usage has not been studied thoroughly. The purpose of this study was to identify the characteristics of the adverse effects when using a high dose steroid for a short term. We also compared the adverse effect of steroid between in- and out-patients. SUBJECTS AND METHODS: The medical record of 500 patients, who were treated with methylprednisolone 48 mg/day for 1-2 weeks, was retrospectively reviewed. Steroid was prescribed due to SSNHL, Bell's palsy, Ramsay-Hunt syndrome and herpes zoster oticus. The incidence of each adverse effect was analyzed, and also the time point of detection was analyzed. The 500 patients were composed of 250 in-patients and 250 out-patients. The adverse effect was compared between these two groups, as well. RESULTS: Adverse effect of steroid was found in 33.0% of the patients. Among these adverse effects, abdominal discomfort (26.8%) was most common, followed by skin rash (14.7%), swelling (13.4%), and hot flush (6.9%). Abdominal discomfort and hot flush was mostly detected on the first week. Meanwhile, the skin rash was usually detected on the third week. The incidence of adverse effect was significantly higher in the out-patient group. CONCLUSIONS: The incidence of high dose short term steroid treatment may be very high. The patients should be warned about these adverse effects. Monitoring should be performed until 3-4 week, since some adverse effects may not be detected until this time point.
Bell Palsy ; Exanthema ; Herpes Zoster Oticus ; Humans ; Incidence ; Medical Records ; Methylprednisolone ; Outpatients ; Retrospective Studies

BACKGROUND AND OBJECTIVES: According to previous reports, patients with vestibular migraine (VM) display variable results from vestibular function tests (VFT): central, peripheral, or normal. The aim of this study was to classify the VM patients into the three groups according to interictal VFT findings (central, peripheral or normal) and to clarify the relationship between VFT results and the clinical manifestations and prognosis in each group. SUBJECTS AND METHODS: We reviewed the medical records of 81 patients diagnosed as VM using the criteria of Neuhauser, et al. between December 2004 and June 2009. Patients were divided into three groups according to the results of VFT. We compared the clinical manifestations and prognosis between groups. Characteristics including dizziness, the nature of headache, associated otologic symptoms, hearing threshold, duration of illness, and recovery time were analyzed. RESULTS: The number of patients with central, peripheral vestibular dysfunction and normal finding in VFT were 15, 28, and 38 respectively. There were no significant differences in the nature of headache, associated otologic symptoms, hearing threshold, duration of illness, and recovery time. A small difference was observed in the mean age and characteristics of dizziness, but these were not significant. CONCLUSIONS: In patients with VM, classification according to the type of vestibular dysfunction was not helpful in the prediction of prognosis and clinical manifestations.
Dizziness ; Headache ; Hearing ; Humans ; Medical Records ; Migraine Disorders ; Prognosis ; Vertigo ; Vestibular Function Tests

OBJECTIVES: The purpose of this study was to evaluate the therapeutic effect of three different types of sounds on tinnitus patients undergoing tinnitus retraining therapy (TRT). METHODS: This is a single-institution retrospective study, performed in one tertiary otological referral center. Thirty-eight adults with subjective idiopathic tinnitus who were followed for at least 9 weeks were enrolled. Sound therapy was delivered in 3 different ways: narrowband noise TRT (nTRT); mixed band noise TRT (mTRT); broadband noise TRT (bTRT). Treatment response was measured through validated psychometric questionnaires: Tinnitus Handicap Inventory (THI), visual analog scale (VAS) on annoyance, and numerical description of hours of tinnitus perception (awareness hours). RESULTS: A total of 38 patients were followed for at least 9 weeks. In nTRT group, all outcome measures including THI, VAS, and the awareness hours, decreased over 9 weeks with no statistical significance. In mTRT group, all outcome measures except for awareness hours significantly improved 9 weeks after the beginning of the treatment. In bTRT group, all outcome measures decreased significantly in 9 weeks. When therapeutic success is defined as improvement in THI 7 or more, bTRT group (77.8%) showed a higher success rate than other groups for 38 patients with the minimum follow-up of 9 weeks. CONCLUSION: All three sounds can provide relief in patients with annoying tinnitus after TRT. However, there is difference in the therapeutic effect according to sound types. Broadband sound seems to be better than narrowband sound or mixed sound in relieving the patients from tinnitus. Therefore, sound therapy with broadband noise may be more appropriate during TRT, but further evidence is needed for precise conclusion.
Adult ; Follow-Up Studies ; Humans ; Noise ; Outcome Assessment (Health Care) ; Psychometrics ; Referral and Consultation ; Retrospective Studies ; Tinnitus* ; Treatment Outcome* ; Visual Analog Scale ; Surveys and Questionnaires

PURPOSE: Contrast-enhanced 3-D ultrafast MR angiography is a widely accepted MR imaging technique for theevaluation of the carotid artery, aorta, renal artery, mesenteric artery and portal venous system. To esti-mateitsclinical usefulness, single -and double- dose contrast-enhanced 3-D ultrafast pulmonary MR angiography wasassessed after a timing examination was performed. MATERIALS AND METHODS: Twenty volunteers underwentgadolinium-enhanced ultrafast pulmonary MR angiog-raphy( 3-D FISP, TR[msec]/TE[msec]=5.0/2.0, with 25 degrees flipangle). In ten volunteers(single-dose injection group) pulmonary MR angiography was performed after theadminstration of 0.1 mmol/kg(single dose injec-tion group), while the other ten(double-dose injection group) eachreceived, prior to angiography, 0.2 m m o l / kg. In all cases, a timing examination was performed during axialturbo-FLASH imaging(TR/TE/TI=8.5/4.0/100, 1 0 degree flip angle) after injection of the same dose as that used forsubsequent contrast-enhanced pulmonary MR angiography. In both groups, overall image quality, pulmonary arteryvisibility and contrast-to-noise ratio of the pulmonary artery were assessed on the basis of images obtained.RESULTS: With regard to overall image quality, there was no significant statistical difference between the twogroups (P>0.05), and in both, depiction of the central and lobar pulmonary artery was excellent. As regardsdepiction of the segmental artery, the average grading of the single dose injection group was 2.83 +/- 0.32, that ofthe double dose injection group was 2.85 +/-0.3, with no statistical significance(P>0.05). With respect tocon-trast-to-noise ratio of the central, lobar, and segmental arteries, the best results were obtained by thedouble dose injection group(P<0.05). CONCLUSION: Although the contrast-to-noise ratio in the double-dose injectiongroup was better than that in the single-dose group, differences in overall image quality and pulmoanry arterydepiction were not statistically significant. Thus, single-dose, contrast-enhanced 3-D ultrafast pulmonary MRangiography can provide useful images in clinical trials.
Angiography* ; Aorta ; Arteries ; Carotid Arteries ; Magnetic Resonance Imaging ; Mesenteric Arteries ; Pulmonary Artery ; Renal Artery ; Volunteers

Postoperative vertigo after tympanomastoidectomy can be attributed to several causes such as inner ear damage due to excessive ossicle handling, labyrinthitis, BPPV resulting from vibration of drilling, iatrogenic lateral semicircular canal damage, and perilymphtic fistula. Differential diagnosis is critical for the proper management and prognosis of accompanied sensorineural hearing loss, but it may be difficult in some cases. Especially it is quite difficult to distinguish between the serous and suppurative labyrinthitis. In this article we present a case with simultaneous serous labyrinthitis and BPPV. The patient developed whirling vertigo and hearing loss on the 5th day after tympanomastoidectomy. After conservative treatment with steroid and antibiotics, his hearing recovered to preoperative level. We retrospectively reviewed the pitfalls to make a correct diagnosis in this patient and the serial change in nystagmus during the treatment period. The usefullness of the rotation chair test to predict the prognosis of sensorineural hearing loss in labyrinthitis was also discussed.
Anti-Bacterial Agents ; Diagnosis, Differential ; Ear, Inner ; Fistula ; Handling (Psychology) ; Hearing ; Hearing Loss ; Hearing Loss, Sensorineural ; Humans ; Labyrinthitis ; Mandrillus ; Prognosis ; Retrospective Studies ; Semicircular Canals ; Vertigo ; Vibration