Esophageal leiomyoma is a benign tumor that accounts for two-thirds of esophageal benign tumors. In general, patients with esophageal leiomyoma are asymptomatic; however, as the tumor grows in size, symptoms such as dysphagia, chest discomfort, obstruction, or bleeding can appear. A 65-year-old man visited our clinic to receive treatment for a subepithelial tumor in the lower esophagus, which was incidentally found during endoscopy for work-up of chest discomfort and indigestion. On endoscopic ultrasonography (EUS), the tumor was 2.6×1.9 cm in size, with a cystic lesion located in the submucosal and proper muscle layers and thick cystic wall. Therefore, it was highly likely to be a duplication cyst. As the patient had symptoms such as chest discomfort, surgical resection was performed. The tumor was finally diagnosed as a leiomyoma with cystic degeneration. Leiomyoma with cystic change that has similar EUS features to duplication cyst is rare. Thus, we report the case with a literature review.

Esophageal leiomyoma is a benign tumor that accounts for two-thirds of esophageal benign tumors. In general, patients with esophageal leiomyoma are asymptomatic; however, as the tumor grows in size, symptoms such as dysphagia, chest discomfort, obstruction, or bleeding can appear. A 65-year-old man visited our clinic to receive treatment for a subepithelial tumor in the lower esophagus, which was incidentally found during endoscopy for work-up of chest discomfort and indigestion. On endoscopic ultrasonography (EUS), the tumor was 2.6×1.9 cm in size, with a cystic lesion located in the submucosal and proper muscle layers and thick cystic wall. Therefore, it was highly likely to be a duplication cyst. As the patient had symptoms such as chest discomfort, surgical resection was performed. The tumor was finally diagnosed as a leiomyoma with cystic degeneration. Leiomyoma with cystic change that has similar EUS features to duplication cyst is rare. Thus, we report the case with a literature review.

Tumarkin otolithic crisis is an unusual manifestation of Meniere's disease that shows sudden falling without loss of consciousness. As a kind of life-threatening otologic emergency due to high risk of injury, the surgical ablation therapy rather than the medical one is preferred. Intratympanic injection of gentamicin (ITIG) is being introduced as a treatment by chemical ablation of vestibular function. The authors report a case of life-threatening Tumarkin otolithic crisis in 76-year-old female, after onset of Meniere's disease, failed to treat with multiple application of ITIG, and successfully eradicated the symptom with total labyrinthectomy after then. Also we introduce her clinical feature of Tumarkin otolithic crisis. A 76-year-old female visited clinic suffering from recurrent rotatory vertigo accompanied with fluctuating hearing loss and tinnitus on her left ear, and diagnosis of Meniere's disease was made. Four months after medical treatment, the patient experienced sudden drop attack during walking on the street without any prodromes, and her right wrist and skull base were fractured as a result. She denied to got surgery and ITIG was applied. During 1 year after initial drop attack, she experienced 7 times of severe drop attack and 4 times of ITIG, and finally she accepted to get surgery. The patient no longer suffered from drop attack after total labyrinthectomy later. Tumarkin otolithic crisis is an otologic emergency, may cause life-threatening falling. Our experience from this case is that vestibular ablation by surgical method is needed for safety and quality of life of patients.
Aged ; Ear ; Emergencies ; Female ; Gentamicins ; Hearing Loss ; Humans ; Meniere Disease ; Otolithic Membrane ; Quality of Life ; Skull Base ; Stress, Psychological ; Syncope ; Tinnitus ; Unconsciousness ; Vertigo ; Walking ; Wrist

BACKGROUND AND OBJECTIVES: Pediatric dizziness is difficult to diagnose because of the nonspecific nature of symptom, and difficulty in history taking, physical examination or diagnostic tests. The authors tried to analyze the proportion of diseases in children suffering from dizziness, and introduce cases with atypical clinical characteristics and uncommon diagnosis. MATERIALS AND METHODS: The medical records of 53 pediatric patients suffering from dizziness were analyzed retrospectively. We analyzed the findings of history taking, physical examination for nystagmus and cerebellar function, pure tone audiogram and caloric tests in all patients. RESULTS: Diagnosis of migrainous vertigo was most common (32.7%), followed by psychological cause (11.5%) and labyrinthitis due to the otitis media (7.7%). Cases of cerebellar hemangioblastoma, neurofibromatosis and drug intoxication were also found. CONCLUSION: The clinical characteristics and causative diseases of pediatric dizziness are different from those of adults. Appropriate history taking and diagnostic tests are improtant for differential diagnosis.
Adult ; Caloric Tests ; Child ; Diagnosis, Differential ; Diagnostic Tests, Routine ; Dizziness ; Ear, Inner ; Hemangioblastoma ; Humans ; Labyrinthitis ; Medical Records ; Migraine Disorders ; Neurofibromatoses ; Otitis Media ; Physical Examination ; Retrospective Studies ; Stress, Psychological ; Vertigo

Traumatic pseudoaneurysms in the head and neck region are very rare. Particularyly, pseudoaneurysms of the internal maxillary artery are known to be very rare. The authors report a 20-year old male who was diagnosed as having a pseudoaneurysm of the internal maxillary artery. The cause was assumed to be a mandible ramus fracture. When he visited our emergency room, we did not consider a pseudoaneurysm because of his other life-threatening conditions. Fortunately, he re-visited our hosipital before the aneurysm ruptured. He was diagnosed with angiography and was treated by using embolization with glue. The rupture of the pseudoaneurysm could have caused a life-threatening hemorrhage.
Adhesives ; Aneurysm ; Aneurysm, False ; Angiography ; Emergencies ; Head ; Hemorrhage ; Humans ; Male ; Mandible ; Maxillary Artery ; Neck ; Rupture

BACKGROUND AND OBJECTIVES: Benign recurrent vertigo has been defined as recurrent spells of vertigo lasting minutes to hours without cochlear and neurologic signs. The etiology is still unclear, but viral and vasospastic etiology as migraine equivalent has been suggested. We attempt to analyze the symptoms and vestibular function test of Benign recurrent vertigo that has clinically diagnosed. MATERIALS AND METHODS: We analyzed retrospectively the clinical characteristics and vestibular function test including ocular-motor test, rotation test and computerized dynamic posturography from 100 patients with a Benign recurrent vertigo diagnosis. RESULTS: Eight two percent of the patients were female, mean age was 52 years, and mean duration of prevalence was 47.3 months. In the characteristics of vertigo, 91% of patients have spinning sensation during attack. The vertigo attacks most commonly lasts several hours (57%), and frequency of attack is three to twelve time per year in 47%. A high incidence (40%) of headache was detected, but incidence of other associated symptoms including fluctuating hearing loss (3%), tinnitus (27%), aural fullness (9%) was relatively low. The incidence of spontaneous nystagmus and positional nystagmus was 18% and 10% each. Saccadic undershoot was observed in 21% of patients, but it was not associated with other ocular-motor test abnormalities. In rotation test, low gain, phase lead and asymmetry was observed in 18%, 3% and 9%, respectively. There were no abnormal findings in posturography. CONCLUSIONS: Although benign recurrent vertigo did not show any characteristic clinical findings or vestibular function test, it deserves to be considered for differential diagnosis of episodic vertigo.
Diagnosis, Differential ; Female ; Headache ; Hearing Loss ; Humans ; Incidence ; Migraine Disorders ; Neurologic Manifestations ; Nystagmus, Physiologic ; Prevalence ; Retrospective Studies ; Tinnitus ; Vertigo ; Vestibular Function Tests

Esophageal duplication cyst is a rare congenital gastrointestinal malformation. It is the second most common duplication cyst following small bowel duplication cyst in the gastrointestinal tract. Patients with an esophageal duplication cyst are generally asymptomatic; however, some patients may present the following symptoms: dysphagia, chest pain, stridor, unproductive cough, and epigastric discomfort by compression of the surrounding structures. Surgical removal is the treatment of choice in symptomatic cases and can be considered in asymptomatic cases if they are at risk for developing complications, such as ulceration or perforation. Herein, we report a case of hemorrhage of an esophageal duplication cyst, which was improved by endoscopic drainage.
Chest Pain ; Cough ; Deglutition Disorders ; Drainage* ; Endosonography ; Esophagus ; Gastrointestinal Tract ; Hemorrhage* ; Humans ; Respiratory Sounds ; Ulcer

A 77-year-old man visited our department because of dizziness from one month ago. Dizziness was continuous and non-whirling and this type of dizziness was the first time. He also complained of tinnitus and hearing impairment of the right ear. On physical examination, he showed spontaneous left-beating horizontal and torsional nystagmus and rightward head thrust was positive. He was admitted under the first impression of right vestibular neuritis. On inner ear MRI, there was a well-demarcated 2.5x2.3 cm sized mass of right cerebellopontine angle. This mass showed somewhat low signal intensity in both T1 and T2-weighted image and modest enhancement with Gadolinum. And approximately 4.5x3 cm sized mass could be seen in the simple chest roentgenogram. On chest CT, there was a poorly demarcated 3x2.5 cm sized mass in left lower lobe of lung. The patient was diagnosed as small cell lung cancer with brain metastasis by Per-Cutaneous Needle Aspiration of lung. In spite of radiotherapy and concurrent chemotherapy, he expired after 5 months.
Aged ; Brain ; Cerebellopontine Angle ; Dizziness ; Drug Therapy ; Ear ; Ear, Inner ; Head ; Hearing Loss ; Humans ; Lung ; Magnetic Resonance Imaging ; Needles ; Neoplasm Metastasis ; Physical Examination ; Radiotherapy ; Small Cell Lung Carcinoma* ; Thorax ; Tinnitus ; Tomography, X-Ray Computed ; Vestibular Neuronitis*

BACKGROUND AND OBJECTIVES: Low tone sensorineural hearing loss is deterioration in audiometric low frequencies (250 and 500 Hz), preservation of high frequencies (2, 4, and 8 kHz). The aim of this study is to find out differences of clinical manifestation and prognosis of acute low tone sensorineural hearing loss (ALHL), a subtype of sudden sensorineural hearing loss, and potential progression to Meniere's diseases. MATERIALS AND METHODS: Among 465 patients with unilateral hearing loss initially diagnosed with sudden sensorineural hearing loss, we analyzed clinical characteristics of 96 patients who had acute low tone sensorineural hearing loss, but had no history of previous ALHL. RESULTS: The clinical features of ALHL include a predominance of female suffers (72.9%), more dizziness (36%), high incidence of sound perception change (16.7%), tinnitus (42.8%), and ear fullness (20.8%). The prognosis shows recovery in 67.7% of patients. However, 24.0% of patients show recurrence of low tone loss, and 15.6% develop Meniere's disease. Specially, if the dizziness symptoms were accompanied, progression to Meniere's disease was more common (31.4%). CONCLUSION: Our RESULTS: appear that clinical characteristics were different in the ALHL patients compared to the idiopathic sensorineural hearing loss patients. Therefore, when dizziness, ear fullness and tinnitus are accompanied with low tone hearing loss, an appropriate patient education on possible progression to Meniere's disease is necessary.
Dizziness ; Ear ; Female ; Hearing ; Hearing Loss ; Hearing Loss, Sensorineural ; Hearing Loss, Unilateral ; Humans ; Incidence ; Meniere Disease ; Patient Education as Topic ; Prognosis ; Recurrence ; Tinnitus

BACKGROUND AND OBJECTIVES: Rotation test is a widely used method to evaluate the function of the vestibular system. Generally, the head position to be tilted forwards 30degrees during rotation is preferred in order to bring the horizontal semicircular canals into the plane of rotation, thus ensuring maximum response. However literatures do not provide a clear reference concerning head position during the rotation test. So, we evaluated the vestibuloocular reflex (VOR) induced by sinusoidal rotation in the horizontal plane in the two different head positions: the head tilted forward 30degrees and with the head upright. MATERIALS AND METHODS: A total of 20 men with no known neuro-otological disorders and 9 guinea pigs were studied. The rotations of slow harmonic acceleration on various frequencies were performed with the subject's head in the upright position and in the 30 pitched down position. Computerized electronystagmography in human and magnetic coil in guinea pigs were used to measure the maximum velocity of slow component of horizontal nystagmus and to calculate gain, phase and symmetry of VOR responses. RESULTS: In both groups, results showed no significant differences in gain, phase and symmetry. CONCLUSION: In the two different head positions, there were no significant differences in gain, phase and symmetry. The posture of head upright is more comfortable for the patient and gives enough response for the evaluation of vestibular function.
Acceleration ; Animals ; Electronystagmography ; Guinea Pigs ; Head ; Humans ; Magnetics ; Magnets ; Male ; Nystagmus, Pathologic ; Posture ; Reflex, Vestibulo-Ocular ; Semicircular Canals