BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate the effects of middle ear lesions on pre and postoperative hearing in patients with chronic otitis media (COM) and to assess the relationship between various prognostic factors and pre and postoperative hearing using more than 2000 COM surgery records retrieved from a computerized database released by the Korean Otologic Society in 2005. SUBJECTS AND METHODS: Data of 2312 COM surgeries, which had been conducted by a single surgeon from 1989 to 2009, were reviewed retrospectively. Mean preoperative and postoperative air-bone gap (ABG) was analyzed using a four-frequency (500, 1000, 2000, and 3000 Hz) pure tone average (PTA). Pre and postoperative ABGs were compared with regard to several prognostic factors, including disease duration, age, Eustachian tube function, existence of otorrhea, size of tympanic membrane perforation, degree of ossicular destruction, presence of cholesteatoma, and its type. RESULTS: Mean pre and postoperative ABGs of PTA in the 2079 cases studied were 27.88+/-13.33 dB and 17.38+/-15.64 dB, respectively, with a hearing success rate of 69%. The results suggested that preoperative ABGs were affected by Eustachian tube function, Griffin grade, presence of cholesteatoma and its type, and the degree of ossicular destruction. Hearing gains differed significantly among the groups when compared with factors of Griffin grade, presence or type of cholesteatoma, and the degree of ossicular destruction. CONCLUSIONS: Many factors affected pre and postoperative ABGs and postoperative hearing outcomes. These results will be useful for designing future clinical studies on COM surgery, as well as for surgical planning and patient counseling in clinical practice.
Cholesteatoma ; Counseling ; Ear, Middle ; Eustachian Tube ; Hearing ; Humans ; Otitis ; Otitis Media ; Prognosis ; Retrospective Studies ; Tympanic Membrane Perforation

About 5% of all malignancies involve the oral cavity. Metastatic cancers to the oral cavity from distant sites are very rare, and only a few cases have been reported in the clinical literature. The most common tumors that metastasize to the oral cavity originate in the breast, lung, and kidney. We recently experienced a patient who had a non-small cell lung cancer that metastasized to the gingiva. The patient was 56-year-old man. The disease status was a progressive condition, although the patient had received third-line chemotherapy. The patient had multiple bony metastases including vertebral bodies, femurs, and clivus as well as the gingival metastasis. The gingival tumor was histopathologically diagnosed as a poorly differentiated adenocarcinoma. The metastatic gingival tumor had the same pathology as the primary lung cancer.
Adenocarcinoma ; Breast ; Carcinoma, Non-Small-Cell Lung* ; Cranial Fossa, Posterior ; Drug Therapy ; Femur ; Gingiva* ; Humans ; Kidney ; Lung ; Lung Neoplasms ; Middle Aged ; Mouth ; Neoplasm Metastasis ; Pathology

The authors studied clinical features, thymus histology, acetylcholine receptor antibody titers and the responses to multiple modalities of treatment in a consecutive series of 151 patients to know the characteristics of myasthenia gravis in Korea and to clarify the selection of theraputic regimens. The MG subjects were enrolled in Seoul National University Hospital Myasthenia Gravis Registry and followed for at least over 12 months from 1986 to 1991. The overall clinical features were nearly the same as other previous reports in other country except that pure ocular MG group showed younger age of onset and no significant sexual difference. When we classified 151 MG subjects by several criteria. The most valid grouping variables were whether the thymoma was present or not and whether the symptoms were generalized or not. However there was no difference of clinical features when they were divided by age of onset. Therefore we thought that it may be reasonable to classify the MG subjects by a few variables listed above for it will be helpful for comparing therapeutic modalities, estimating the prognosis, and understanding the basic pathomechanisms underlying each subgroups.
Acetylcholine ; Age of Onset ; Follow-Up Studies* ; Humans ; Korea ; Myasthenia Gravis* ; Prognosis ; Seoul ; Thymoma ; Thymus Gland

Meningioma is well known as common disease of the central nervous system, whereas primary extracranial meningioma is rare, representing 1% to 2% of all meningiomas. We have experienced a case of primary extracranial meningioma presenting as a right cheek mass. The tumor was completely excised via a right lateral rhinotomy incision. Histopathologic examination confirmed the diagnosis of primary extracranial meningioma.
Central Nervous System ; Cheek* ; Diagnosis ; Meningioma*

BACKGROUND AND OBJECTIVES: Pre-operative eustachian tube function (ETF) and mastoid aeration are important in maintaining a post-operative aerated middle ear. In this study, we evaluated the prognostic value of pre-operative ETF and of mastoid aeration predicting post-operative outcomes after chronic otitis media surgery. SUBJECTS AND METHOD: One hundred eighty patients of non-cholesteatomatous chronic otitis media who underwent type 1 tympanoplasty were categorized into two groups (well-patent ETF versus obstructed ETF) according to the results of Valsalva maneuver test, and also categorized into four groups according to the results of a modified pressure inflation-deflation equilibration test. The extent of mastoid aeration was measured using high resolution computerized tomography scan of the temporal bone and image analysis software (Rapidia(R)). The post-operative outcomes at 3 months of surgery were compared with those of the tympanoplasty only group and the mastoidectomy with tympanoplasty (MT) group as well as with the different pre-operative ETF groups. RESULTS: Successful post-operative outcome was 87.9% in the well-patent ETF group and 82.8% in the obstructed ETF group according to the Valsalva maneuver test (p=0.418). Successful outcome was 90.6% in the good ETF group and 74.5% in the poor ETF group according to the modified pressure equilibration inflation-deflation test, which was significantly different (p=0.047). Patients with successful outcome had greater extent of mastoid aeration than those with poor surgical outcome (p=0.026). Distributions of surgical outcome were not statistically different between the tympanoplasty only group and the MT group (p>0.05). CONCLUSION: The ETF measured by modified pressure inflation-deflation equilibration test and the extent of mastoid aeration measured using the Rapidia(R) program were valuable information that can be used to predict post-operative outcomes after chronic otitis media surgery.
Ear, Middle ; Eustachian Tube ; Humans ; Mastoid ; Otitis Media ; Prognosis ; Temporal Bone ; Tympanoplasty ; Valsalva Maneuver

Intramural esophageal dissection is a rare esophageal disorder characterized by sudden severe retro-sternal pain, hematemesis, odynophagia and dysphagia due to longitudinal separation of submucosa from muscle layer of the esophagus. Even though the etiology of this disorder still remains uncertain, it is usually associated with a rapid increase of intra-esophageal pressure in addition to coagulation disorder. We treated a patient who initially presented with retropharyngeal abscess, but finally progressed to an intramural esophageal dissection, which was successfully treated by endoscopic procedure. This is the first case that recorded disease progression and treatment from a retropharyngeal abscess to esophageal dissection.
Abscess ; Deglutition Disorders ; Disease Progression ; Esophagus ; Hematemesis ; Humans ; Muscles ; Retropharyngeal Abscess

Prevalence of dizziness has been reported to be as high as nearly twenty percent and one half of these population had social handicap to some degree. The diagnostic approach of dizziness heavily relies on the premise that dizziness type predicts the underlying etiology-e.g, vertigo with vestibular causes and presyncope with cardiovascular causes. However, such symptomatological approach sometimes delays correct diagnosis as the presenting symptom of individual patient is typically vague to designate the type. In this paper, a case of a 57-year-old woman who has experienced recurrent rotatory vertigo of cardiovascular origin was discussed. When her head were turned to the left, a fast downbeat nystagmus following a slow upward eye deviation was recorded using video nystagmogram. Hence, we report this single case of syncope presented as peripheral vertigo type with literature review.
Dizziness ; Eye ; Female ; Head ; Humans ; Middle Aged ; Nystagmus, Pathologic ; Prevalence ; Syncope ; Vertigo

OBJECTIVES: This study aims to develop a Korean version of the Composite International Diagnostic Interview(K-CIDI). METHODS: The Composite International Diagnostic Interview(CIDI) is a comprehensive, fully standardized interview that can be used to assess psychiatric disorders and provide diagnoses. The K-CIDI was developed according to the guidelines provided by the WHO. The reliability and validity of the K-CIDI was evaluated by examining 135 psychiatric patients and five community residents. Subjects were jointly interviewed twice with a one-week interval. A psychiatric resident and clinical psychologist jointly determined clinical diagnoses using the Structured Clinical Interview for DSM-IV. RESULTS: Notable modifications were done in sex-related expression, health system and help-seeking behavior, subjects for phobic disorder, and kinds of alcohol and substance. Long and complex questions were divided into two or more questions. Field test and back-translation of the K-CIDI confirmed the appropriateness of the translation of the CIDI. The inter-rater reliability, test/retest reliability, and validity of the K-CIDI indicated kappa values ranging from 0.86-1.00, 0.42-0.89, and 0.50-1.00, respectively. CONCLUSION: The K-CIDI was deemed to be appropriate for the sociocultural background of Koreans. The reliability and validity of the K-CIDI were judged to be exceptionally acceptable.
Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Epidemiology ; Humans ; Phobic Disorders ; Psychology ; Reproducibility of Results

OBJECTIVES: Aims of this study were 1) to estimate prevalence rates of suicidal ideation and suicide attempt, 2) to find out whether the gender difference and age difference(13-15 years vs 16-18 years) for suicide behaviors exist, 3) to analyse correlates of suicide attempts among junior and high school adolescents aged 13-18 years old. METHODS: A self-administered questionnaire was used in a cluster random sample of 2,203 school adolescents(male 1,105, female 1,098). Data were obtained on a wide range of constructs including suicidal ideation and attempts during past 2 weeks, depressive symptoms, symptoms of DSM-IV alcohol dependence, family structure, socioeconomic status, smoking, satisfaction with school achievements, and subjective health status. Chi-square test were done for analysing gender difference and age difference of suicide behaviors. Statistical analyses including uni-variate and multi-variate logistic regression analysis were done for each sex, respectively. RESULTS: 1) The prevalence of suicide ideation during past 2 week was 30.7% in the total sample. The prevalence rates of male and female ideators were 26.9% and 34.9% respectively. The prevalence of suicide attempt during past 2 week was 5.3% in the total sample. The prevalence of suicide attempt in males was 3.4% and 7.3% in females. 2) Gender difference was significant. That is, female respondents showed higher rate of suicidal ideation and suicide attempt. In our study age difference was found only at the rate of suicide attempt. That is, older adolescents(16-18 years) showed only statistically significant higher rate of suicide attempt than younger adolescents(13-15 years). 3) Multi-variate logistic regression analysis revealed that the correlates for suicide attempt were female, moderate to severe depressive symptoms, alcohol dependence in the total sample. In males the correlate for suicide attempt was alcohol dependence. In females, were moderate to severe depressive symptoms, and alcohol dependence. CONCLUSION: Depressive symptoms, alcohol dependence, presence of suicidal ideation were strong predictors for suicide attempts. This suggest that early detection of treatment of depression and alcohol dependence is important and psychiatric approach and follow-up be needed for the prevention of suicide.
Adolescent* ; Alcoholism ; Surveys and Questionnaires ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Female ; Humans ; Logistic Models ; Male ; Prevalence* ; Risk Factors* ; Smoke ; Smoking ; Social Class ; Suicidal Ideation ; Suicide*

BACKGROUND AND OBJECTIVES: This study is designed to assess the effect of smoking on the outcome of endoscopic sinus surgery. MATERIALS AND METHODS: A total of 66 patients who underwent endoscopic sinus surgery with the diagnosis of chronic sinusitis were evaluated. They were divided into 3 groups; non-smoking, quit-smoking and still-smoking groups. Preoperative and postoperative visual analogue scale (VAS), Sinonasal Outcome Test (SNOT), and endoscopic score for each group were obtained and compared. RESULTS: There were statistically significant correlations between VAS, SNOT score and smoking. However, all patients showed a similar degree of improvement on the subjective symptoms regardless of smoking or nonsmoking. And, postoperative relief of subjective symptoms was not apparent after smoking cessation. In objective findings, postoperative endoscopic scores were 1.6 in non-smoking group, 1.8 in quit-smoking group and 2.7 in still-smoking group. Stillsmoking group had the worst endoscopic result, However, these differences did not reach a statistical significance. CONCLUSION: This study suggests that smoking had a negative effect on subjective symptoms but not in objective endoscopic findings. In addition, the cessation of smoking after sinus surgery may have no meaningful benefit on the outcome of surgery.
Humans ; Sinusitis ; Smoke ; Smoking ; Smoking Cessation ; Treatment Outcome