Immunoglobulin G4 (IgG4)-related sclerosing disease (RSD) is a chronic inflammatory disorder characterized by elevated serum IgG4 levels as well as an abundant infiltration of IgG4-positive plasmacytes. Involvement of the paranasal sinus is very rare, so it is difficult to make an accurate diagnosis. Hence, various differential diagnoses, which typically include elevated serum IgG4 levels and the infiltration of IgG4-postive cells into tissues, need to be excluded, especially for malignant diseases and mimicking disorders. Systemic corticosteroids are generally effective at inducing IgG4-RSD remission. Recently, a 43-year-old woman presented with a mass originating from the ethmoid sinus, suggesting malignancy. The patient underwent biopsy of the lesion. The pathologic specimen revealed the magnitude of IgG4-positive plasma cell infiltration, which was consistent with IgG4-RSD. In addition, serum IgG4 levels were markedly increased. After glucocorticoid treatment, the serum IgG4 levels decreased and the symptoms improved. We present a rare case of IgG4-RSD with isolated involvement of the paranasal sinuses.
Adrenal Cortex Hormones ; Adult ; Biopsy ; Diagnosis ; Diagnosis, Differential ; Ethmoid Sinus ; Female ; Humans ; Immunoglobulin G ; Immunoglobulins* ; Paranasal Sinuses ; Plasma Cells

Ceruminous glands are specialized apocrine glands located in the external auditory canal (EAC). Pleomorphic adenoma (PA) of the EAC is derived from these ceruminous glands. Tumors arising from these ceruminous glands are rare. Furthermore, ceruminous PA of the EAC is extremely rare. About 35 cases have been reported to date in the English literature, and only 4 cases have been reported in Korea. There are several controversial issues about these rare tumors such as nomenclature, histogenesis and classification. We report here on two cases of ceruminous PA and review the cases in the Korean literature.
Adenoma ; Adenoma, Pleomorphic* ; Apocrine Glands ; Classification ; Ear Canal* ; Korea

Chronic venous insufficiency (CVI) of the lower extremities manifests itself in various clinical spectrums, ranging from asymptomatic but cosmetic problems to severe symptoms, such as venous ulcer. CVI is a relatively common medical problem but is often overlooked by healthcare providers because of an underappreciation of the magnitude and impact of the problem, as well as incomplete recognition of the various presenting manifestations of primary and secondary venous disorders. The prevalence of CVI in South Korea is expected to increase, given the possible underdiagnoses of CVI, the increase in obesity and an aging population. This article reviews the pathophysiology of CVI of the lower extremities and highlights the role of duplex ultrasound in its diagnosis and radiofrequency ablation, and iliac vein stenting in its management.

Background and Objectives: Virtual reality (VR) users have prevalently experienced motion sickness called cybersickness. Recently, it has been suggested that stimulating the mastoid by vibration relieves cybersickness. This study aimed to verify this proposition.Subjects and Method Fifty-four young male adults (aged 18 to 27 years) without any experience of severe motion sickness or cybersickness participated in this study. Participants were divided in half into two groups, the experimental group and control group. The experimental group used VR with mastoid vibration, and the control group experienced VR without mastoid vibration. Participants responded to the simulator sickness questionnaire (SSQ) to quantify cybersickness. Results: The total severity scores of cybersickness in the experimental group ranged from 0 to 183.3 with the mean value of 46.7±49.0. The total severity scores of cybersickness in the control group ranged from 0 to 194.9 with the mean value of 44.9±45.1. There were no significant differences between the two groups. Conclusion There was no improvement of cybersickness in the VR participants when the mastoid was stimulated by vibration. However, cybersickness might be relieved with changes in the VR condition or vibration settings.

Background and Objectives: Sudden sensorineural hearing loss (SSNHL) is characterized by sudden onset of impaired hearing, and systemic steroid is the most widely accepted treatment option for it. The aim of this study is to evaluate the effectiveness of stellate ganglion block (SGB) as a treatment option for SSNHL.Subjects and Method A total of 318 patients diagnosed with SSNHL were treated with systemic steroid and SGB (SGB group, 127 patients) or systemic steroid only (non-SGB group, 191 patients). Hearing improvement was defined as a hearing gain of more than slight improvement using Siegel’s criteria. Results: The SGB group did not show any significant effects on hearing improvement compared with the non-SGB group (60% vs. 65%). However, some patients with profound hearing loss of more than 90 dB have recovered above average after the SGB treatment. Also, we used multiple regression analysis to ascertain which factors influenced hearing recovery, and found that the initial pure-tone audiometry thresholds at 2000 Hz and 4000 Hz were statistically associated with hearing recovery. Conclusion In conclusion, SGB did not show a clear therapeutic effect, but suggested the possibility of treatment for improving the inner ear circulation of patients with profound hearing loss.

Objectives: . Intratympanic dexamethasone injection (ITDI) has been introduced as a treatment option for subjective tinnitus. However, the effects of ITDI on patients with tinnitus remain unclear. In the present systematic review and metaanalysis, we evaluated the effectiveness of ITDI for tinnitus treatment. Methods: . We searched Medline, the Cochrane Central Register of Controlled Trials, and Embase. Four double-blind randomized controlled trials that tested the efficacy of ITDI compared with a placebo were deemed eligible for a quantitative meta-analysis, while four prospective studies and seven retrospective studies reporting the effectiveness of ITDI on tinnitus treatment were included in a qualitative synthesis. Results: . In the four studies included in the quantitative meta-analysis, ITDI did not show evidence of tinnitus improvement compared with placebo (odds ratio [OR], 1.38; 95% confidence interval, 0.53–3.61). In the 11 studies included in the qualitative synthesis, seven retrospective studies without controls reported rates of tinnitus improvement after ITDI ranging from 35.9% to 91.3%. In the four prospective studies with controls, ITDI seemed to be effective when combined with other drugs for tinnitus treatment. Conclusion . ITDI alone did not show a significant effect for treating tinnitus compared with placebo. However, the potential of combination treatment of ITDI with other drugs for tinnitus therapy should be further studied in more systematic research.

OBJECTIVE: To describe factors associated with the severity of post-stroke dysphagia. METHODS: We reviewed retrospectively medical records of patients having dysphagia following stroke in Seoul National University hospital from April 2002 through Dec 2009. A total of 578 patients (male and female, 331 and 247) were included. The following parameters were recorded and analyzed: patient's sex, age, type of stroke, onset of dysphagia, location of lesion and the American Speech-Language-Hearing Association National Outcome Measurement System Swallowing Scale (ASHA NOMS). Using Binary logistic regression and multiple regression analysis, the relationship between dysphagia severity and other factors were analyzed. RESULTS: Their average duration between onset of stroke and the date of videofluoroscopic swallowing study (VFSS) was 32.3 +/- 18.4 days. Patients with hemorrhagic stroke (172 patients, ASHA 4.06 +/- 1.98) showed poorer swallowing function than those with ischemic stroke (406 patients, ASHA 4.49 +/- 2.02, p=0.013). Binary logistic regression analysis showed that patients who had longer duration from onset to the first study, hemorrhagic stroke, bilateral lesion and older age were at higher risk for dysphagia requiring non-oral supplements (p=0.031, 0.039, 0.042, and 0.043, respectively). Multiple regression analysis revealed that longer duration from onset to study, older age and hemorrhagic stroke were associated with the lower ASHA NOMS (p=0.006, 0.009 and 0.021, respectively). Bilateral lesion, sex, history of previous stroke and involvement of the brainstem, however, were not significant factors. CONCLUSION: Hemorrhagic stroke, longer duration from stroke onset to the initial evaluation, and older age were identified as associated factors with the poorer swallowing function after stroke. Further prospective studies will be required to evaluate the prognostic value of these characteristics.
American Speech-Language-Hearing Association ; Brain Stem ; Deglutition ; Deglutition Disorders ; Female ; Humans ; Logistic Models ; Medical Records ; Regression Analysis ; Retrospective Studies ; Stroke

The diagnostic accuracy of the data reported in the Korean tuberculosis surveillance system (KTBS) has not been adequately investigated. We reviewed the clinical data of pulmonary tuberculosis (PTB) cases notified from private medical facilities through KTBS between January and June, 2004. PTB cases were classified into definite (culture-proven), probable (based on smear, polymerase chain reaction, histology, bronchoscopic finding, computed tomography, or both chest radiograph and symptoms) or possible (based only on chest radiograph) tuberculosis. Of the 1126 PTB cases, sputum AFB smear and culture were requested in 79% and 51% of the cases, respectively. Positive results of sputum smear and culture were obtained in 43% and 29% of all the patients, respectively. A total of 73.2% of the notified PTB cases could be classified as definite or probable and 81.7% as definite, probable, or possible. However, where infection was not confirmed bacteriologically or histologically, only 60.1% of the patients were definite, probable, or possible cases. More than 70% of PTB notified from private sectors in Korea can be regarded as real TB. The results may also suggest the possibility of over-estimation of TB burden in the use of the notification-based TB data.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Female ; Humans ; Male ; Middle Aged ; Mycobacterium tuberculosis/isolation & purification ; Private Sector ; Republic of Korea/epidemiology ; Severity of Illness Index ; Sputum/microbiology ; Tuberculosis, Pulmonary/*diagnosis/epidemiology/pathology ; Young Adult

BACKGROUND AND OBJECTIVES: The present study reports radiological and histological observations of temporal dorsal bullae obliterated by implantation of hydroxyapatite granules (Bongros(R)). MATERIALS AND METHOD: The guinea pigs underwent obliteration of the left dorsal temporal bullae with hydroxyapatite granules (Bongros(R)). MicroCT images were obtained preoperatively and postoperatively. All animals were killed 3 months later. In 8 animals, light microscopic examination of bullae were conducted, and in 4 animals, morphological changes in the cochlear hair cells were examined by scanning electron microscopy (SEM). RESULTS: The microCT images obtained at 3 months after operation demonstrated high signal intensity areas suggesting new bone formations at implanted sites. Light microscopic examinations showed new bone ingrowth and good osteointegration, but no inflammatory response or foreign-body reaction. SEM showed normal-looking hair cells on all examined animals' specimen. CONCLUSION: Our results suggest that Bongros(R) may be safe and reliable alloplastic materials for mastoid obliteration. (Korean
Animals ; Blister ; Bone Transplantation ; Cholesteatoma ; Durapatite ; Foreign-Body Reaction ; Guinea ; Guinea Pigs ; Hair ; Light ; Mastoid ; Microscopy, Electron, Scanning ; X-Ray Microtomography

Paranasal sinus mucoceles are benign non-neoplastic condition characterized by cystic expansion. They are classified into primary and secondary mucoceles by known causes. Most mucoceles are located in the frontal and anterior ethmoid sinuses and they involve the frontoethmoial region, expanding to the region of the orbit, leading to the ocular symptoms. The primary maxillary sinus mucoceles are not common, whereas secondary ones such as postoperative maxillary sinus mucoceles (POMMs) developing after Caldwell-Luc operation are pretty common. POMMs have often multiple septated mucoceles. However, most of the primary maxillary sinus mucoceles are an expansile and cystic mass of maxillary sinus with medial bulging. We present a case of primary septated mucocele in the maxillary sinus of a 36-year-old male who underwent revision surgery.
Adult ; Ethmoid Sinus ; Humans ; Male ; Maxillary Sinus* ; Mucocele* ; Orbit