Obstructive sleep apnea (OSA) is a common disorder characterized by recurrent cessation of breathing due to complete or partial upper airway occlusion during sleep. The incompetent tone of palatal, pharngeal, and glossal muscles which fail to maintain airway patency during sleep causes narrowing of the airway dimension and increased resistance of breathing. The identification of the sites of upper airway obstruction in patients with OSA is important in understanding the pathogenesis and deciding the treatment modality of snoring and/or OSA. Various upper airway imaging modalities have been used to assess upper airway size and precise localization of the sites of upper airway obstruction during sleep. Dynamic imaging modalities enabled assessment of dimensional changes in the upper airway during respiration and sleep. This article focused on reviews of various upper airway imaging modalities, especially dynamic upper airway imaging studies providing important information on the pathogenesis of OSA.
Airway Obstruction ; Diagnostic Imaging ; Humans ; Muscles ; Respiration ; Sleep Apnea, Obstructive* ; Snoring

OBJECTIVE: The purpose of this study was to describe the MR imaging appearance of the dural ligaments which is connected between the anterior dura mater and the posterior longitudinal ligament. MATERIALS AND METHODS: In 10 cadavers with formalin fixation, the dural ligaments were evaluated and photographed after removal of the posterior element of the spinal canal. MR studies of 12 patients who had distinct dural ligaments were evaluated. Spin-echo MR images were obtained on a 1. 5T unit. RESULTS: In seven of the ten cadavers, the midline dural ligament was observed; the lateral dural ligament was observed in 3 cadavers. On MR, the dural ligaments were imaged as thin lines of low signal intensity between the anterior dural margin and the posterior longitudinal ligament. Dural ligaments were well-visualized at the level of the lower lumbar spine which had a more prominent anterior epidural space than that of the upper level of the spine. Eight of 12 cases had well developed midline dural ligaments. Two cases showed distinct lateral dural ligaments and the remaining 2 cases had distinct midline and lateral dural ligaments. CONCLUSION: MR images of the dural ligament demonstrate a thin low signal line at the anterior epidural space.
Cadaver* ; Dura Mater ; Epidural Space ; Formaldehyde ; Humans ; Ligaments ; Longitudinal Ligaments ; Magnetic Resonance Imaging* ; Spinal Canal ; Spine

PURPOSE: To compare the changes in strabismus angle and deviation between two groups: a bilateral lateral rectus recession (Group 1) and a unilateral lateral rectus recession in exotropia (Group 2). METHODS: A retrospective survey was conducted on 198 patients who had received exotropia surgery in our ophthalmology clinic from September 2003 to April 2007. A total of 116 patients were in Group 1, and 82 patients were in Group 2. RESULTS: The average deviations of the first postoperative month and the first postoperative year were -1.96 D +/- 4.75, 2.5 D +/- 7.82 for Group 1 and 0.77 D +/- 2.87, 5.94 D +/- 3.38 for Group 2. Revealing statistical significance between the 2 Groups: Group 1 had 30 failure cases (25.9%) and their 1 postoperative year average deviation was 5.42 D +/- 13.97, while Group 2 showed 24 failure cases (29.3%) and their 1-postoperative-year average deviation was 13.0-79 +/- 3.04. Group 1 had less strabismus angle and a greater standard deviation than Group 2, as Group 1 had more overcorrection. Among the 30 failure cases of Group 1, 9 were overcorrected and 21 were undercorrected, but all 24 failure cases in Group 2 were undercorrected. CONCLUSIONS: The strabismus angle after lateral rectus recession showed a wider variation and a larger difference in bilateral lateral rectus recession than in the unilateral lateral rectus recession.
Exotropia ; Humans ; Ophthalmology ; Retrospective Studies ; Strabismus

No abstract available.
Infant, Newborn ; Jaundice, Neonatal*

Age-related hearing loss (presbycusis) refers to bilaterally symmetrical hearing loss resulting from aging process. Presbycusis is a complex phenomenon characterized by audiometric threshold shift, deterioration in speech-understanding and speech-perception difficulties in noisy environments. Factors contributing to presbycusis include mitochondria DNA mutation, genetic disorders including Ahl, hypertension, diabetes, metabolic disease and other systemic diseases in the intrinsic aspects. Extrinsic factors include noise, ototoxic medication and diet. However, presbycusis may not be related to the intrinsic and extrinsic factors separately. Presbycusis affects not only the physical, cognitive and emotional activities of patients, but also their social functioning. As a result, patients' quality of life deteriorates, compounded by various symptoms including depression, social isolation and lower self-esteem. Presbycusis is classified into six categories, as based on results of audiometric tests and temporal bone pathology, established by Schuknecht (1993): sensory, neural, metabolic or strial, cochlear conductive, mixed and indeterminate types. Among these, metabolic presbycusis is the mainstay of presbycusis types. Age-related changes also develop in the central hearing system. Functional decline of the central auditory system, caused by aging, reduces speech-understanding in noisy background and increase temporal processing deficits in gap-detection measures. This study reviews the literature on the age-related hearing loss.
Aging ; Depression ; Diet ; DNA ; Hearing ; Hearing Loss ; Humans ; Hypertension ; Metabolic Diseases ; Mitochondria ; Molecular Biology ; Noise ; Presbycusis ; Quality of Life ; Social Isolation ; Temporal Bone

Hearing impairment is one of the most common sensory disorders in human. The major causes of sensorineural hearing loss are aging, noise, genetics, ototoxicity, and autoimmune. A better understanding of sensorineural hearing loss is required to understand the mechanisms by which specific causes lead to hearing impairment. The study of sensorineural hearing impairment in humans is limited by the inability to follow inner ear development and elucidate the true mechanism of hearing loss in human. Animal experiment is an essential part of research and testing in the life sciences. Because of the complicated structures of the inner ear, every morphological study is made to be appropriate for such a special tissue. Here I will outline the several morphological methods of the rodent inner ear covering such basic things including fixation, and sectioning.
Aging ; Animal Experimentation ; Animals ; Biological Science Disciplines ; Ear, Inner ; Hearing Loss ; Hearing Loss, Sensorineural ; Humans ; Immunohistochemistry ; Mice ; Noise ; Rodentia ; Sensation Disorders

Subjective tinnitus can be defined as sound sensations (ringing or roaring) occurring in the absence of external auditory stimulus. It is one of the most widespread disorders of auditory system that might be caused by the peripheral auditory injury and insults to somatosensory levels. There were some theories in pathophysiology of tinnitus, such as change in biochemical systems, discordant dysfunction, and spontaneous hyperactivity of auditory tract or imbalance between inhibitory and excitatory transmitter actions of central auditory tracts. Theories related to neural plasticity and cortical reorganization have been recently introduced. Current understanding of pathophysiology in tinnitus is essential to therapeutic approaches. Although there were many studies addressing pathophysiology of tinnitus, controversies exist regarding the pathophysiology of tinnitus. The aim of this review was to review and summarize the recent studies related to pathophysiology of tinnitus.
Plastics ; Sensation ; Tinnitus*

In patients with acquired stenosis of external auditory canal, traditional canaloplasty surgery using skin graft may be performed when symptoms are severe or persistent. However, the risk of restenosis during follow-up period remains a main concern for surgeons. Herein, we present a novel surgical technique using wide cortical bone drilling and reconstruction using the anterior-based periosteal flap. We also report the preliminary results of case series using this surgical technique comparing it with the traditional method.

PURPOSE: To define the anatomy of apical pleural tenting commonly seen in computed tomography(CT) of the upper posterior thorax. MATERIALS & METHODS: Chest CTs of 393 patients with no pleural disease clinically and radiographically were analyzed. GE-9800 Quick and Toshiba-900S were used, employing the usual contrast enhanced CTtechnique. CT findings of focal pleural tenting on the inner side of the upper posterior thorax(apical pleural tenting) were evalvated and analysed in terms of location and shape. The CT findings were compared with the gross findings of the inner aspect of the posterior cadaveric thorax. RESULTS: Apical pleural tenting was formed by the upper border of the subcostal muscle. It's incidence was 44%(n=171), with bilaterality in 29%(n=49), and unilaterality in 71% of cases(n=122). This tenting was most frequently found between the third rib and the fourth intercostal space(81%), and seen in the outer third(42%) or central third(41%) part of the posterior costalpleura. In fifteen cases(7%), it was directed obliquely and had changed its location from the inner to the centralor the central to the outer part. The shapes of the tenting were classified as follows : type 1(convex innerborder with sharp apex, 62%) ; type 2(convex inner border with broad apex, 23%) ; type 3(undulated contour ofapex, 13%) ; and type 4(two-spike apices, 1%). CONCLUSION: Apical pleura tenting is a normal CT finding probably demonstrated by the upper border of the subcostal muscle. Misdiagnosis of pleural disease can be avoided by recognition of the location and type of this tenting.
Cadaver ; Diagnostic Errors ; Humans ; Incidence ; Pleura ; Pleural Diseases ; Ribs ; Thorax ; Tomography, X-Ray Computed

OBJECTIVES: To evaluate retrospectively, the possible difference in diffusion tensor imaging (DTI) metric of fractional anisotropy (FA) between good and poor surgical outcome cochlear implantation (CI) patients using investigator-independent voxel-wise analysis. METHODS: Eighteen patients (11 males, 7 females; mean age, 5.9 years) with profound sensorineural hearing loss underwent DTI scans using a 3.0 Tesla magnetic resonance scanner. Among the 18 patients, 10 patients with categories of auditory performance (CAP) score over 6 were classified into the good outcome group and 8 patients with CAP score below 6 were classified into the poor outcome group. The diffusion tensor scalar measure was calculated from the eigenvalues of the tensor on a voxel-by-voxel basis from each subject and two-sample t-test evaluation between good and poor outcome subjects were performed for each voxel of FA values, across the entire brain, with a voxel-wise intensity threshold of P<0.0005 (uncorrected) and a contiguous cluster size of 64 voxels. Individual values of FA were measured by using the region-of-interest based analysis for correlation analysis with CAP scores, open sentence and open word scores. RESULTS: Two-sample t-test evaluation using SPM voxel-wise analysis found significantly higher FA values at the several brain areas including Broca's area, genu of the corpus callosum, and auditory tract in good outcome subjects compared to poor outcome subjects. Correlation analyses between FA and CAP scores, open sentence and open word scores revealed strong correlations at medial geniculate nucleus, Broca's area, genu of the corpus callosum and auditory tract. CONCLUSION: Investigator-independent voxel-based analysis of DTI image demonstrated that good outcome subjects showed better neural integrity at brain areas associated with language and auditory functions, suggesting that the conservation of microstructural integrity of these brain areas is important. Preoperative functional imaging may be helpful for CI.
Anisotropy ; Brain ; Cochlear Implantation ; Cochlear Implants ; Corpus Callosum ; Diffusion ; Diffusion Tensor Imaging ; Hearing Loss ; Hearing Loss, Sensorineural ; Humans ; Magnetic Resonance Spectroscopy ; Male ; Retrospective Studies