Triggering of the flexor tendon at the wrist is a rare phenomenon. The triggering can be caused by many different conditions, including anomalous muscle, thickened synovium, rheumatoid disease and tumors. We report the case of a 34-year-old man with triggering at the wrist and carpal tunnel syndrome caused by a fibroma of the flexor tendon.
Carpal Tunnel Syndrome ; Fibroma ; Muscles ; Synovial Membrane ; Tendons ; Wrist

OBJECTIVES: The study investigated the role of prenatal testosterone on the development of sexually dimorphic psychological phenotype. Finger length ratio (2nd digit/ 4th digit, 2D/4D), especially on the right hand, is thought to be influenced by prenatal exposure to testosterone. We evaluated the relationship between 2D/4D and psychological characteristics in college students. METHODS: Participants were 137 college students who completed 3 self-report measures : the Emotional Empathy Scale, Aggression Scale, and Bem Sex Role Inventory (BSRI). After copying right ventral surface of the participant's hand, we measured the lengths of the 2nd and 4th fingers, from basal crease to tip, using vernier calipers. We performed statistical analyses using correlation tests and t-tests to examine the relationship between 2D/4D and psychological characteristics (empathy, aggression, and sex role) RESULTS: We observed significant correlations between sex differences and average 2D/4D ratio. Men had a lower 2D/4D ratio than women, confirming the typical sex difference in digit proportions. In women, there was a significant correlation between 2D/4D ratio and empathy. Women with higher, more feminine, finger length ratios had higher empathy scores. We found no correlation between 2D/4D and aggression or sex role. CONCLUSION: There was a positive correlation between 2D/4D and empathy, but in women only. Low prenatal testosterone might play important role in the development of an essential, typically feminine, psychological phenotype (empathy), in women.
Aggression ; Coat Protein Complex I ; Empathy ; Female ; Fingers ; Gender Identity ; Hand ; Humans ; Male ; Phenotype ; Sex Characteristics ; Testosterone

Salivary gland choristoma (ectopic or heterotopic salivary gland tissue) is a rare condition that occurs in various locations within the head and neck regions. A choristoma is a non-neoplastic proliferation of histologically normal tissue that forms at an abnormal site. It appears to be a developmental abnormality and may be associated with abnormalities of adjacent structures. Salivary gland choristoma in the middle ear usually occurs with unilateral conductive hearing loss and requires a differential diagnosis from other mass lesions in the middle ear cavity. Because the lesions commonly involve the facial nerve, intraoperative facial nerve monitoring is helpful for allowing safe biopsy without facial nerve damage. We present two cases of salivary gland choristoma in the middle ear with a review of the literature.
Biopsy ; Choristoma* ; Diagnosis, Differential ; Ear, Middle* ; Facial Nerve ; Head ; Hearing Loss, Conductive ; Neck ; Salivary Glands*

BACKGROUND AND OBJECTIVES: Bone anchored hearing aid (BAHA) is an alternative method applicable to patients with chronic draining ear, congenital aural atresia and single sided deafness, who cannot benefit from conventional air conduction hearing aids. The objective of this study was to evaluate the experience of 14 patients who underwent BAHA surgery. SUBJECTS AND METHOD: We retrospectively reviewed the medical records of 14 patients who underwent BAHA surgery. Preoperative pure tone air and bone conduction thresholds and air-bone gap, postoperative BAHA-aided thresholds were measured. Hearing improvement as a result of implantation and complications related to implant were evaluated. RESULTS: The most common indication for BAHA was congenital aural atresia (8 patients) and the rest consisted of chronic otitis media (3 patients) and unilateral sensorineural hearing loss (3 patients). The average threshold improvement with BAHA was 40 dB and 34 dB in patients with congenital aural atresia and chronic otitis media, respectively. Patients with unilateral hearing loss had a postoperative aided threshold of 25 dB. Complications were limited to the periabutment skin problem in two patients. One patient received revision surgery replacing the diseased skin with split-thickness skin graft from a thigh and the other patient received surgery to remove the abutment and the wound was closed with rotation flap, leaving the fixture underneath the skin. CONCLUSION: BAHA could be one of the safe and reliable treatment options available for auditory rehabilitation. Systematic evaluation for candidate selection might be needed to increase hearing gain and decrease co-morbidity.
Bone Conduction ; Deafness ; Ear ; Hearing ; Hearing Aids ; Hearing Loss, Conductive ; Hearing Loss, Sensorineural ; Hearing Loss, Unilateral ; Humans ; Medical Records ; Otitis Media ; Postoperative Complications ; Retrospective Studies ; Skin ; Suture Anchors ; Thigh ; Transplants

BACKGROUND AND OBJECTIVES: A higher residual rates after surgery have been reported in patients with congenital cholesteatoma than those with acquired cholesteatoma. The aim of this study was to document the risk factors of residual cholesteatoma after surgery for congenital cholesteatoma. SUBJECTS AND METHOD: From 1989 to 2006, 90 patients with congenital cholesteatoma treated at the Department of Otorhinolaryngology, Seoul National University Hospital were investigated retrospectively. Data were analyzed according to the location, type, stage, ossicular involvement, and initial surgery types for residual cholesteatoma. RESULTS: Residual cholesteatoma was detected in 18.9% (17/90) of total patients. With respect to residual cholesteatoma, significant risk factors were found with the open type, mastoid involvement and stapes supra-structure erosion. On the other hand, location, initial surgery types did not show statistical significance. CONCLUSION: The Staged 2nd look operation should be performed for patients with congenital cholesteatoma, especially in either case of the open type, advanced stage or in the presence of supra-structure erosion.
Cholesteatoma ; Hand ; Humans ; Mastoid ; Otolaryngology ; Retrospective Studies ; Risk Factors ; Stapes

BACKGROUND AND OBJECTIVES: Chronic suppurative otitis media (CSOM) is a common infectious disease in childhood of poor hygiene group. In addition, in industrialized countries, with rising popularity of tympanostomy tubes for management of otitis media with effusion, CSOM is a potential problem in any child who had inserted ventilating tubes previously. Hearing loss following CSOM can negatively affect learning, speech, and cognitive function, so effective and timely management of CSOM is mandatory. The surgical procedure may be necessary in some children with CSOM, but when it is performed at a too early age, there might be more chances of recurrence than adults. SUBJECTS AND METHOD: Used in the study were 51 ears from patients who received tympanomastoidectomy due to CSOM in tertiary referral center from 1995 through 2004. The mean age was 9 years and 6 months. Cholesteatoma was found in 30 cases (58.8%). Age at operation, hearing outcomes, and the surgical results were retrospectively reviewed. RESULTS: Canal wall down mastoidectomy was performed in 23 cases and canal wall up procedure in 28 cases. Revision surgery was performed in 9 cases (17.6%) and mean duration between first and revision surgery was 27 months. In the cases of cholesteatoma, the rate of revision surgery was different between under 6 years old and over 7 years old group (p=.045). The age at 1st operation and postoperative hearing outcome had no correlation. CONCLUSION: Since the1st operation is performed earlier, the rate of revision may increase, especially in cases of cholesteatoma.
Adult ; Child ; Cholesteatoma ; Communicable Diseases ; Developed Countries ; Ear ; Hearing ; Hearing Loss ; Humans ; Hygiene ; Learning ; Middle Ear Ventilation ; Otitis Media ; Otitis Media with Effusion ; Otitis Media, Suppurative* ; Otologic Surgical Procedures ; Recurrence ; Retrospective Studies ; Tertiary Care Centers

BACKGROUND AND OBJECTIVES: Facial nerve stimulation (FNS) as a complication of cochlear implantation can produce significant discomfort, limit effective use of cochlear implant, and require extensive reprogramming in some patients. The purpose of this study is to review the clinical features of children with FNS after cochlear implantation and to discuss its possible solutions. SUBJECTS AND METHOD: Thirteen children who had FNS after cochlear implantation were included. Their medical records were reviewed retrospectively regarding the presence of inner ear anomaly (IEA), the programming techniques for cochlear implant, timing and progression of FNS, and the management of it. RESULTS: Ten out of 13 children (76.9%) with FNS had IEA. In those 10 patients with IEA, FNS appeared within 6 months from the operation and showed a tendency of being relevant to all electrodes. Authors used four methods to eliminate FNS. They included (a) turning off the specific electrodes when FNS seems related to some specific electrodes, (b) changing the coding strategy or the programming mode, which proved not to be effective, (c) reducing the C-level, which resulted in severe narrowing of dynamic range as well as a relative control of FNS, and (d) surgical exploration in specific cases. CONCLUSION: FNS after CI is at greater risk for IEA. FNS in those cases can interfere with the progression of speech development. This should be sufficiently informed of the parents of CI candidates with IEA preoperatively. Surgical exploration can be reserved for elimination of FNS in specific cases.
Child* ; Clinical Coding ; Cochlear Implantation* ; Cochlear Implants* ; Ear, Inner ; Electrodes ; Facial Nerve* ; Humans ; Medical Records ; Parents ; Retrospective Studies

BACKGROUND AND OBJECTIVES: The canal wall down (CWD) precedure provides relatively safer access and lower recidivism rate compared to the canal wall up (CWU) procedure. Choice of initial surgical procedure and staging can be variable according to the surgeon's preference and experience. Aims of this study were to analyze the frequency and causes of reoperation and to analyze postoperative hearing results between two groups according to the status of stapes and staging. MATERIALS AND METHODS: Initial surgical management for 179 cases of cholesteatoma performed by 2 senior authors from 1993 through 1998 were reviewed retrospectively. RESULTS: CWD procedure was the preferred procedure (n=151, 84%) and surgery for hearing gain was performed in 103 cases regardless of staging. The numbers and causes of reoperation were analyzed. In CWD cases, the emergence of recidivism (i.e., residual or recurrent cholesteatoma) persisted during the follow up and annual rate of recidivism was around 2%. Between CWD and CWU group, there was no statistical difference in the annual incidence of recidivism. Hearing results according to the types of mastoidectomy and the status of stapes were analyzed at 1 year of the follow up. Air-bone gap closure (ABG closure) didn't show any differences in both groups. In both groups, there were no statistical differences in the ABG closure according to the status of stapes. CONCLUSION: Even though CWD surgery was mainly performed in extended and advanced cases, the rate of recidivism and postoperative hearing results showed no statistical differences between the two groups. A well-performed primary canal wall down surgery is safe with a few problems requiring no further procedure in cholesteatoma surgery.
Adult* ; Cholesteatoma* ; Follow-Up Studies* ; Hearing* ; Humans ; Incidence ; Reoperation ; Retrospective Studies ; Stapes

BACKGROUND AND OBJECTIVES: Automated auditory brainstem response (AABR) and automated distortion product otoacoustic emission (ADPOAE) are being used in newborn hearing screening in our country nowadays. This study investigates the efficacy of automated tests in newborn hearing screening never disclosed before in our country and establishes the proper newborn screening protocol using two automated hearing screening tools. MATERIALS AND METHOD: 75 normal neonates (150 ears) and 28 high risk neonates (56 ears) have been screened using two automated screening tools from Nov.2002 through Mar.2003. Normal neonates showing "Refer" in any of the two tests and all high risk neonates undertook the conventional ABR (c-ABR), the results of which were considered to be the gold standard reflecting the real hearing threshold, 1 month after the two automated screening tests. The sensitivity and specificity of two automated tests were calculated in neonates who undertook c-ABR and the refer rate of each test was also investigated. Based upon these data, several screening protocols using AABR and ADPOAE were suggested and compared in terms of sensitivity, specificity and refer rate, retrospectively. RESULTS: Sensitivity and specificity of ADPOAE were 100% and 78.5%, with those of AABR being 71.4% and 89.4%, respectively. The refer rates of two tests were 9.7% and 5.33%, respectively. Of 64 ears, which undertook both AABR and c-ABR, 53 ears passed the AABR test. Of those 53 ears that passed AABR, 2 ears showed the hearing threshold of worse than 60dB in c-ABR, with their sweeps being statistically much higher than the means of sweeps of other 51 ears. Of various suggested protocols, the one-step protocol using ABBR alone while taking sweep into consideration, and in which "pass" with high sweep was regarded as "refer, " and the two-step protocol that uses AABR first and ABR next while also taking sweep into consideration, commonly showed the highest efficacy with relatively high sensitivity (100%), and specificity (89.4%), with low refer rate (6.7%). CONCLUSION: The newborn hearing screening protocol using ADPOAE and AABR is less time consuming, efficient, and reliable, especially when we consider the "sweep" in AABR and adopt the two-step screening protocol. This can also serve well to keep pace with the current trend of JCK which recommends neonatal hearing screening in all neonates.
Ear ; Evoked Potentials, Auditory, Brain Stem* ; Hearing* ; Humans ; Infant, Newborn ; Mass Screening* ; Neonatal Screening ; Retrospective Studies ; Sensitivity and Specificity

BACKGROUND AND OBJECTIVES: This study aims to evaluate audiologic results and subjective satisfaction of bone anchored hearing aids (BAHA) patients. SUBJECTS AND METHOD: Preoperative air-conduction and bone-conduction thresholds, postoperative aided thresholds were measured for 14 patients. To evaluate patient satisfaction, two questionnaires derived from single sided deafness (SSD) questionnaire and Bern Benefit in SSD questionnaire were used. RESULTS: The mean age of patients, consisting of 8 males and 6 females, was 40.0+/-5.9 year. Ten patients (71%) received implantations for conductive or mixed hearing loss and 4 (29%) for SSD. The mean follow-up period was 27.8+/-5.6 months. The mean preoperative bone-conduction threshold of conductive or mixed hearing loss group was 21.4 dB and the mean air-conduction threshold was 65.4 dB. The mean bone-conduction threshold of SSD group was 60.0 dB and the mean air-conduction threshold was 105.9 dB. The postoperative aided threshold was significantly improved in conductive or mixed hearing loss group (p=0.005). The patients in the conductive or mixed hearing loss group showed more satisfaction with BAHA than those in the SSD group did, but the degree of satisfaction was not statistically significant (p=0.08 for questionnaire 1, p=0.12 for questionnaire 2). Patients with better preoperative bone-conduction threshold and patients with better preoperative speech discrimination score showed more satisfaction with BAHA in the questionnaire 1 (p=0.045, p=0.036). CONCLUSION: BAHA can be considered effective and beneficial for patients with conductive or mixed hearing loss and SSD. Further studies will be needed to choose the appropriate indications for BAHA, especially in SSD group in Korea.
Bone Conduction ; Deafness ; Female ; Follow-Up Studies ; Hearing ; Hearing Aids ; Hearing Loss, Conductive ; Hearing Loss, Mixed Conductive-Sensorineural ; Humans ; Korea ; Male ; Patient Satisfaction ; Surveys and Questionnaires ; Silver Sulfadiazine ; Speech Perception ; Suture Anchors