BACKGROUND AND OBJECTIVES: One of problems for the management of horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV) is the difficulty of determining the affected ear using Ewald's second law. The purpose of this study is to develop the new "Bow and Lean Test (BLT)" to determine easily the affected ear of HSC-BPPV and evaluate its efficiency. MATERIALS AND METHOD: We compared the efficiency between the classical method and BLT in 26 patients with HSC-BPPV. The classical method is based on Ewald??s second law comparing the intensity of nystagmus or symptoms in head roll test. BLT is based on the direction of both "bowing nystagmus" and "leaning nystagmus" at head's bowing and leaning state on sitting position. The affected ear is the same direction of bowing nystagmus in canalolithiasis and the same direction of leaning nystagmus in cupulolithiasis. RESULTS: In 26 patents (15 canalolithiasis, 11 cupulolithiasis), 3 (11.5%) patients did not show a prominent affected ear in the classical method, and 7 (26.9%) patients showed the different affected ear between two methods. All 10 patients were successfully treated with just one trial of barbecue rotation based on the affected ear in BLT. Three patients did not show any bowing or leaning nystagmus. The side with canal paresis in all 4 patients, who showed significant canal paresis in bithermal caloric tests, was equal to the affected ear based on BLT. CONCLUSION: "Bow and Lean Test" (also called "Choung's test") is a new method which can easily determine the affected ear of HC-BPPV.
Caloric Tests ; Ear ; Head ; Humans ; Jurisprudence ; Paresis ; Semicircular Canals ; Vertigo*

BACKGROUND AND OBJECTIVES: One of problems for the management of horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV) is the difficulty of determining the affected ear using Ewald's second law. The purpose of this study is to develop the new "Bow and Lean Test (BLT)" to determine easily the affected ear of HSC-BPPV and evaluate its efficiency. MATERIALS AND METHOD: We compared the efficiency between the classical method and BLT in 26 patients with HSC-BPPV. The classical method is based on Ewald??s second law comparing the intensity of nystagmus or symptoms in head roll test. BLT is based on the direction of both "bowing nystagmus" and "leaning nystagmus" at head's bowing and leaning state on sitting position. The affected ear is the same direction of bowing nystagmus in canalolithiasis and the same direction of leaning nystagmus in cupulolithiasis. RESULTS: In 26 patents (15 canalolithiasis, 11 cupulolithiasis), 3 (11.5%) patients did not show a prominent affected ear in the classical method, and 7 (26.9%) patients showed the different affected ear between two methods. All 10 patients were successfully treated with just one trial of barbecue rotation based on the affected ear in BLT. Three patients did not show any bowing or leaning nystagmus. The side with canal paresis in all 4 patients, who showed significant canal paresis in bithermal caloric tests, was equal to the affected ear based on BLT. CONCLUSION: "Bow and Lean Test" (also called "Choung's test") is a new method which can easily determine the affected ear of HC-BPPV.
Caloric Tests ; Ear ; Head ; Humans ; Jurisprudence ; Paresis ; Semicircular Canals ; Vertigo*

No abstract available.
Ischemia* ; Skin*

BACKGROUND AND OBJECTIVES: Otitis media with effusion (OME) is one of the most common diseases in children and may be frequently related with dizziness. However, the association between OME and dizziness seems to be not clear and remains controversy. The purpose of this study was to determine the incidence of dizziness in children with long lasting OME, and to investigate the difference in vestibular functions between children with long lasting OME and the control group. MATERIALS AND METHOD: Thirty one children who had long-lasting OME over than 6 months (study group) and 28 normal hearing children without OME who were scheduled for adenotonsillectomy (control group), were given questionnaires and vestibular function tests (VFT) including electronystagmography (ENG) and rotation chair test (RCT). Statistical analysis was performed with chi-square test. RESULTS: Dizziness was found in 7 (22.6%) of 31 children in the study group and 2 (7.1%) of 28 children in the control group (p>0.05). The difference of abnormal findings in VFT between the study group and the control was not significant except visual vestibulo-ocular reflex (VVOR) in RCT. Most of the correlations in the study group, bilateral vs. unilateral OME, OME with dizziness vs. OME without dizziness, and preoperative vs. postoperative, were not significant. CONCLUSION: We did not find any evidences of significant difference of the incidence of dizziness and findings of VFT between children with long lasting OME and children without OME. However, there was a significant abnormal response in VVOR in RCT in children with long-lasting OME, suggesting the children with OME may be more dependent on the nonvestibular system including visual compensation to maintain balance.
Child* ; Compensation and Redress ; Dizziness ; Electronystagmography ; Hearing ; Humans ; Incidence ; Otitis Media with Effusion* ; Otitis Media* ; Otitis* ; Surveys and Questionnaires ; Reflex, Vestibulo-Ocular ; Vestibular Function Tests

The acute vestibular neuritis is rarely seen in children and it is hard to find the related reports. In this paper, we report three cases of acute vestibular neuritis less than 15 years old that we experienced during last 10 years. The three cases are 14 and 11-year old boys and a 12-year-old-girl. They complained vertigo without hearing loss. Only one of three cases had previous common cold history and they showed all negative reactions in virus blood tests. After medical treatment and early rehabilitation, vertigo was completely controlled within 3 weeks and there was no recurrent symptoms so far. This recovery in children seems to be faster and more complete than in adults.
Adolescent ; Adult ; Child* ; Common Cold ; Hearing Loss ; Hematologic Tests ; Humans ; Rehabilitation ; Vertigo ; Vestibular Neuronitis*

BACKGROUND AND OBJECTIVES: The alternative binaural bithermal (ABB) caloric test by Fitzgerald and Hallpike has become a standard procedure in caloric tests. But it brings patient discomfort and is a time consuming procedure. This study was aimed to investigate the efficacy of the monothermal caloric test as a replacement of ABB caloric test. MATERIALS AND METHOD: The results of 690 complete ABB caloric tests collected from 1997 through 1999 were analyzed retrospectively. We have examined the correlations between canal paresis value (CP) derived from an ABB caloric test and compared with the canal paresis value (CPmono) derived from the monothermal caloric component of a bithermal caloric test. RESULTS: There was a stronger correlation between CP and CPmono of warm monothermal component (Pearson correlation coefficient=0.86) than that of cold monothermal caloric test (Pearson correlation coefficient=0.55). Excluding cases with spontaneous nystagmus (n=553), similar results was observed. A warm monothermal caloric test has higher sensitivity and specificity than a cold monothermal caloric test. When the sensitivity of warm monothermal caloric test was more than 90%, the false positive rate was more than about 20%. The false positive rate was unacceptably high. CONCLUSION: The monothermal caloric test cannot be used as a replacement of ABB caloric test.
Caloric Tests* ; Diagnosis* ; Humans ; Paresis ; Retrospective Studies ; Sensitivity and Specificity

BACKGROUND AND OBJECTIVES: Episodic vertigo and/or dizziness in children are not frequent symptoms. Causes of benign episodic vertigo in pediatric age include bengin paroxysmal vertigo of childhood(BPV) and bengin paroxysmal positional vertigo(BPPV). While BPPV has been frequently observed in adult, less frequently observed in children. The aim is to review the clinical manifestations in children with BPPV. MATERIALS AND METHOD: 154 children with dizziness or vertigo, who visited the Dizziness Clinic in the Department of Otolaryngology, Ajou University Hospital, Suwon, Korea between January 2001 and November 2006 were selected for this study. From all the patients, a comprehensive history was obtained, followed by clinical examination of the ears, nose, and throat and a complete audiologic and neurotologic examination including electronystagmography. All patients were treated with an appropriate canalith repositioning maneuver(CRP), depending on the type of BPPV. RESULTS: Seven (4.5%) of 154 children with dizziness or vertigo showed typical BPPV. The mean age was 11.8 years old (9-15 years). The horizontal and anterior semicircular canals were involved in 6 (85.8%) whereas the multiple semicircular canals were involved in 1 (14.2%) patients. Vertigo symptom subsided immediately in 6 (85.7%) patients after one or two trials of CRP, but 1(28.6%) patient showed recurred vertigo, that was treated with retrial of CRP. CONCLUSION: The incidence of BPPV in children were much lower than that of adult BPPV, but it was higher than we expected before. We recommend that clinical tests such as Dix-Hallpike maneuver and head rolling test should be performed on all children with dizziness to establish the diagnosis of BPPV
Adult ; Child ; Diagnosis ; Dizziness ; Ear ; Electronystagmography ; Gyeonggi-do ; Head ; Humans ; Incidence ; Korea ; Nose ; Otolaryngology ; Pharynx ; Semicircular Canals ; Vertigo*

BACKGROUND AND OBJECTIVES: A human cholesteatoma in the middle ear is characterized by the presence of a keratinizing epithelium from hyperproliferative properties. It needs intercellular signal exchange through gap junctions as well as intracellular signal pathway for hyperproliferation. Connexin (Cx) is a gap junction protein for intercellular communication, and especially Cx26 and Cx43 are plenty in human epithelial cells. The objective of this study was to analyze the expression pattern of Cx43 and Cx26 in human middle ear cholesteatomas against normal epitheliums. SUBJECTS AND METHOD: Ten retroauricular skins (RAS), ear canal skins (ECS), and cholesteatomas were taken during middle ear operations at the Department of Otolaryngology. Immunohistochemical staining, reverse transcription-polymerase chain reaction (RT-PCR), and Western blotting were used to detect Cx43 and Cx26. RESULTS: In human cholesteatomas, Cx43 were expressed in the whole suprabasal layers, especially in the middle portion, except in the basal layer, and Cx26 were usually expressed in the supra layer and in the basal layers. But normal RASs showed weak expression of Cx43 in the upper spinosal and granular layers, but not in the basal layers, and the restricted localization of Cx26 in the basal layer. The expression of Cx43 and Cx26 in EASs was weak but showed similar patterns to that of cholesteatomas. In RT-PCR and Western blot, the expression of Cx43 and Cx26 were increased in cholesteatomas than in RASs. CONCLUSION: Human middle ear cholesteatomas showed upregulated expression and different localization of Cx43 and Cx26, gap junction proteins for intercellular communication, compared with normal RASs, suggesting that perturbations of intercellular communication through gap junctions may be associated with the pathology of human middle ear cholesteatomas.
Blotting, Western ; Cholesteatoma ; Cholesteatoma, Middle Ear* ; Connexin 43 ; Connexins* ; Ear Canal ; Ear, Middle* ; Epithelial Cells ; Epithelium ; Gap Junctions* ; Humans* ; Otolaryngology ; Pathology ; Signal Transduction ; Skin

BACKGROUND AND OBJECTIVES: The use of intraoperative facial nerve monitoring (IOFNM) improves facial nerve outcomes in acoustic neuroma surgeries, but the role of IOFNM in middle ear and mastoid surgeries is poorly defined. This study was performed to evaluate the role of IOFNM in middle ear and mastoid surgeries and to systemize IOFNM. SUBJECTS AND METHOD :We carried out a prospective study of 83 patients who undertook middle ear and mastoid surgeries with IOFNM. We checked the facial nerve dehiscence and estimated its location and length using a surgical microscope ('surgical dehiscence'). We stimulated the facial nerve with constant current, unipolar stimulation using Nerve Integrity Monitor (NIM)-2(TM) (Xomed (TM), U.S.A.) and estimated the minimal threshold of electric current making the electromusculography of facial muscle changes. RESULTS: Thirty six (43.4%) of 83 cases showed 'surgical dehiscence' and all responded to 0.7 mA or less of electrical stimulation. The most common site of 'surgical dehiscence' was middle portion of the tympanic segment. We defined the response to electrical stimulation within 0.7 mA as 'electrical dehiscence.' 'Electrical dehiscence' was presented in 63 (75.9%) cases and 82.5% of these cases responded to stimulation of 0.4 mA or less. The mean threshold of minimal electrical stimulation was 0.28 mA for tympanic segment and 0.48 mA for mastoid segment. CONCLUSION: "Electrical dehiscence" based on responses of electrical stimulation is safer than "surgical dehiscence," which is based on microscopic observation in middle ear and mastoid surgery. Based on this study, we recommend the electrical stimulation of 0.7 mA for first screening and 0.4 mA for second exploration in defining facial nerve using intraoperative NIM-2(TM) monitoring in middle ear and mastoid surgeries.
Ear, Middle* ; Electric Stimulation ; Facial Muscles ; Facial Nerve* ; Humans ; Mass Screening ; Mastoid* ; Monitoring, Intraoperative ; Neuroma, Acoustic ; Prospective Studies

No abstract available.