보청기 재활 실패군의 임상적 원인 분석

Background and Objectives: An hearing aid is a useful tool for hearing rehabilitation when surgical hearing correction is not indicated. Successful hearing aid rehabilitation is affected by various factors such as the degree and types of hearing impairment, personality, motivation and duration of adaptation. We aimed to identify factors for satisfying hearing aid by analysis and comparison of the successful and the failure groups of hearing aid users, and to recognize problems of hearing aid prescribed in the non-medical institutes. Subjects and Method: Two hundred and sixty six ears of 202 hearing aid users were referred to the Ajou Hearing Center for two years, and their clinical data were retrospectively reviewed including hearing status and hearing aid type. Twenty ears were prescribed by the non-medical institutes and others were 1st time users. The failure group of hearing aid users was defined when they gave up using hearing aid and requested for refund after an adaptation period of more than one month. Results: Hearing aids failed to work in 9% of 266 ears. All problems of previous hearing aid users were solved by represcription and functional modification of hearing aids. The portion of patients older than 65 year old was not different in two groups, but the portion of female patients in the failure group was significantly larger than that in the success group (p=0.01). The unaided speech discrimination score was significantly higher in the success group (p=0.02). The most common cause of hearing aid failure was poor speech discrimination than expectation. Conclusion: The speech discrimination score and sex are considered as important factors for successful rehabilitation of hearing aid. The prescription of hearing aids and follow-ups in the experienced medical institutes would predict better outcome. The realization of expectation level is of importance when interviewing hearing aid candidates. Further clinical study is necessary for satisfying hearing aid rehabilitation

A Study on the Awareness and Practice of the Elderly Welfare in the Church: Focused on the General Assembly of Presbyterian Church of Korea in Gumi City 교회 노인복지에 대한 인식 및 실천방안 연구: 예장합동 구미노회 소속 교회를 중심으로

Facing the aging society, the Korean church has made various initiatives and efforts to realize quality social welfare for the elderly and has contributed greatly to society by expanding welfare facilities and operating and implementing various programs. Nevertheless, it is true that there are no specific measures to evaluate specific details and that the role of the church has been relatively undervalued. What the researcher noticed while studying the social welfare field professionally as a pastor was that the Korean church is not aware of its role and importance despite its considerable benefits and influence to the nation and society by investing and developing numerous financial and human resources. In response, the researcher will analyze the recognition and examples of churches in the Presbyterian Church of Korea by studying the concept of biblical theory, practice of Christian welfare, prior researches and surveys through literature, etc.; and will examine how real the churches in Gumi are contributing to meet the needs of the welfare for seniors. This study will evaluate the cases of welfare for seniors in practice by analyzing the advantages and disadvantages of churches, and thereby, present an alternative model for positive perception of welfare for senior citizens and active participation

정상고막을 가진 선천성 이소골 기형

BACKGROUND AND OBJECTIVES: A nonprogressive and conductive hearing loss in the range of 40 to 60 dB with normal tympanic membrane which has no history of trauma or infection is highly suggestive of a congenital ossicular malformation. Stapes anomaly is the most common among such ossicular anomalies and it is clinically important because hearing loss can be corrected by appropriate procedures. In this study, we attempted to describe the patterns of ossicular anomalies encountered in patients who have a normal eardrum. We also analyzed the surgical result with special reference to the pattern of ossicular anomaly. MATERIALS AND METHOD: We experienced 28 ears (23 patients) of congenital ossicular anomalies which were confirmed through the exploratory tympanotomy at Ajou University Hospital between September 1994 and December 2001. The preoperative and postoperative audiologic findings, operative findings and CT findings were analyzed. RESULT: There were 7 patterns of ossicular anomalies among which stapes footplate fixation was the most common anomaly. We could get 64.3% of hearing improvement after ossiculoplasty with several kinds of prosthesis. CONCLUSION: There was a great diversity of patterns of ossicular anomalies without certain rule. Stapes anomaly was the most commonly detected. Stapes footplate fixation was the most common type which was usually bilateral. Anomalies associated with incus and malleus were usually unilateral. The surgical result of congenital ossicular anomaly was generally good

인체중이상피세포주에서 점막상피세포 특성의 보존

BACKGROUND AND OBJECTIVES: The stable cell line system of middle ear epithelial cells is essential for studying molecular pathogenesis of otitis media. Recently, we succeeded in establishing the human middle ear epithelial cell line (HMEEC) using a retrovirus. The cell line retains many of the phenotypic and morphological properties of the non-transformed, parental cultures such as the expression of cytokeratin and tight junctions. We aimed to show the conservation of mucosal characteristics and subcellular mechanisms of transcriptional regulation in this cell line. MATERIALS AND METHOD: RT-PCR was performed using mucin gene specific primers and total RNA extracted from HMEEC. The luciferase-expressing vector containing 5' flanking region of human beta defensin 2 (hBD-2), an inducible antimicrobial peptide, was transfected to HMEEC. After starvation of serum, HMEEC was treated with interleukin 1 alpha (IL-1alpha) and subsequently harvested 10 hrs later. Luciferase activity was measured using luminometer after the corresponding substrate was supplemented to the cell lysate. RESULTS: Expression of mucin genes (MUC1, 2 and 5B) in HMEEC was demonstrated by RT-PCR. Luciferase assay showed that IL-1alpha up-regulates the promoter activity of hBD-2 more than 10 fold. This transcriptional regulatory mechanism was also demonstrated in the well established reference cell lines, HeLa cells and A549 cells. CONCLUSION: We demonstrated the conservation of mucin gene expression and transcriptional regulatory mechanism of hBD-2 in HMEEC. The proposed cell line can serve as a useful experimental model for elucidating the pathogenesis of middle ear mucosa-related diseases

Propofol 목표농도조절주입 시 후두마스크 삽입에 필요한 Remifentanil의 예상 효과처농도

Background: The addition of remifentanil during the propofol induced anesthesia facilitates the insertion of laryngeal mask airway (LMA) with minimal adverse hemodynamic disturbances. This study predicted the optimal effect-site concentration of remifentanil for LMA insertion with propofol target-controlled infusion (TCI). Methods: In 25 adults patients, aged 18?60 years, anesthesia was induced with propofol TCI at the effect-site concentration of 4μg/ml. Two minutes later, the predetermined effect-site concentration of remifentanil was started. The remifentanil concentration was determined using modified Dixon’s up-and-down method (0.5 ng/ml as a step size). The first patient was tested at 2.0 ng/ml remifentanil. The insertion of LMA was attempted 3 min after remifentanil TCI began. The response of the patients to the insertion of LMA was classified as either ’movement’ or ’no movement’. Results: The remifentanil concentration at which there was a 50% probability of successful LMA insertion (EC50) was 3.18 ? 0.53 ng/ml. From probit analysis, the EC50 of remifentanil was 3.10 ng/ml (95% confidence limits, 2.55?4.11 ng/ml), and the EC95 was 4.31 ng/ml (95% confidence limits, 3.64?11.11 ng/ml). Conclusions: The predicted effect-site concentration of remifentanil for facilitating LMA insertion was 3.18 ng/ml in 50% of adults during propofol TCI at an effect-site concentration of 4μg/ml without premedication

선천성 이소골 기형의 분류법 제안

BACKGROUND AND OBJECTIVES: There are many different types of congenital ossicular anomalies, which may be broadly divided into major ear anomalies and minor ear anomalies. Minor congenital anomalies are restricted to the middle ear, while major congenital anomalies are malformations of the middle ear and external meatus and sometimes the auricle. The great diversity of anomalies of the middle ear described in the literature makes it difficult to compare and analyze it. The objective of this study is to review and analyze the isolated congenital ossicular anomalies published in the Korean literatures with special reference to the pattern of anomalies and surgical treatment results, and to propose a new systematic classification of isolated congenital ossicular anomalies. SUBJECTS AND METHOD: We reviewed retrospectively 10 Korean literatures concerning isolated congenital ossicular anomalies, which included 117 cases. We also reviewed 9 cases of isolated congenital ossicular anomalies from Ajou University Hospital from Jan 2002 to June 2003, which were not reported in the literature. Among the total 126 cases of isolated congenital ossicular anomalies, follow-up on the hearing results was possible in 112 ears. RESULTS: We proposed a new classification of isolated congenital ossicular anomalies using 5 types based on the stapes status. Twenty-six anomalous patterns were detected out of 126 cases of isolated congenital ossicular anomalies. Using the new classification, the more severe anomaly stapes could be displayed, and the worse postoperative hearing gain could be also predicted. CONCLUSION: Ossicular anomalies were detected without a certain rule of pattern, and big variety of those patterns could be detected in the future. Our proposed new classification will be helpful to analyze the pattern and surgical result of congenital ossicular anomalies

복합 교원성 질환 환자에서 발생한 장분절 바렛식도 1예

Barrett’s esophagus is a metaplasia of the esophageal epithelium of any length, such that normal squamous epithelium is replaced by specialized columnar epithelium with goblet cells. It is important to diagnose and survey Barrett’s esophagus because it is believed to be the major risk factor for development of esophageal adenocarcinoma. However, the prevalence of Barrett’s esophagus in Korea is low. Mixed connective tissue disease (MCTD) is a systemic disorder in which patients have combinations of the clinical features of systemic lupus erythematosus, systemic sclerosis, and polymyositis. Although gastroesophageal reflux disease is common in esophageal involvement in MCTD, long-segment Barrett’s esophagus in MCTD has not been reported in Korea. We report here a 15 cm-long segment of Barrett’s esophagus extending to the proximal esophagus in a female patient who has had MCTD for 2 years, and we review the literature.바렛식도는 정상 식도편평상피가 배세포를 동반한 특수 원주상피로 이형성 된 것을 말한다. 바렛식도는 식도 선암의 발생에 있어 가장 중요한 위험요인으로 정확한 진단 및 주 기적 감시가 중요하다. 그러나 한국에서의 바렛식도 유병률 은 아직까지 높지 않고 이에 대한 연구가 부족한 현실이다. 복합교원성 질환은 전신성 홍반성 루푸스, 전신성 경화증 및 다발성 근염의 임상증상을 함께 가지는 전신 질환이다. 복합 교원성 질환에서 위식도 역류증은 흔한 것으로 알려져 있으 나 본 증례와 같이 장분절 바렛식도가 동반된 보고는 한국 에서 없었다. 저자들은 복합교원성 질환과 함께 근위부 식도 까지 연결되어 있는 15 cm 정도의 긴 장분절 바렛식도를 가 지고 있는 여성 환자를 경험하고 2년 동안 추적관찰하여 문 헌 고찰과 함께 보고하는 바이다

소아 어지러움증의 임상적 양상 및 진단적 분류

BACKGROUND AND OBJECTIVES:Vertigo in children is relatively uncommon. The severity of vertigo in children varies from mild balance disturbance to true vertigo with obvious nystagmus and falling. There is not much concern about vertigo in children, thus only a few articles exist. The purpose of this study is to analyze the clinical characteristics and the results of audiological and vestibular evaluation, to classify the diagnostic causes of vertigo, and to provide the information about vertigo in children. MATERIALS AND METHODS: A total of 49 patients with vertigo or dizziness who visited Dizziness Clinic in the Department of Otolaryngology at Ajou University Hospital from January 1995 to December 2001 were included in this study. These patients were retrospectively reviewed based on clinical charts. The average age of the patients was 11.9 years, with a minimum of 3 years and a maximum of 15 years. All patients performed questionnaires and pure tone audiometries. Caloric tests and rotational tests were performed in 39 and 40 patients respectively. In selective cases, computed tomography, magnetic resonance imaging, electroencephalogram and hematologic test were performed. RESULTS: Migraine and benign paroxysmal vertigo of childhood (BPVC) were 32.7% and 20.4% in children with vertigo, respectively. Other causes were trauma, Meniere's disease, delayed endolymphatic hydrops, benign positional vertigo, cerebellopontine angle tumor, seizure, otitis media and unknown causes were 16.3%. Audiometry, caloric and rotational chair tests showed abnormal findings in 11 cases (22%), 5 cases (13%) and 30 cases (75%), respectively. CONCLUSION: Vertigo in children has different causes from adult vertigo, showing migraine and BPVC to be the most frequent causes. The evaluation of vertigo in children should include a complete history (questionnaire) and physical examination, an audiogram, and vestibular function tests. In selective cases, EEG, Hematologic evaluation and scanning of the brain or temporal bone should be performed

이소골 성형술의 치료성적 및 청력개선에 미치는 영향 인자

Background and Objectives：Hearing gain is basically the final purpose in the middle ear surgery. Ossiculoplasty is the surgical method that reconstructs the ossicular chain to get hearing gain, but the result of ossiculoplasty can be different according to the various factors such as eustachian tube function, ossiculoplatic materials, and surgeon’s technique. The purpose of this study is to evaluate hearing results of ossicular chain reconstruction and to analyze its affecting factors. Materials and Method：Five hundred and thirty five cases of ossiculoplasty done at the Department of Otolaryngology in Ajou University Hospital from June 1994 to December 2000 were included in this retrospective study and we reviewed the formulated operation note and OPD chart including preand post-operative audiogram. We analyzed the results of hearing gain according to patient, disease, and operation factors. A successful hearing gain was defined as a post-operative air-bone gap of ≤20 dB, and we classified ossiculoplasty by using that of Japan Otology Society (2000). Results：Overall successful hearing gain in our series was noted in 40.9%. Young patients had more successful result than old patients. Patients with chronic otitis media had poorer result than patients with other diseases. Of course, patients with patent E-tube had better hearing result than patients with non-patent E-tube. Patients without mastoidectomy had better hearing result than patients with mastoidectomy. In cases with mastoidectomy, patients with intact canal wall mastoidectomy had better hearing result than patient with open cavity mastoidectomy. Patients with stapes suprastructure had better hearing result than patient without stapes suprastructure. Also, hearing result of ossiculoplasty was slightly different according to its materials. Senior surgeons had better hearing result than junior surgeon. Conclusion：We could confirm that successful hearing gain of ossiculoplasty was affected by the E-tube orifice status, surgeon’s technigue, and existence of stapes suprastucture and mastoidectomy