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We investigated the work-life balance of clinical professors in charge of patient care, research, and education at medical schools and the demand for work-life balance support according to position (professor, associate professor, or assistant professor). In total, 163 clinical professors completed the consent form and participated in the study. They filled out an online survey consisting of questions about essential characteristics, a work-life balance test, stress, burnout, work-life satisfaction, and work-life balance support needs. We analyzed the results by analysis of variance and cross-tabulation using IBM SPSS ver. 23.0. Differences were found in work-life balance, stress, burnout, and satisfaction with life and work by position. The requirements for support for work-life balance also varied by professional status. Professors had a higher balance between life and work than associate professors or assistant professors. The specific requirements for work-life balance support were also slightly different for each position. Overall, there was a high demand for work process simplification and efficiency for work support, flexible working hours and sabbatical years for family and leisure, and career management consulting and training support for growth. Assistant professors and associate professors had a lower level of work-life balance than professors, as well as higher levels of stress and burnout. Professors' job satisfaction was also higher than that of the other groups. Based on the results of this study, we hope that a healthy work environment can be established through work-life balance support suitable for clinical professors’ positions.

Exposure to cigarette smoke (CS) is a factor that could delay or worsen the recovery of otitis media (OM) by causing inflammatory swelling of the Eustachian tube (ET). However, despite the suggested relationship, little is known about the association between OM and CS. Therefore, we aimed to evaluate the effects of CS on the development, progression, and recovery of OM, as well as the histological and molecular changes caused by CS exposure, by using a rat model of OM infected with non-typeable Haemophilus influenzae (NTHi). Eighty Sprague–Dawley rats with normal middle ears (MEs) were divided into four groups (n = 20 rats/group): control, CS, OM, and CS + OM. The CS and CS + OM groups were exposed to CS for 2 weeks. The inflammatory reaction to NTHi was more intense and lasted longer in the CS + OM group than in the other groups. Goblet cell proliferation and mucus secretion in the ET were more significant in the CS and CS + OM groups than in the other groups. These findings suggested that because CS directly affects the ET and ME mucosa, bacterial OM can become more severe and may resolve more slowly in the presence of CS exposure rather than in its absence.

Langerhans cell histiocytosis (LCH) is commonly characterized by abnormal function and differentiation or proliferation of monocytes. In LCH, granulomatous lesions, including langerine-positive histocytes and inflammatory infiltrates, can occur to all tissues, particularly well in the bones, skin, lungs, and pituitary gland. In case of external auditory canal LCH, conductive hearing loss may occur, and the most common symptom is otorrhea. Here we present a case that 49-year-old male with external auditory canal mass. Since no invasive findings were seen in radiologic study, endoscopic transcanal excision was performed and LCH was proven by pathologic report. We present this case of external auditory canal LCH with the review of literature.

Mucosal hyperplasia is common sequela of otitis media (OM), leading to the secretion of mucus and the recruitment of leukocytes. However, the pathogenic mechanisms underlying hyperplasia are not well defined. Here, we investigated the role of the AKT pathway in the development of middle mucosal hyperplasia using in vitro mucosal explants cultures and an in vivo rat model. The Akt inhibitor MK2206 treatment inhibited the growth of middle ear mucosal explants in a dose-dependent manner. In vivo, MK2206 also reduced mucosal hyperplasia. Unexpectedly, while PTEN is generally thought to act in opposition to AKT, the PTEN inhibitor BPV reduced mucosal explant growth in vitro. The results indicate that both AKT and PTEN are mediators of mucosal growth during OM, and could be potential therapeutic targets.

Hemangiomas are very common tumors characterized by large numbers of vessels filled with blood. Capillary hemangioma is the most common type of hemangioma, whereas capillary hemangiomas of the tympanic membrane and external auditory canal are extremely rare vascular tumors. The authors present capillary hemangioma of the tympanic membrane and external auditory canal in a 54-year-old woman with right-sided aural fullness for 3 months. Under local anesthesia, the mass was resected by transcanal microscopic surgery. Histologically, the tumor was composed of thin-walled capillaries with scant stroma and diagnosed as capillary hemangioma. After surgery, her symptoms improved and she did not exhibit any signs of recurrence for 1 year. The authors also review the relevant literature related to this report.

When lidocaine is locally delivered into the inner ear, it rapidly paralyzes the peripheral vestibular afferent neurons and induces unilateral vestibular loss. The goals of this study were to explore the possibility of developing intratympanic injection (IT) of lidocaine as a modality for treating acute vertigo. To evaluate the minimum concentration required, latent time, action duration, and possibility of lidocaine IT readministration to the vestibular system, we compared the development of horizontal nystagmus after IT of 2, 4, 6, 8, and 10% lidocaine solutions in rats. To identify the induction of vestibular compensation, c-Fos-like protein expression was observed in the vestibular nucleus. Results of our investigation showed that lidocaine IT concentrations greater than 4% induced vestibular hyporeflexia in the injected ear. In order to induce hyporeflexia 4 and 6% lidocaine solutions could also be repeatedly injected. Regardless of concentration, effects of the lidocaine IT dissipated gradually over time. Our findings could be used to develop novel methods for symptom control in vestibular disorder patients.

In many cases of mucormycosis, immediate surgical treatments are necessary because of its fulminant course and destructive characteristics in an immunocompromised patient. However, a chronic indolent type is also observed in a healthy group of people. We experienced rhinomucormycosis in a 56-year-old woman with diabetes who previously had pulmonary mucormycosis. She was treated successfully through endoscopic sinus surgery and nasal irrigation with antifungal agent. Herein, we report the clinical courses and symptoms of this patient with literature review.

BackgroundLocomotion involves an integration of vision, proprioception, and vestibular information. The parieto-insular vestibular cortex is known to affect the supra-spinal rhythm generators, and the vestibular system regulatesanti-gravity muscle tone of the lower leg in the same side to maintain an upright posture through the extra-pyramidal track. To demonstrate the relationship between locomotion and vestibular function, we evaluated the differences in gait patterns between vestibular neuritis (VN) patients and normal subjects using a gyroscope sensor and long-way walking protocol.MethodsGyroscope sensors were attached to both shanks of healthy controls (n=10) and age-matched VN patients (n= 10). We then asked the participants to walk 88.8 m along a corridor. Through the summation of gait cycle data, we measured gait frequency (Hz), normalized angular velocity (NAV) of each axis for legs, maximum and minimum NAV, up-slope and down-slope of NAV in swing phase, stride-swing-stance time (s), and stance to stride ratio (%).ResultsThe most dominant walking frequency in the VN group was not different compared to normal control. The NAVs ofz-axis (pitch motion) were significantly larger than the others (x-,y-axis) and the values in VN patients tended to decrease in both legs and the difference of NAV between both group was significant in theipsi-lesion side in the VN group only (p=0.03). Additionally, the gait velocity of these individuals was decreased relatively to controls (1.11 ± 0.120 and 0.84 ± 0.061 m/s in control and VN group respectively,pipsi-lesion side. Moreover, in the VN group, the maximum NAV of the lesion side was less, and the minimum one was higher than control group. Furthermore, the down-slope and up-slope of NAV decreased on the impaired side.ConclusionThe walking pattern of VN patients was highly phase-dependent, and NAV of pitch motion was significantly decreased in theipsi-lesion side. The change of gait rhythm, stance and stride time, and maximum/minimum NAV of theipsi-lesion side were characteristics of individuals with VN.

Various materials such as fascia, perichondrium, and cartilage have been used for reconstruction of the tympanic membrane in middle ear surgery. Because of its stiffness, cartilage is resistant to resorption and retraction. However, cartilage grafts result in increased acoustic impedance, the main limitation to their use. The aim of this study was to compare the hearing results after cartilage tympanoplasty versus fascia tympanoplasty. This study included 114 patients without postoperative tympanic membrane perforation who underwent tympanoplasty type I between 2007 and 2010, 31 with fascia and 83 with cartilage. Preoperative and 1 year postoperative air-bone gap (ABG) and postoperative gain in ABG at frequencies of 0.5, 1, 2, and 3 kHz were assessed. Both groups were statically similar in terms of the severity of middle ear pathology and the preoperative hearing levels. Overall, postoperative successful hearing results showed 77.4% of the fascia group and 77.1% of the cartilage group. Mean postoperative gains in ABG were 9.70 dB for the fascia group and 9.78 dB for the cartilage group. These results demonstrate that hearing after cartilage tympanoplasty is comparable to that after fascia tympanoplasty. Although cartilage is the ideal grafting material in problematic cases, it may be used in less severe cases, such as in type I tympanoplasty, without fear of impairing hearing.

A numerical analysis has been performed to estimate the effect of thermal stratification in the safety injection piping system. The Direct Vessel Injection (DVI) system is used to perform the functions of Emergency Core Cooling and Residual Heat Removal for an APR1400 nuclear power plant (Korea’s Advanced Power Reactor 1400 MW-Class). The thermal stratification is anticipated in the horizontally routed piping between the DVI nozzle of the reactor vessel and the first isolation valve. Non-axisymmetric temperature distribution across the pipe diameter induced by the thermal stratification leads to differential thermal growth of the piping causing the global bending stress and local stress. Thermal hydraulic analysis has been performed to determine the temperature distribution in the DVI piping due to the thermal stratification. Piping stress analysis has also been carried out to evaluate the integrity of the DVI piping using the thermal hydraulic analysis results. This paper provides a methodology for calculating the global bending stresses and local stresses induced by the thermal stratification in the DVI piping and for performing fatigue evaluation based on Subsection NB-3600 of ASME Section III.Copyright © 2012 by ASME

In modern times, state-centered and nationalistic ideas on security have become dominant in many parts of East Asia as several governments have pursued autocratic and repressive policies in the pursuit of securing regime and economic development. This state-centered security orientation follows the Machiavellian edict that the end justifies the means, and orders the relations between state and society (Alagappa 2003). Concerns with national security and related ideas concerning the relations between the state and the outside world were lacking in East Asia during the premodern period and emerged as a reaction to imperialistic violence imposed by Chinese dynasties, Japanese colonialism, and competitions within East Asia among Western imperialistic powers (Duara 2006). In order to provide a context for the thinking of East Asians concerning national, family, and individual security, this chapter first addresses East Asia’s historical, sociocultural, and economic backgrounds. Then, current issues in this region are addressed.

The authors measured the diameters of vessels around the surgical plane of tonsillectomy to investigate an anatomical basis to reduce hemorrhage. Thirty tonsils removed from 15 adult cadavers with the mean age of 56 years (range 44-71 years) at the time of death were studied. Calibration of the vessels across the tonsillar capsule was performed at the 1-mm intracapsular, capsular, and 1-mm extracapsular plane as artery and vein, respectively. The average diameter of the arteries was 73.0 +/- 33.1 mum at the 1-mm intracapsular plane, 94.7 +/- 33.5 mum at the capsular plane, and 139.5 +/- 51.2 mum at the 1-mm extracapsular plane. For the veins, it was 62.9 +/- 38.7 mum at the 1-mm intracapsular plane, 86.8 +/- 50.4 mum at the capsular plane, and 133.6 +/- 78.6 mum at the 1-mm extracapsular plane. The diameters of the vessels at the 1-mm intracapsular plane were significantly smaller than those at the capsular plane (P < 0.01), and likewise the diameters of the vessels at the capsular plane were significantly smaller than those at the 1-mm extracapsular plane (P < 0.01). The result of this study on the diameter of the vessels across the tonsillar capsule could be considered to be an important factor providing an anatomical rationale for a change in recommendation leading to safer tonsillectomies that minimize vascular injury.

The applicability of the melanoma antigen gene (MAGE) to the molecular diagnosis of cancer, by detecting MAGE mRNA in the sputa of head and neck cancer patients, was investigated.Nested reverse transcription-polymerase chain reaction (RT-PCR) with the MAGE common primers designed to detect MAGE A1-6 genes was conducted with sputa of 17 head and neck squamous cell carcinoma patients.Of the 17 sputa specimens from patients with squamous cell carcinoma, MAGE mRNA was detected in 13 cases, while the detection rate was 2 out of 40 in the normal control group, showing significant correlation (p0.05) between head and neck squamous cell carcinoma and MAGE mRNA expression in sputa.MAGE may be a useful tumor marker of head and neck cancer.

Background and ObjectivesZZSudden hearing loss remain a controversial issue with respect to its prognostic indicators. In a recent study, the change in distortion product otoacoustic emission (DPOAE) has been shown to provide useful information about its prognosis. The purpose of this study is to evaluate the relationship between the changes of DPOAE and hearing improvement in sudden deafness patients. Subjects and MethodZZSixty-one patients underwent pure tone audiometry (PTA) and DPOAE on their first hospital day ; among them 35 patients underwent DPOAE after 2 weeks. These patients were divided into mild (≤40 dB) group, moderate to moderately severe (41-70 dB) group and severe (≥71 dB) group according to their initial hearing thresholds. ResultsZZOf the 22 patients in the moderate to severe group, 11 patients showed a DPOAE response and 5 patients (45%) showed hearing improved. In 11 non-DPOAE response patients, 4 patients (36.4%) had improved. We compared PTA and OAE sum gap results by analyzing 35 patient’s initial thresholds with those measured 2 weeks after the therapy. The correlation coefficient between the two group was 0.547 (p＜0.05). ConclusionZZThe results show that OAE sum is an efficient and non-invasive objective meth od and that it can be used to monitor the effects of treatment in sudden hearing loss patients. � Korean J Otorhinolaryngol-Head Neck Surg 2013;56:212-6 Key WordsZZOtoacoustic emissions ㆍPrognosis ㆍSudden hearing loss.

Ramsay Hunt 증후군 혹은 이성대상포진은 수두대상포진 바 이러스의 감염과 관련되어 있으며 말초성 안면마비, 이개 및 안 면부의 대상성 포진 등의 특징적인 증상을 보인다. 흔히 안면신 경 이외에 8번 뇌신경 마비는 흔히 동반되어 청력소실, 현훈 등 의 증상이 나타난다. 드물게 다발성 뇌신경 마비를 일으켜 3번, 4번, 5번, 6번, 9번, 10번, 11번, 12번 마비가 동반되어 안구운동 장애, 안면부 감각이상, 애성, 연하곤란, 흉쇄유돌근의 위축, 혀 운동 장애 등의 증상이 동반될 수 있다. 또한 수두대상포진 바이러스가 혈관병증(vasculopathy)을 유발한다면 중추계의 허 혈성 경색, 동맥류, 지주막하 출혈(subarachnoid hemorrhage), 소뇌 출혈(cerebral hemorrhage), 경동맥 박리(carotid dissection)까지도 발병할 수 있다. 저자들은 국내에서 처음으로 이 성대상포진 발병 후 다발성 뇌신경 마비와 연수(medullar oblongata)의 허혈성 병변이 발견된 경우를 경험하였기에 이에 대 해 보고하는 바이다.

Septochoanal polyp is a rare entity that originates in the nasal septum and extends into the choana. Based on nasal endoscopy, a 43-year-old woman, presenting with nasal obstruction, was suspected of having a nasopharyngeal tumor. A CT scan revealed a large choanal polyp pedicle with calcification in the central area. Because a simple polypectomy carries a high risk of recurrence, the treatment of the septochoanal polyp should involve a resection of the septal mucosa and complete surgical removal by either endonasal or transoral approach. Korean J Otorhinolaryngol-Head Neck Surg 2010;53:228-31 Key WordsZZNasal polyps·Calcification.

Background and Objectives : Many materials such as fascia, perichondrium and cartilage are used for reconstruction of the tympanic membrane in middle ear surgery. Because of its stiffness, cartilage is resistant to resorption and retraction. However, cartilage grafts result in increased acoustic impedance, so its use has caused controversies as to the acoustic transfer aspect. The aim of this study is to assess hearing results after cartilage tympanoplasty and after fascia tympanoplasty. Subjects and Method : This study included 74 patients who had received tympanoplasty type I between 2007 and 2009, of whom 44 received cartilage and 30 fascia. The middle ear risk index was used to statistically compare the preoperative state of the two groups. Preoperative and six months- postoperative air-bone gaps at the frequency 0.5, 1, 2 and 3 kHz were assessed. Results : Both groups were statistically similar with respect to the severity of middle ear pathology and the preoperative hearing levels. Overall postoperative hearing results showed air-bone gaps (ABG) 20 dB in 73% for the fascia group and 71% for the cartilage group. The mean postoperative gains in ABG were 8.97 dB for the fascia group and 10.84 dB for the cartilage group. There were no statistically significant differences in the postoperative frequency specific gains in ABG between the two groups. Conclusion : These results demonstrate that hearing results after cartilage tympanoplasty are comparable to those after fascia tympanoplasty. Although cartilage is the ideal grafting material in problem cases, a more liberal application might be suggested in such cases as in tympanoplasty type I without fear of impairing hearing.