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Background and Objectives Several drugs which can improve blood flow have been used as treatment options for sudden sensorineural hearing loss (SSNHL) based on the theory that improvement of perfusion into the inner ear will help restore hearing. Lipo-prostaglandin E1 (lipo-PGE1) is a well-known vasodilator that increases peripheral blood flow. The purpose of this study was to investigate the effect of lipo-PGE1 on the recovery of the SSNHL patients with hypertension or diabetes.Subjects and Method We retrospectively analyzed 801 patients who were diagnosed with SSNHL from January 2007 to December 2018. All patients were treated with 48 mg of methylprednisolone for 5 days; some patients received lipo-PGE1, depending on the attending physician. They were divided into four groups according to the presence or absence of hypertension and diabetes. Hearing test was performed again one month after treatment and compared with the test results at the time of diagnosis.Results As a result of comparing the hearing thresholds before and after the treatment in each group, there was a significant improvement in hearing thresholds in all groups (p

Background and Objectives: Autophagy is known to be associated with pathogen infection. However, the expression of autophagy-related proteins has not been studied in chronic otitis media without cholesteatoma (COM) or with cholesteatoma (CholeOM). This study aimed to determine whether there is a difference between COM and CholeOM in autophagy-related gene mRNA expression. Subjects and Methods: For 47 patients with chronic otitis media, the inflammatory tissues were classified into granulation tissue (COM) or cholesteatoma (CholeOM) according to biopsy results. Results: PI3K mRNA expression (COM vs. CholeOM, mean±SD, 0.009±0.010 vs. 0.003±0.004; p=0.004) was lower, whereas Beclin-1 mRNA expression (0.089±0.107 vs. 0.176±0.163; p=0.034) was higher in the CholeOM group. Expression of PI3K mRNA in the CholeOM group was lower than that in the COM subgroups with presence of bacteria (0.022±0.019 vs. 0.001±0.001; p=0.001), otorrhea (0.049±0.068 vs. 0.003±0.004; p=0.004), and hearing loss over 40 dB (0.083±0.130 vs. 0.003±0.004; p=0.005). Conclusions: The data suggested that different autophagy proteins play important roles in chronic otitis media according to the presence or absence of cholesteatoma.

The prevalence of sensorineural hearing loss has increased along with increases in life expectancy and exposure to noisy environments. Metabolic syndrome (MetS) is a cluster of co-occurring conditions that increase the risk of heart disease, stroke and type 2 diabetes, along with other conditions that affect the blood vessels. Components of MetS include insulin resistance, body weight, lipid concentration, blood pressure, and blood glucose concentration, as well as other features of insulin resistance such as microalbuminuria. MetS has become a major public health problem affecting 20–30% of the global population. This study utilized health examination to investigate whether metabolic syndrome was related to hearing loss. Methods: A total of 94,223 people who underwent health check-ups, including hearing tests, from January 2010 to December 2020 were evaluated. Subjects were divided into two groups, with and without metabolic syndrome. In addition, Scopus, Embase, PubMed, and Cochrane libraries were systematically searched, using keywords such as “hearing loss” and “metabolic syndrome”, for studies that evaluated the relationship between the two. Results: Of the 94,223 subjects, 11,414 (12.1%) had metabolic syndrome and 82,809 did not. The mean ages of subjects in the two groups were 46.1 and 43.9 years, respectively. A comparison of hearing thresholds by age in subjects with and without metabolic syndrome showed that the average pure tone hearing thresholds were significantly higher in subjects with metabolic syndrome than in subjects without it in all age groups. (p &lt, 0.001) Rates of hearing loss in subjects with 0, 1, 2, 3, 4, and 5 of the components of metabolic syndrome were 7.9%, 12.1%, 13.8%, 13.8%, 15.5% and 16.3%, respectively, indicating a significant association between the number of components of metabolic syndrome and the rate of hearing loss (p &lt, 0.0001). The odds ratio of hearing loss was significantly higher in subjects with four components of metabolic syndrome: waist circumference, blood pressure, and triglyceride and fasting blood sugar concentrations (p &lt, 0.0001). Conclusions: The number of components of the metabolic syndrome is positively correlated with the rate of sensorineural hearing loss.

Although metabolic syndrome (MetS) has been associated with various diseases, few studies to date have addressed the association between MetS and hearing loss.This cross-sectional review of health examination center data sought to determine the association between MetS and hearing disturbance.This study involved 28,866 subjects. Height, weight, waist circumference, and blood pressure were measured, and basic blood tests and pure-tone audiometry (PTA) were performed. Other factors analyzed included body mass index, hypertension, diabetes mellitus, and hyperlipidemia.Age and gender did not differ between subjects with and without MetS. PTA was slightly higher in subjects with than without MetS, but the difference was not statistically significant (p = .47). The incidence of hearing loss was no higher in subjects who met three of the five diagnostic criteria of MetS than in those who met 0-2 criteria, but was significantly higher in subjects who met four (p = .04) and five (p .01) criteria.MetS may be associated with hearing loss, especially in subjects who meet four or five of the diagnostic criteria for MetS.

Objectives: Unfolded proteins in the endoplasmic reticulum (ER) cause an ER stress response and can result in various pathologic conditions, including inflammation. Otitis media is the most common disease in otolaryngology and is associated with inflammation. The pathophysiology of chronic otitis media is not well understood; we therefore investigated the expression pattern of ER stress-related mRNAs in chronic otitis media. Methods: Specimens were obtained from 47 patients with chronic otitis media over a period of 2 years. Expression levels of 6 ER stress transcription factors were quantitatively assessed using real-time RT-PCR. Results: The mRNA expression of sXBP1 was significantly higher in the otorrhea present group than in the otorrhea absent group (p < 0.05). ATF6 expression was significantly higher in the ossicle destruction group than in the ossicle intact group (p < 0.05). mRNA expression of the 6 ER stress-related genes did not differ significantly between those patients with positive microbial cultures versus those with negative cultures (p > 0.05) or those with facial nerve dehiscence versus those without facial nerve dehiscence (p > 0.05). Conclusions: sXBP1 appears to be involved in chronic otitis media-associated inflammation, including otorrhea. ATF6 is associated with the destruction of ossicles. Our results suggest that certain ER stress-related genes are expressed in chronic otitis media-associated inflammation.

Background: Neutrophil-to-lymphocyte ratio (NLR) has emerged as a marker for degree of inflammation. Inflammation has been regarded as one of the causes of idiopathic sudden sensorineural hearing l...

BACKGROUND AND OBJECTIVES Viral and vascular disorders are considered to be a major cause of idiopathic sudden sensorineural hearing loss (ISSNHL). Lipoprostaglandin E1 (lipo-PGE1) has vasodilating activity and has been used to treat ISSNHL. The purpose of this study was to determine the specific therapeutic effects of lipo-PGE1 and compare them to other treatment modalities for ISSNHL. SUBJECTS AND METHODS The study group had 1,052 patients diagnosed with ISSNHL. All were treated with steroid, carbogen inhalation, stellate ganglion block (SGB), or PGE1. The CP group (steroid, carbogen inhalation, and PGE1 injection; 288 patients) was treated with lipo-PGE1 and carbogen inhalation, the CS group (steroid, carbogen inhalation, and stellate ganglion block; 232 patients) with steroid, carbogen inhalation, and SGB, the C group (steroid and carbogen inhalation; 284 patients) with steroid and carbogen, and the control group (steroid only; 248 patients) with steroid only. Patients in the groups receiving lipo-PGE1 received a continuous infusion of 10 µL lipo-PGE1. RESULTS The overall recovery rate after treatment was 52.2%, and recovery rates by group were 67.7% in the CP group, 54.3% in the CS group, 52.1% in the C group, and 32.2% in the control group. Therefore, the therapeutic results in groups treated with lipo-PGE1 were better than results in other groups. The difference was statistically significant. CONCLUSIONS The study results suggested that the CP group received effective treatment modalities for ISSNHL. The combined therapy of lipo-PGE1 with carbogen inhalation in patients with ISSNHL was more beneficial than other treatment modalities.

Changes over time in pathogens and their antibiotic sensitivity resulting from the recent overuse and misuse of antibiotics in otitis media (OM) have complicated treatment. This study evaluated changes over 5 years in principal pathogens and their antibiotic sensitivity in patients in Korea diagnosed with acute OM (AOM) and OM with effusion (OME). The study population consisted of 683 patients who visited the outpatient department of otorhinolaryngology in 7 tertiary hospitals in Korea between January 2010 and May 2015 and were diagnosed with acute AOM or OME. Aural discharge or middle ear fluid were collected from patients in the operating room or outpatient department and subjected to tests of bacterial identification and antibiotic sensitivity. The overall bacteria detection rate of AOM was 62.3% and OME was 40.9%. The most frequently isolated Gram-positive bacterial species was coagulase negative Staphylococcus aureus (CNS) followed by methicillin-susceptible S. aureus (MSSA), methicillin-resistant S. aureus (MRSA), and Streptococcus pneumonia (SP), whereas the most frequently isolated Gram-negative bacterium was Pseudomonas aeruginosa (PA). Regardless of OM subtype, ≥ 80% of CNS and MRSA strains were resistant to penicillin (PC) and tetracycline (TC); isolated MRSA strains showed low sensitivity to other antibiotics, with 100% resistant to PC, TC, cefoxitin (CFT), and erythromycin (EM); and isolated PA showed low sensitivity to quinolone antibiotics, including ciprofloxacin (CIP) and levofloxacin (LFX), and to aminoglycosides. Bacterial species and antibiotic sensitivity did not change significantly over 5 years. The rate of detection of MRSA was higher in OME than in previous studies. As bacterial predominance and antibiotic sensitivity could change over time, continuous and periodic surveillance is necessary in guiding appropriate antibacterial therapy.

Background: Serum thyroid hormone levels are closely related to the normal functioning of the cochlea. However, the relationship between initial auditory brainstem response (ABR) results and levels...

Objectives We investigated the epidemiological and antibiotic resistance differences in methicillin-resistant Staphylococcus aureus (MRSA) infections in patients with otitis media with effusion (OME), acute otitis media (AOM), chronic suppurative otitis media (CSOM), and chronic cholesteatomatous otitis media (CCOM). Materials and methods We conducted a retrospective study of patients with newly identified MRSA infections from January 2009 through January 2017. Overall, 3,522 patients from 10 tertiary referral hospitals were included in the study. An antibiotic sensitivity test was performed for each isolate. Results MRSA infections in patients with CSOM and CCOM were more resistant to ciprofloxacin, clindamycin, erythromycin, gentamicin, levofloxacin, and tetracycline. Patients showed good susceptibility to rifampicin, trimethoprim/sulfamethoxazole (TMP/SMX), and vancomycin. Conclusion MRSA infections in various otitis media cases showed different resistance patterns. MRSA infections in patients with COM and CCOM were more resistant to antibiotics than those in patients with OME and AOM.

Underweight and severe obesity were associated with an increased prevalence of hearing loss in a Korean population.The relationship between weight and hearing loss is unclear. This study, therefore, analyzed the relationship between hearing loss and body mass index (BMI) in a Korean population.The prevalence and severity of hearing loss were assessed in 61 052 subjects who underwent health screening examinations, including hearing tests. Subjects were divided into five groups according to BMI (underweight, normal, overweight, obese, and severely obese). The relationships between the prevalence and severity of hearing loss and BMI were analyzed, after adjusting for the effects of age.The rates of mild or greater hearing loss in the underweight, normal, overweight, obese, and severely obese groups were 24.9%, 20.4%, 21.8%, 21.2%, and 24.1%, respectively. Mild severity of hearing loss was the most common in all five groups, followed by moderate, moderately severe, and severe hearing loss, in that order. Multivariate analysis, showed that the odds ratios of hearing loss in the severely obese, and underweight groups, compared with the normal group, were 1.312 and 1.282, respectively.

Although tinnitus patients have different audiometric configuration, we evaluated them using the same approach. Thus we analyzed the clinical features of patients with subjective tinnitus classified according to audiometric configuration.The study cohort consisted of 123 patients with subjective tinnitus who visited the tinnitus clinic from April 2013 to April 2014. Patients with a previous history of otologic disease or migrainous vertigo were excluded. Factors evaluated included pure tone audiometry, tinnitogram, auditory brainstem response (ABR), distortion product otoacoustic emissions (DPOAEs) and transient evoked otoacoustic emissions (TEOAEs).Tinnitus patients could be divided into three groups: Flat, high frequency gently sloping (HFGS) and high frequency steeply sloping (HFSS). HFGS showed female predominance and HFSS male predominance (p0.05 each). THI score was higher in the HFGS than in the other groups (p0.05). Tinnitus pitch and occupations varied, but showed specific tendencies in each group. On ABR, the HFSS group showed significant prolongation of wave I, III, and V latencies (p0.05 each). On DPOAEs, the HFSS group showed significantly lower response rates at 3, 4, and 6 kHz (p0.05 each). TEOAE normal rates were significantly higher in the Flat than in the HFGS and HFSS groups (p0.05).Average pure tone thresholds were similar, but threshold values at high frequencies, ABR, DPOAEs, and TEOAEs differed among the groups. Therefore, different access to tinnitus patients could be required according to audiometric shape.

Objective To investigate changes in Pseudomonas aeruginosa (PA) and methicillin-resistant Staphylococcus aureus (MRSA) and their antibiotic sensitivities over 13 years in patients diagnosed with chronic suppurative otitis media (CSOM). Materials and methods The current study reports on a retrospective analysis of the outcomes of 2256 outpatients who visited the Department of Otorhinolaryngology clinics of 3 tertiary medical centers and who were diagnosed with chronic otitis media (COM) or chronic cholesteatomatous otitis media (CCOM) from January 2001 to December 2013. Aural discharge was collected from each patient. Infectious bacteria were identified, and their antibiotic sensitivities were determined. Results The most frequent age range of patients diagnosed with CSOM was 41 to 50 years. In patients aged more than 30 years, CSOM was more frequent in females than in males, whereas in those aged less than 30 years, it was more frequent in males. Regardless of age, the isolated MRSA strains showed high sensitivity to vancomycin, teicoplanin, and trimethoprim/sulfamethoxazole, whereas the isolated PA strains showed high sensitivity to cefepime, amikacin, and ceftazidime. The isolation rate of MRSA in patients with CSOM slightly decreased over the 13-year study period; however, PA resistance to quinolones and aminoglycosides showed a tendency to increase. Conclusion Bacteria isolated from patients with CSOM showed little change between 2001 and 2013, whereas their antibiotic resistance showed changes; in particular, increased PA resistance to quinolones was observed. Empirical antibiotic treatment can lead to bacterial resistance, and changes in antimicrobial agents commonly used to treat CSOM should be considered.

BackgroundSinonasal inverted papilloma (IP) is one of the most common benign tumors of the sinonasal area and malignant transformation has frequently been reported. However, the exact mechanism of the transition from benign lesion to malignancy is not known. The Wnt signaling pathway involves a network of multiple signaling glycoproteins that are known to play an important role in embryogenesis and carcinogenesis.ObjectiveThe purpose of this study was to evaluate the role of the Wnt pathway and signaling proteins in malignant transformation of IP to dysplasia and squamous cell carcinoma.MethodsExpression of the Wnt signaling pathway proteins, including Wnt-1, beta-catenin, cyclin D1, and Dishevelled-1 (Dvl-1), were detected by immunohistochemistry by using 3-mm tissue core microarrays that consisted of 115 cores of IP tissue. Each of the IP cores was graded as I (prominent squamous metaplasia), II (inverted pattern), III (dysplasia), or IV (squamous cell carcinoma). The expression pattern of each protein and the correlation between the expression of each target protein and IP grade were evaluated.ResultsMembranous staining of beta-catenin showed a significant positive correlation with IP grade (ρ = 0.247, p < 0.001), as did staining of cyclin D1 (ρ = 0.365, p < 0.001), which showed a nuclear pattern and staining of Dvl-1 (ρ = 0.380, p < 0.001), which showed a membranous, cytoplasmic, and nuclear pattern. For Dvl-1, a nuclear expression pattern was more frequently observed in grade III and IV IP (p = 0.036). In the case of Wnt-1, cytoplasmic expression was observed; however, it did not show a significant correlation with IP grade (ρ = 0.141, p = 0.130).ConclusionsWnt signaling proteins, including beta-catenin, cyclin D1, and Dvl-1, may play crucial roles in the malignant transformation of IP.

Fusarium graminearum is a filamentous fungal plant pathogen that infects major cereal crops. The fungus produces both sexual and asexual spores in order to endure unfavorable environmental conditions and increase their numbers and distribution across plants. In a model filamentous fungus, Aspergillus nidulans, early induction of conidiogenesis is orchestrated by the fluffy genes. The objectives of this study were to characterize fluffy gene homologs involved in conidiogenesis and their mechanism of action in F. graminearum. We characterized five fluffy gene homologs in F. graminearum and found that FlbD is the only conserved regulator for conidiogenesis in A. nidulans and F. graminearum. Deletion of fgflbD prevented hyphal differentiation and the formation of perithecia. Successful interspecies complementation using A. nidulans flbD demonstrated that the molecular mechanisms responsible for FlbD functions are conserved in F. graminearum. Moreover, abaA-wetA pathway is positively regulated by FgFlbD during conidiogenesis in F. graminearum. Deleting fgflbD abolished morphological effects of abaA overexpression, which suggests that additional factors for FgFlbD or an AbaA-independent pathway for conidiogenesis are required for F. graminearum conidiation. Importantly, this study led to the construction of a genetic pathway of F. graminearum conidiogenesis and provides new insights into the genetics of conidiogenesis in fungi.

Objectives. Although many studies have assessed sudden deafness in adults, sudden deafness has not been evaluated in children. We therefore evaluated the differences in sudden deafness between children and adults. Methods. We compared clinical manifestations, including gender, audiogram pattern of initial hearing loss, and recovery rate after treatment in 87 children and 707 adults diagnosed with sudden deafness from September 2003 and August 2012. Results. There were no differences in sex, side, or audiogram between children and adults (P>0.05 each). Hearing recovery rates in children and adults were 72.4% and 70.6%, respectively (P>0.05). Both children and adults with mild hearing loss showed significantly greater hearing recovery rates than individuals with profound hearing loss (P

Mungbean, Vigna radiata (L.) R. Wilczek, is an important legume crop in many countries, providing protein and other essential nutrients. In October 2017, at the Seoul National University Suwon Experimental Farm (Suwon, Republic of Korea), we observed several individual plants across various mungbean accessions with dark-brown leaf spots. Spots were most prominent on the underside of the leaf and were circular to irregular in shape. On average, the diameter of spots was approximately 2 mm. A standard tissue isolation method was used, and a total of seven fungal isolates were made. The produced conidia were beaked or beakless, had transverse and sometimes latitudinal septa, ellipsoid or obclavate, with an average width of 11 µm and an average length of 22 µm, similar to the description of Alternaria alternata by Woudenberg et al. (2015). Genomic DNA of the fungi from two out of seven isolates was extracted using GeneAll Exgene Plant SV mini (Seoul, Republic of Korea). Using each DNA as a template, we amplified the internal transcribed ribosomal spacer region (ITS) and the 28s large subunit ribosomal RNA D1/D2 region using ITS1/ITS4 primers (White et al. 1990) and NL1/NL4 primers (Reynolds and Taylor 1993), respectively. BLAST analysis of these amplicon sequences showed 100% identity match to those of A. alternata, and the sequence was deposited in GenBank (no. MH633697-700). Furthermore, we compared ITS and D1/D2 sequences to the A. alternata reference sequence from Woudenberg et al. (2015) by aligning the sequences using ClustalW (BioEdit, version 7.0.5.3). Both of the isolates had >99.99% sequence identity with the reference. Based on both sequencing and morphological information, we concluded that the isolates were A. alternata. To fulfill Koch’s postulates, we carried out both in vivo and in vitro inoculation tests. For in vitro test, we harvested the conidia by flooding the fungal plate with 0.1% Tween 20. The concentration of spores was adjusted to 1 × 10⁵ conidia/ml by further diluting with 0.1% Tween 20. Detached leaves from 3-week-old mungbean plants were sprayed with the conidia suspension until there was surface run-off, and the leaves were placed in a humidity chamber. The control leaves were sprayed with 0.1% Tween 20. After 5 days, we observed brown spots on the surface of the leaves, but no symptoms appeared on the control plants. For the in vivo test, 1-month-old potted mungbean plants were inoculated with conidia suspended in sterile distilled water adjusted to 1 × 10⁴ conidia/ml. Each plant was sprayed with 5 ml of solution. The in vivo test showed a similar symptom to the in vitro test, producing brown leaf spots. From the brown leaf spots, we again isolated the fungi and sequenced the 28s large subunit ribosomal RNA D1/D2 region. The sequencing result showed 100% similarity of the reisolate with the original inoculum, fulfilling Koch’s postulates. To our knowledge, this is the first report that A. alternata causes leaf spot disease in mungbean in Korea. This report helps to develop mungbean cultivars resistant to biotic stresses affecting mungbean yield.

Recent studies have shown that allergic diseases may be associated with the pathogenesis of recurrent otitis media with effusion (OME). We aimed to assess the relationship between OME and allergic diseases and other types of disease in children with OME. We also evaluated the between group differences in the characteristics of middle ear effusion.We evaluated 370 patients diagnosed with OME between January 2007 and December 2012 and, as a control group, 100 children with no medical history of OME but who had undergone blood tests and MAST-CLA (multiple allergosorbent test - chemiluminescent assay) were selected.Among the allergic diseases, the incidence of allergic rhinitis alone was significantly higher in children with OME (33.8%) than without OME (16.0%) (p0.05). The rate of adenoid, but not tonsil, hypertrophy was significantly greater in patients with than without OME also (p0.05). When we evaluated the characteristics of middle ear effusion (MEE) in patients with OME, we found that 186 had serous, 129 had mucous and 55 had purulent MEE. Of these patients, 75 (40.3%), 36 (27.9%) and 14 (25.5%), respectively, had allergic rhinitis and the rates of allergic rhinitis and asthma were significantly higher in the serous group than in the mucous group (p0.05).Allergic rhinitis was significantly more frequent among pediatric patients with than without OME, although the rates of other allergic diseases did not differ in these two groups. The likelihoods of allergic rhinitis and asthma were higher in patients with serous than with mucous MEE.

Background and Objectives To investigate whether taste thresholds, as determined by electrogustometry (EGM) and chemical taste tests, differ by age and the severity of facial palsy in patients with Bell's palsy. Subjects and Methods This study included 29 patients diagnosed with Bell's palsy between January 2014 and May 2015 in our hospital. Patients were assorted into age groups and by severity of facial palsy, as determined by House-Brackmann Scale, and their taste thresholds were assessed by EGM and chemical taste tests. Results EGM showed that taste thresholds at four locations on the tongue and one location on the central soft palate, 1 cm from the palatine uvula, were significantly higher in Bell's palsy patients than in controls (p0.05). The severity of facial palsy did not affect taste thresholds, as determined by both EGM and chemical taste tests (p>0.05). The overall mean electrical taste thresholds on EGM were higher in younger Bell's palsy patients than in healthy subjects, with the difference at the back-right area of the tongue differing significantly (p0.05). Conclusions Electrical taste thresholds were higher in Bell's palsy patients than in controls. These differences were observed in younger, but not in older, individuals.

Background and Objectives Viral and vascular disorders are considered to be a major cause of idiopathic sudden sensorineural hearing loss (ISSNHL). Lipoprostaglandin E1 (lipo-PGE1) has vasodilating activity and has been used to treat ISSNHL. The purpose of this study was to determine the specific therapeutic effects of lipo-PGE1 and compare them to other treatment modalities for ISSNHL. Subjects and Methods The study group had 1,052 patients diagnosed with ISSNHL. All were treated with steroid, carbogen inhalation, stellate ganglion block (SGB), or PGE1. The CP group (steroid, carbogen inhalation, and PGE1 injection; 288 patients) was treated with lipo-PGE1 and carbogen inhalation, the CS group (steroid, carbogen inhalation, and stellate ganglion block; 232 patients) with steroid, carbogen inhalation, and SGB, the C group (steroid and carbogen inhalation; 284 patients) with steroid and carbogen, and the control group (steroid only; 248 patients) with steroid only. Patients in the groups receiving lipo-PGE1 received a continuous infusion of 10 µL lipo-PGE1. Results The overall recovery rate after treatment was 52.2%, and recovery rates by group were 67.7% in the CP group, 54.3% in the CS group, 52.1% in the C group, and 32.2% in the control group. Therefore, the therapeutic results in groups treated with lipo-PGE1 were better than results in other groups. The difference was statistically significant. Conclusions The study results suggested that the CP group received effective treatment modalities for ISSNHL. The combined therapy of lipo-PGE1 with carbogen inhalation in patients with ISSNHL was more beneficial than other treatment modalities.

Objectives. To assess the rate of isolation of Pseudomonas aeruginosa (PA) and multidrug-resistant PA (MDR-PA) from patients with chronic suppurative otitis media (CSOM) otorrhea and the annual trend of antibiotic-resistance. Methods. Otorrhea samples were collected aseptically from 1,598 CSOM patients. The rate of bacterial isolation and the results of antibiotic susceptibility testing were evaluated retrospectively. Results. The PA isolation rate from CSOM otorrhea was 24.4%. Of the 398 isolated strains tested for their susceptibilities to 10 antibiotics, 395 strains showed definitive results. Of these, 183 (46.3%) were susceptible to whole antibiotics and 212 (53.7%) was resistant to more than 1 antibiotics, with the frequency of antibiotics-resistance increasing significantly over time. Although strains susceptible to all antibiotics decreased over time, the rate of isolation of MDR-PA did not change significantly. Resistance to aminoglycosides and quinolones was higher than to other antibiotics and significantly increased over time, whereas resistance to other antibiotics showed no trend. Conclusion. MDR-PA, assessed using five individual antibiotics and six antibiotic-classes, showed no tendency to increase or decrease over time. This may have been due to increased concern about antibiotic-resistant bacterial strains, leading to improved infection control within hospitals and healthcare centers.

Temporal bone fractures are traditionally classified as transverse, longitudinal or mixed. Since these categories have shown little association with clinical symptoms, new classifications have been introduced, including those related to the involvement of the petrous bone and otic capsule. We have formulated a new classification based on the involvement of four parts of the temporal bone (squama, tympanic, mastoid, and petrous) and assessed which of these classification systems is the most rational using a retrospective chart review in hospital settings (KyungHee Medical Center, Seoul, Korea and Samsung Changwon Hospital, Changwon, Korea). The association between each classification and clinical symptoms was examined by analyzing temporal bone computed tomography scans of 129 patients diagnosed as temporal bone fractures over the past 7 years. Using the traditional classification, there was a significant correlation between transverse fractures and the incidence of sensorineural hearing loss. Patients with petrous bone fractures had significantly higher incidence rates of sensorineural hearing loss, vertigo, and eardrum perforation than patients without petrous bone involvement. Involvement of the otic capsule was significantly associated with sensorineural hearing loss and the severity of hearing loss. The associations of the traditional classification and the classification according to the involvement of the otic capsule, four parts of temporal bone with clinical symptoms were not high. Petrous bone fractures were significantly associated with sensorineural hearing loss, vertigo, and eardrum perforation, suggesting that this classification may be optimally associated with clinical symptoms including hearing and the results of otological examination.

Objective. Although topical decongestants and anesthetics are widely used in preparation for nasal endoscopy, no con- trolled trials have evaluated the effects of these agents on olfaction. Study Design. Randomized double-blinded controlled trial. Setting. Tertiary referral hospital. Materials and Methods. The authors recruited 72 healthy subjects and randomly assigned them to 1 of 4 groups (control, phenylephrine group, lidocaine group, and both agents). After baseline tests with the Korean version of Sniffin' Stick Test II (KVSS II), topical agents were applied to each nostril. Fifteen minutes later, repeat tests were car- ried out. Pre- and postspray results of the olfactory tests were compared, and the differences among groups were analyzed. Results. The mean 6 SD prespray KVSS II score of the study group was 30.2 6 3.8, and there were no statistically signifi- cant differences among the study groups (P = .353). Mean 6 SD pre- and postspray KVSS II scores were 29.0 6 3.5 and 30.7 6 3.7 (P = .128) in the control group, 30.6 6 3.6 and 31.7 6 3.3 (P = .262) in the phenylephrine group, and 31.4 6 3.6 and 32.1 6 3.1 (P = .557) in the lidocaine group, respec- tively. In the phenylephrine and epinephrine spray group, the mean 6 SD pre- and postspray scores were 29.9 6 4.4 and 31.3 6 3.7 (P = .071), respectively. Conclusions. Neither topical intranasal phenylephrine nor lidocaine use affected the results of the olfactory test, even when the agents were used in combination.

Objectives. To investigate the changes in gustatory function as a complication after radiofrequency tongue base reduction (RTBR) in patients with obstructive sleep apnea (OSA). Study Design. Before-and-after study. Setting. Academic tertiary medical center. Subjects and Methods. Thirty-four patients with suspected velopharyngeal collapse only underwent uvulopalatopharyngo- plasty (UPPP group). Twenty-five patients with velopharyngeal and retrolingual collapse underwent concurrent UPPP with RTBR (RTBR group). All patients were evaluated before surgery and at 1 and 4 weeks after surgical treatment. A questionnaire was given to assess symptoms of hypogeusia, dysgeusia, hypos- mia, and sensation of the tongue. Electrogustometry (EGM) in 4 areas was used to determine gustatory function. Results. Postoperative values for subjective symptoms did not significantly change following surgical treatment in either group. EGM thresholds of all tested in both groups did not significantly change 1 week and 4 weeks after surgery. Conclusions. Gustatory function remained unchanged after RTBR in patients with OSA. The authors suggest that RTBR is a safe procedure in terms of taste sensation in OSA patients.

Purpose The purpose of this study was to evaluate the efficacy of combined therapy with steroid, carbogen inhalation, and lipoprostaglandin E1 (lipo-PGE1) treatment and compare the results with other treatment modalities in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). Subjects and methods The study group consisted of 670 patients diagnosed with unilateral ISSNHL. Two hundred patients (DCP group) were treated with steroid, lipo-PGE1 and carbogen inhalation combination therapy, 194 patients (DC group) with steroid and carbogen inhalation, and 276 patients (D group) with steroid medication only. The therapeutic effects of the treatment groups were evaluated 2 months after treatment, using pure tone averages. Siegel's criteria for hearing improvement were used for the assessments. Results The overall recovery rate after treatment was 57.5%. For each group, the recovery rate was as follows: 67.0% in the DCP group, 52.6% in the DC group, and 53.9% in the D group. The DCP group had a significantly better improvement rate than the other 2 groups. In addition, the DCP treatment was better than the other 2 groups for patients: less than 50 years of age, with an initial hearing loss less than 90 dB HL, had treatment started within 1 week from the onset of hearing loss, had tinnitus or an ascending type audiogram, and/or had no vertigo. Conclusion Steroid, lipo-PGE1, and carbogen inhalation therapy was more effective than the other treatment modalities studied for patients with ISSNHL.

Pattern recognition receptors (PRRs) induce appropriate immune responses after recognizing certain molecular characteristics of pathogens. It is not known, however, whether PRRs are expressed in middle ear infections and whether the expression of PRRs and immunoglobulins is correlated in recurrent otitis media with effusion (OME). We therefore investigated the expression of PRRs and immunoglobulins in children with OME.The study population consisted of 66 children with OME, of whom 27 had more than 4 episodes in 12 months or more than 3 episodes in 6 months (otitis-prone group), and 39 had fewer than 4 episodes in 12 months or 3 episodes in 6 months (non-otitis-prone group). The expression in middle ear effusion of Toll-like receptor (TLR)-9, nucleotide-binding oligomerization domain (NOD)-1, NOD-2, and retinoic acid-inducible gene (RIG)-I mRNA, as determined by real-time PCR, and the concentrations of IgG, IgA, and IgM, as determined by ELISA, were compared between the two groups.The levels of TLR-9, NOD-1 and RIG I mRNAs were significantly lower in the otitis-prone than in the non-otitis-prone group (p0.05 each). The concentrations of IgG, IgA and IgM in effusion fluid did not differ significantly between the two groups (p0.05), and there were no correlations between immunoglobulin concentration and the expression of PRPs (p0.05).Decreased expression of PRRs may be associated with increased susceptibility to OME.

Objective To evaluate the level of immunogloblins and expression of the transcription factors in the adenoids. Methods The study population consisted of 30 children with otitis media with effusion (OME), 22 children with chronic rhinosinusitis (CRS) and 27 children with adenoid hyperplasia. IgA, IgG, IgD and IgM concentrations in these three groups were compared immunohistochemically. We also compared the levels of expression of B lymphocyte inducer of maturation program 1 (BLIMP-1), a promoter of plasmacytosis, and B cell leukemia/lymphoma-6 (BCL-6), a repressor of plasmacytosis, in the adenoids of these children. Results The expression of antibody to Ig A in the OME and CRS groups each was significantly lower than the score in the adenoid hyperplasia group. The staining scores of antibodies to IgG, IgD and Ig M did not differ significantly among the three groups. The expression of antibody to BLIMP-1 in the CRS and adenoid hyperplasia groups showed a significant difference. Staining scores of Antibody to BCL-6 did not differ significantly among the three groups. Conclusions We found that the reduction of IgA in the adenoids was associated with pediatric OME and CRS, and that reduction of expression of the transcription factor BLIMP-1 rather than BCL-6 was associated with CRS.

Objectives OK-432 has been widely used to treat lymphangioma and ranula; however, there are few studies for its use in treatment of branchial cleft cyst (BCC). We conducted this study to evaluate the effectiveness of sclerotherapy using OK-432 in treatment of BCC. Study Design and Setting Case series with planned data collection. Subjects and Methods From 2004 to 2007, we treated 23 patients with BCC using OK-432 sclerotherapy. Of these 23 patients, 18 had unilocular cysts and five had multilocular cysts. The sizes of the BCCs were measured and compared before and after treatment. Results Of the 23 cases, 14 (60.8%) showed complete regression; all of these were unilocular cysts. Of the remaining individuals with unilocular cysts, only one patient failed to show any response. This individual subsequently underwent surgical excision. A total of five patients with multilocular cysts showed no or partial response and subsequently underwent surgical excision. Minor adverse effects including fever and local pain were reported by 13 (56.5%) patients. Conclusion These results suggest that sclerotherapy using OK-432 is an effective and safe treatment modality for BCC, especially for unilocular cysts. Sclerosing of unilocular BCC with OK-432 should therefore be considered before surgical excision.

Patients with epiglottic abscesses showed more severe symptoms than those with acute epiglottitis and were at increased risk of airway compromise. All 11 patients with epiglottic abscesses underwent spinal needle aspiration; all were cured without severe complications. These findings indicate that spinal needle aspiration is both safe and effective in patients with epiglottic abscesses.Acute epiglottitis is a disease that may become serious or even fatal because of sudden upper airway obstruction. An epiglottic abscess may result from a coalescent epiglottic infection due to acute epiglottitis or secondary infection of an epiglottic mucocele. There have been few reports comparing acute epiglottitis with epiglottic abscess. We therefore assessed the clinical characteristics of each condition, as well as the efficacy of spinal needle aspiration and drainage of epiglottic abscesses.We retrospectively reviewed the records of 90 hospitalized patients diagnosed with acute epiglottitis and epiglottic abscess by flexible nasopharyngolaryngoscopy between March 2006 and February 2008. All patients were treated with medication; in addition, those with epiglottic abscess underwent spinal needle aspiration.Of 90 patients, 79 had acute epiglottitis and 11 had epiglottic abscesses. Acute epiglottitis was most common in May (16.5%) and epiglottic abscesses were most common in June (27.3%). The most common symptoms were sore throat (91.1%), dysphagia (38.9%), voice change (33.3%), and dyspnea (16.7%). All patients were treated with antibiotics and steroids. The mean length of hospitalization was 5 days. No patient required a tracheostomy or orotracheal intubation.

Background and Objectives: In general, benign neck cysts are treated by surgical excision. This can present technical difficulties and frequent recurrences, because of insufficient surgery. Sclerosing agents such as OK-432 have been tested for the nonsurgical treatment of these cysts. We have assessed the efficacy of OK-432 sclerotherapy for benign neck cysts. Materials and Methods: The study group consisted of 75 patients (42 men, 33 women) diagnosed with and treated for benign neck cysts between March 2001 and December 2007 by intralesional injection of OK-432. The liquid content of each cyst was aspirated as much as possible, and the same volume of OK-432 solution was injected. Patients were assessed by ultrasonography or computerized tomography, and therapeutic outcomes and adverse effects were evaluated by patient age, sex, cyst type, and number of injections. Results: Of the 75 treated patients, 31 (41.3%) showed total shrinkage, seven (9.3%) showed near-total shrinkage (>90% of cyst volume), five (6.6%) showed marked shrinkage (>70% of cyst volume), and 17 (22.7%) showed partial shrinkage (

Factors prognostic of recovery from low frequency sensorineural hearing loss without vertigo are co-occurrence of tinnitus, PTA determined hearing level on the affected side before treatment initiation, and time from onset to treatment initiation. The rate of hearing recovery was higher in the oral steroid than in the intra-tympanic steroid and combined groups.Although many studies have assessed acute sudden hearing loss, few have analyzed low-frequency hearing loss. Clinical characteristics of patients with hearing loss may vary by type of hearing loss. This study, therefore, analyzed the clinical characteristics, recovery rates, and factors associated with hearing recovery in patients with low-frequency sensorineural hearing loss unaccompanied by vertigo.This study included 50 patients with severe low frequency hearing loss unaccompanied by vertigo and with normal tympanic membrane status who visited hospitals from July 2005 to May 2014 due to sudden tinnitus, ear fullness, or hearing loss. Of these patients, 29 were treated with oral steroids, eight with tympanic steroid injections, and 13 with both. Clinical and auditory characteristics before and after treatment, as well as treatment outcomes, were compared in these three groups.Age, sex, affected side, co-occurrence of ear fullness, and accompanying chronic diseases were similar in the three groups. All patients started on treatment within 10 days of hearing loss showed significant recovery, with complete recovery, unaccompanied by tinnitus, observed in 10 patients. Treatment outcomes were not affected by hearing thresholds on the unaffected side. Of the patients treated with both oral and intra-tympanic steroids, 39% showed complete recovery, and 77% showed audiometric improvement. The complete recovery rate was significantly higher in the oral steroid than in the other two groups (p = 0.029); and the audiometric improvement rate tended to be lower in the intra-tympanic steroid group than in the other groups. Cure rates, defined as complete disappearance of symptoms and normal findings on pure tone audiograms (PTA), in the oral, intra-tympanic, and combined steroid groups were 49%, 25%, and 23%, respectively. There were no significant differences among the three groups in cure, subjective improvement, and audiometric improvement rates. Factors prognostic of non-recovery of hearing included late treatment initiation (p = 0.044), accompanying tinnitus (p = 0.049), and higher hearing thresholds on the affected side before treatment initiation (p = 0.005).

In this paper, seismic qualification analysis for the Plant control Panel is carried out to confirm the structural integrity under the seismic conditions represented by required response spectra(RRS). The finite element method(FEM) is used for the analysis and a mode combination method is adopted to obtain a more reliable spectrum analysis results. In addition, the experimental analysis is performed to compare the reliability of the analytical results. The analysis results shows that the plant control panel system is designed to have the dynamic rigidity with no resonance frequency below 33 Hz. The analytically calculated maximum stress of the plant control panel system is of the field strength of material, thus it can be shown that the system has a stable structure for the seismic load.

This paper is the result of a experimental study about non-linear one to one modal coupling of a flexible circular cantilever beam which was transversely excited with harmonic excitation. It was proved that 2 order jumping in out of plane was caused by jump phenomenon in in-plane of flexible circular cantilever beam, because of non-linear coupling. In addition, cantilever beam showed hardening spring characteristics in in-plane and softening spring characteristics in out-of-plane.

The increased expression of Dec-205, Bcl-10, Tim-3, and Trem-1 mRNAs indicates that these pattern recognition receptors are involved in the pathogenesis of cholesteatoma.Changes in expression of pattern recognition receptors may be associated with immune responses in patients with cholesteatoma. We therefore assessed the levels of expression of Dec-205, Bcl-10, Tim-3, and Trem-1 mRNAs associated with innate immune responses in patients with cholesteatoma.Cholesteatoma specimens were collected from 23 patients diagnosed with acquired cholesteatoma from August 2010 to July 2012. The posterior auricular skin of each patient was used as control. The levels of expression of Dec-205, Bcl-10, Tim-3, and Trem-1 mRNA were assessed quantitatively using real-time RT-PCR and correlated with sex, hearing level, the presence of bacteria, and the need for repeat surgery.The levels of expression of Dec-205, Bcl-10, Tim-3, and Trem-1 mRNAs were significantly higher in cholesteatoma than in control skin samples (p0.05 each). However, mRNA abundance was not associated with patient sex, hearing level, presence of bacteria or history of reoperation (p0.05 each).

Objectives. Otitis media (OM) is an infectious disease that affects all age brackets. Aural discharge is a typical symptom, occurring in all subtypes of OM. We have compared the identity and antibiotic sensitivity of bacteria isolated from aural discharges of adults and children with various types of OM, including acute OM (AOM), OM with effusion (OME), chronic OM (COM), and cholesteatomatous OM (CSOM). Methods:Me study involved 2,833 patients who visited five tertiary hospitals between January 2001 and December 2010 and were diagnosed with AOM, OMB, COM, or CSOM. The patients were divided into a pediatric group and an adult group, and the distribution of cultured bacteria and their antibiotic sensitivity were compared in the two groups. Results. Bacterial detection rates were higher in adults than in children with OME and COM (P=0.000 each). The majority of the bacteria cultured from patients with AOM and OME bacteria were methicillin-susceptible Staphylococcus aureus (MSSA) and Streptococcus pneumoniae. Bacteria cultured from children were more susceptible to antibiotics (P=0.002) and had higher antibiotic sensitivity (P=0.001) than were bacteria cultured from adults. The majority of bacteria culture from patients with COM and CSOM were MSSA and pathogenic Pseudomonas aeruginosa. The frequency of methicillin-resistant Staphylococcus aureus was significantly higher in adults than in children, and more strains of bacteria isolated from adults were sensitive to the antibiotics septrin, vancomycin, and teicoplanin. Conclusion. Bacteria cultured from children were more susceptible to antibiotics and had higher antibiotic sensitivity than did bacteria cultured from adults.

BackgroundAlthough hearing loss may be caused by various factors, it is also a natural phenomenon associated with the aging process. This study was designed to assess the contributions of diabetes mellitus (DM) and hypertension, both chronic diseases associated with aging, as well as aging itself, to hearing loss in health screening examinees.MethodsThis study included 37,773 individuals who underwent health screening examinations from 2009 to 2012. The relationships between hearing threshold and subject age, hearing threshold at each frequency based on age group, the degree of hearing loss and the presence or absence of hypertension and DM were evaluated.ResultsThe prevalence of hearing loss increased with age, being 1.6%, 1.8%, 4.6%, 14.0%, 30.8%, and 49.2% in subjects in their twenties, thirties, forties, fifties, sixties, and seventies, respectively (pConclusionsThe prevalence of hearing loss increases with age and the presence of DM. Hearing loss was greatest at high frequencies. In all age groups, mild hearing loss was the most common form of hearing loss.

Fusarium graminearum , a prominent fungal pathogen that infects major cereal crops, primarily utilizes asexual spores to spread disease. To understand the molecular mechanisms underlying conidiogenesis in F. graminearum , we functionally characterized the F. graminearum ortholog of Aspergillus nidulans wetA , which has been shown to be involved in conidiogenesis and conidium maturation. Deletion of F. graminearum wetA did not alter mycelial growth, sexual development, or virulence, but the wetA deletion mutants produced longer conidia with fewer septa, and the conidia were sensitive to acute stresses, such as oxidative stress and heat stress. Furthermore, the survival rate of aged conidia from the F. graminearum wetA deletion mutants was reduced. The wetA deletion resulted in vigorous generation of single-celled conidia through autophagy-dependent microcycle conidiation, indicating that WetA functions to maintain conidial dormancy by suppressing microcycle conidiation in F. graminearum . Transcriptome analyses demonstrated that most of the putative conidiation-related genes are expressed constitutively and that only a few genes are specifically involved in F. graminearum conidiogenesis. The conserved and distinct roles identified for WetA in F. graminearum provide new insights into the genetics of conidiation in filamentous fungi.

Backgound The purpose of this study was to investigate differences in the extent of disease in patients with chronic rhinosinusitis (CRS) both with and without asthma. Methods Medical records and computed tomographic (CT) scans of 48 consecutive asthmatic patients and 523 nonasthmatic patients with CRS between April 1995 and December 2001 were reviewed, retrospectively. Each sinus in the ostiomeatal complex CT scans was assigned a score of 0–2 according to the extent of disease using the Lund-Mackay scoring system, and the ratios of the score of each sinus to the total score were analyzed for the difference between the asthmatic and nonasthmatic groups. A Mann-Whitney test was used for statistical evaluation, with p < 0.05 accepted as statistically significant. Results The ratios of ethmoid sinus score to total score were higher in asthmatic patients than in nonasthmatic patients (p < 0.001), and the ratios of the score of maxillary sinus to total score were lower in asthmatic patients than in nonasthmatic patients (p < 0.001). Conclusion Our study shows that the ethmoid sinus is the preferred site of CRS in patients with coexisting asthma.

Conclusion: Contrary to our expectation, that the clinical characteristics of temporal bone fracture would differ in children and adults, we found that the two groups were similar. Objectives: Most studies of temporal bone fractures have been performed in adults. To our knowledge, no study has investigated differences in temporal bone fractures in children and adults. We therefore investigated differences in temporal bone fractures in adults and children by examining the manifestations and clinical symptoms of temporal bone fractures in pediatric patients. Methods: The demographic and clinical characteristics were assessed in 32 children and 186 adults with temporal bone fractures. All patients underwent computed tomography of the temporal bone. Results: Causes of fracture, gender distribution, manifestations of temporal bone fracture, and clinical symptoms were similar in adults and children (p > 0.05 each). Petrous fracture, ear fullness, dizziness, and tinnitus were significantly more frequent...

Fusarium graminearum (teleomorph Gibberella zeae) is a prominent pathogen that infects major cereal crops such as wheat, barley, and maize. Both sexual (ascospores) and asexual (conidia) spores are produced in F. graminearum. Since conidia are responsible for secondary infection in disease development, our objective of the present study was to reveal the molecular mechanisms underlying conidiogenesis in F. graminearum based on the framework previously described in Aspergillus nidulans. In this study, we firstly identified and functionally characterized the ortholog of AbaA, which is involved in differentiation from vegetative hyphae to conidia and known to be absent in F. graminearum. Deletion of abaA did not affect vegetative growth, sexual development, or virulence, but conidium production was completely abolished and thin hyphae grew from abnormally shaped phialides in abaA deletion mutants. Overexpression of abaA resulted in pleiotropic defects such as impaired sexual and asexual development, retarded conidium germination, and reduced trichothecene production. AbaA localized to the nuclei of phialides and terminal cells of mature conidia. Successful interspecies complementation using A. nidulans AbaA and the conserved AbaA-WetA pathway demonstrated that the molecular mechanisms responsible for AbaA activity are conserved in F. graminearum as they are in A. nidulans. Results from RNA-sequencing analysis suggest that AbaA plays a pivotal role in conidiation by regulating cell cycle pathways and other conidiation-related genes. Thus, the conserved roles of the AbaA ortholog in both A. nidulans and F. graminearum give new insight into the genetics of conidiation in filamentous fungi.