• 임상이비인후과
• /
• 제29권2호
• /
• pp.190-197
• /
• 2018

Background and Objectives : Positional OSAS is characterized by an apnea-hypopnea index (AHI) score >5, which, while sleeping in the supine position, is double that in non-supine position. This study was performed to compare the clinical characteristics of positional OSAS and non-positional OSAS patients, and the effects of the modified jaw thrust maneuver during drug-induced sleep endoscopy (DISE) between positional OSAS and non-positional OSAS patients. Materials and Methods : 68 positional OSAS patients and 19 non-positional OSAS patients were included. They all underwent full-night polysomnography and DISE. The modified jaw thrust maneuver was introduced during DISE. Airway structural changes induced by the modified jaw thrust maneuver were evaluated and documented. Results : There were no statistically significant differences in Friedman stage or tonsil grade, body mass index, Epworth sleepiness scale (ESS) score, blood pressure, AHI, or obstructive pattern between the positional and non-positional OSAS patients. However, mean arterial oxygen saturation (SaO2), lowest SaO2, and total arousal index values were more severe in the non-positional OSAS patients. After introduction of the modified jaw thrust maneuver, retrolingual level obstruction showed a tendency toward a higher rate of airway opening in positional OSAS patients than in non-positional OSAS patients. Conclusions : The effects of a mandibular advancement device (MAD) can be estimated by carrying out a modified jaw thrust maneuver during DISE. The tendency toward a higher rate of airway opening in positional OSAS patients than non-positional OSAS patients in retrolingual level obstruction after jaw thrust maneuver introduced during DISE may be clinically important for MAD.

• Journal of Audiology & Otology
• /
• 제25권1호
• /
• pp.43-48
• /
• 2021

Background and Objectives: Conflicting mechanisms have been reported about spontaneous reversal of positional nystagmus during head-roll maneuver in patients with benign paroxysmal positional vertigo (BPPV). The objective of this study is to review the reports about the characteristics and possible mechanisms of reversing positional nystagmus and to present seven new cases. Subjects and Methods: Seven cases (5 males, 2 females; 4 left-sided, 3 right-sided) were recruited among 732 patients with BPPV seen outpatient clinic between 2009 and 2019. Diagnosis of lateral canal canalolithiasis was confirmed when transient geotropic nystagmus was documented during head-roll test. Reversing positional nystagmus was analyzed in each case and clinical characteristics of the patients were documented. Results: The age of patients was ranging between 30 to 64 years (46.44±10.91). Duration of symptoms was short (21.34±19.74). Six of them had a story of head trauma. Initial latency was short. First, intense geotropic nystagmus was observed following provocative head-roll position on the affected side. There was short "silent phase". Then, a longer second-phase of reversed nystagmus was noted. Total duration of nystagmus was 78.40±6.82 seconds. Maximal slow phase velocity was 24.05±6.34 deg/sec. All patients were cured with barbeque maneuver. Conclusions: Ipsilateral reversing positional nystagmus during head-roll maneuver is due to lateral canal canalolithiasis. Mechanism is likely to be due to endolymphatic double flow. Bilateral cases may be due to simultaneous co-existence of canalolithiasis and cupulolithiasis. Longer recording of nystagmus is recommended not to miss the cases with spontaneous direction-changing positional nystagmus.

• 대한청각학회지
• /
• 제25권1호
• /
• pp.43-48
• /
• 2021

Background and Objectives: Conflicting mechanisms have been reported about spontaneous reversal of positional nystagmus during head-roll maneuver in patients with benign paroxysmal positional vertigo (BPPV). The objective of this study is to review the reports about the characteristics and possible mechanisms of reversing positional nystagmus and to present seven new cases. Subjects and Methods: Seven cases (5 males, 2 females; 4 left-sided, 3 right-sided) were recruited among 732 patients with BPPV seen outpatient clinic between 2009 and 2019. Diagnosis of lateral canal canalolithiasis was confirmed when transient geotropic nystagmus was documented during head-roll test. Reversing positional nystagmus was analyzed in each case and clinical characteristics of the patients were documented. Results: The age of patients was ranging between 30 to 64 years (46.44±10.91). Duration of symptoms was short (21.34±19.74). Six of them had a story of head trauma. Initial latency was short. First, intense geotropic nystagmus was observed following provocative head-roll position on the affected side. There was short "silent phase". Then, a longer second-phase of reversed nystagmus was noted. Total duration of nystagmus was 78.40±6.82 seconds. Maximal slow phase velocity was 24.05±6.34 deg/sec. All patients were cured with barbeque maneuver. Conclusions: Ipsilateral reversing positional nystagmus during head-roll maneuver is due to lateral canal canalolithiasis. Mechanism is likely to be due to endolymphatic double flow. Bilateral cases may be due to simultaneous co-existence of canalolithiasis and cupulolithiasis. Longer recording of nystagmus is recommended not to miss the cases with spontaneous direction-changing positional nystagmus.

• 치과방사선
• /
• 제14권1호
• /
• pp.121-134
• /
• 1984

The authors analyzed the morphological change of bone structure from 3,140 radiographs (1570 joints) of 785 patients with temporomandibular joint arthrosis, which were obtained by the oblique lateral transcranial projection and orthopantomographs. The interrelation of bone change and clinical symptoms, duration of the diseases were examined. Also, the bone changes of articular eminence, condyle, articular fossa were examined according to positional change of the condyle in the mouth open and close state. The results were as follows. 1. In the 785 patients with TMJ arthrosis, 782 patients (99.62%) show the positional change of the condyle. Among them 691 patients (88.03%) show the bone change. 2. In TMJ arthrosis patients with bone changes 451 patients (65.27%) showed both the condylar positional changes and bone changes bilaterally. 198 patients (28.65%) show the condylar positional changes bilaterally and bone changes unilaterally. 3. The bone changes in the TMJ arthrosis were in order of frequency eburnation (647 cases, 32.8%), erosion (548 cases, 27.79%), flattening (418 cases, 21.20%), deformity (138 cases, 6.99%). sclerosis (115 cases, 5.83%), marginal proliferation (106 cases, 5.38%). The region of bone change in TMJ arthrosis with condylar positional changes were in order of frequency the articular eminence (43.97%) condylar head (38.64%), articular fossa (17.39%). In the patients with bone changes, their clinical symptoms were pain (44.34%), clicking sound (33.5%), limitation of mouth opening (22.52%). In the patients complaining pain the most frequent bone change was erosion (28.60%), in the patients complaining clicking sound, eburnation (28.97%) in the patients complaining the limitation, eburnation (29.40%). Also in the patients with the duration below 1 year most common bone change was eburnation. 5. The most common condylar positional change was downward position (39.94%) in closed state, restricted movement of condyle (30.07%) in open state. The condylar positional changes and bone changes according to the region were as follows: a) In the condylar head the most frequent bone change was erosion (30.45%) and the most frequent condylar positional change was downward position (37.40%) in closed state, restricted movement of condyle (33.2%) in open state. b) In the articular eminence the most frequent bone change was eburnation (39.91%) and the most frequent condylar positional change was downward position (39.79%) in closed state, restricted movement of condyle (27.22%) in open state. c) In the articular fossa the most frequent bone change was eburnation (53.94%) and the most frequent condylar positional change was downward position (42.57%) in closed state, restricted movement of condyle (30.32%) in open state.

• 치과방사선
• /
• 제13권1호
• /
• pp.151-162
• /
• 1983

The author analyzed the morphologic changes of bone structure from 848 radiograph is (424 joints) of 212 patients with temporomandibular joint arthrosis, which were obtained by the oblque-Iateral transcranial projection and orthopantomography. The interelation of the bone changes and condylar head positions the results were as follows: 1. In the 212 patients with TMJ arthrosis, 210 patients(99.05%) show the condylar positional changes. Among them, 187 patients 989.05%) show the bone changes. 2. In TMJ arthrosis patients with bone changes, 10% patients(57.75%) show both the condylar positional changes and bone changes. 66 patients( %) show the condylar psoitional changes bilaterally and bone changes unilaterally. On the other hand, 11 patients (5.88%) show the condylar positional changes unilaterally and bone change bilaterally. 3. The bone changes in the TMJ arthrosis patients with the condylar positional changes were as follows: There were the flatlening of articular surface in 103 cases (26.55%) the erosion in 99cases 925.57%), and the erosion in 88 cases (22.68%). There were not much differences among the three types of bone changes. And the deformity in 70 cases (18.04%), the sclerosis in 22 cases(5.67%), the marginal protiferation in 6 cases(1.55%) were seen. 4. The regions of bone changes in TMJ arthrosis patients with condylar positional changes were as follows: They occurred at the condyle head(51.04%), the articular eminence(39.20%) and the articular fossa(9.60%) in that order. The condylar positional changes and bone changes according to the regions were as follows: a) In the bone changes at the condyle head, the flatteming (34.63%) was a most frequent finding and the deformity(27.63%) the erosion(24.32%) in the order. In the condylar positional changes, the downward positioning of condyle(41.44%) was a most frequent finding in the mouth closed state and the restricted movement within the articular fossa(35.46%) in the mouth open state. b) In the bone changes at the articular eminence, the eburnation(33.26%) was a most frequent finding and the flatteming(31.16%), the erosion(28.37%) in that order. In the condylar positional changes, the downward positionirg of condyle(39.81%) was a most frequent finding in the mouth closed state and the restricted movement within the articular fossa(24.77%) in the mouth open state. c) In the bone changes at the articular fossa, the eburnation(72.90%) was amost frequent finding and theerosion(17.76%), the sclerosis(9.35%) in that arder. In the condylar positional changes, the downward positionirg of condyle(41.5%) was a most frequent finding in the mouth closed state and the mormal positionirg of condyle(27.78%) in the mouth open state.

• 척추신경추나의학회지
• /
• 제5권1호
• /
• pp.1-9
• /
• 2010

Objectives: The purpose of this study is to evaluate the therapeutic effect of Positional Release Therapy on patients of neck pain, Methods: 12 patients was treated by Positional Release Therapy(PRT) combined with acupuncture, We measured the Visual Analog Scale(VAS) and Neck Disability Index(NDI) before and after treatment The statistical analysis was performed by using the Wilcoxon signed rank test. Results: 1. Patients showed significant improvement in VAS after treatrnent(p<0.05). 2. Patients showed significant improvement in NDI after treatment(p<0.05). Conclusion: These results imply that Positional Release Therapy combined with acupuncture would be effective on relieving pain and increasing functional ability in daily-life of patients of neck pain.

• 대한한방내과학회지
• /
• 제32권3호
• /
• pp.371-386
• /
• 2011

Background : Vertigo is a very common complaint in clinical practice. The number of patients who complain of vertigo has been increasing due to rapid growth of the elderly population. This study was designed to review the clinical features and success of oriental medical treatment of positional vertigo. Methods : This observation was made on 70 subjects diagnosed with positional vertigo. They were hospitalized in the Semyung University Oriental Medicine Hospital. Results : The results were as follows 1. Female patients (82.9%) were more than male patients. The most common age group was 8th decade and the patients rapidly increased after the 5th decade of age. 2. The most common past history of positional vertigo was hypertension, the second was cerebral infarction, and the third was hyperlipidemia. 3. In the oriental medicine diagnosis, phlegm-dampness syndrome (痰濕交阻 眩暈) was the most common disease (92.9%), and in western medicine, BPPV was the most (82.9%). 4. In herbal medication, Banhabaekchulchunma-tang gami (45.7%) was the most commonly used, the second being Taeksa-tang (30%). 5. The vertigo score of 94.3% patients improved and none got worse. 6. In general characteristics, men over 64 years improved best. Past history had no effect on the improvement of vertigo. 7. The sooner patients visited hospital after onset, the shorter hospitalization time was. Conclusions : Vertigo attacks patients well in advanced age, with various causative diseases. Oriental medical treatments have considerable effects on positional vertigo, especially treated with Banhabaekchulchunma-tang gami and Taeksa-tang.

• Journal of Oral Medicine and Pain
• /
• 제42권1호
• /
• pp.1-7
• /
• 2017

Purpose: The aims of this study were to evaluate the clinical characteristics and polysomnographic results of patients visited the Seoul National University Dental Hospital (SNUDH) and to suggest guidelines for the management of sleep disordered-breathing patients in a dental clinic. Methods: Five hundred sixty-two patients who visited the Snoring and Sleep Apnea Clinic of SNUDH were evaluated for clinical characteristics including associated comorbidities, age, gender, body mass index (BMI), neck circumference, and daytime sleepiness and among them 217 patients were performed nocturnal polysomnography for evaluating respiratory disturbance index, apnea-hypopnea index (AHI), oxygen saturation levels, and sleep stages. The associations among clinical characteristics, sleep parameters, and positional and rapid eye movement (REM) dependencies of the patients were analyzed. Results: The most common co-morbidities of the patients were cardiovascular (30.2%), endocrine (10.8%), and respiratory diseases (7.9%). Age (${\beta}=0.394$), total AHI (${\beta}=0.223$), and lowest $O_2$ saturation levels (${\beta}=0.205$) were significantly associated with the number of co-morbidities in patients with obstructive sleep apnea (OSA). Mean $O_2$ saturation was not significantly associated with number of co-morbidities. Non-positional OSA patients had higher BMI, longer neck circumferences, more severe AHI values, and lower mean and lowest $O_2$ saturation levels compared to positional OSA patients. Not-REM-related patients were older and had more severe AHI values compared to REM-related patients. Not-REM-related patients have longer duration of stage I sleep and shorter stage II, III, and REM sleep than REM-related patients. There were no significant differences in each sleep stage between positional and non-positional patients. Neck circumference, positional dependency, REM dependency, and percentage of supine position were significantly associated with severity of OSA. Conclusions: Age, total AHI, and lowest $O_2$ saturation level were significantly associated with the number of co-morbidities in patients with OSA. Neck circumference, positional dependency, REM dependency, and percentage of supine position were significantly associated with severity of OSA.

• 대한임상검사과학회지
• /
• 제40권1호
• /
• pp.62-70
• /
• 2008

Benign paroxysmal positional vertigo (BPPV) is one of the most common clinical entities encountered in a dizzness clinic. Retrosepective review was performed for the patient's diagnosed as BPPV at Sunchon "S" hospital dizzness center. Variables for statistical analysis included age, sex, involved canal presence of recent head tramua, presence of chronic otitis media, history of middle ear surgery, underlying disease such as hypertension or diabetics, headache, central lesion. From July 2004 to May 2005, we sampled the 600 dizzness patient's who visited the dizzness center. Dizzness could be classified into BPPV, vestibulopathy. Among these patients, 256 patients had BPPV, 222 patients had vesibulopathy and 97 patients had Normal. Among these BPPV patients, 80 patients had lateral canalolithiasis BPPV (31.3%), 28 patients had lateral cupulolithiasis BPPV (10.9%), 90 patients had posterior canalolithiasis BPPV (35.2%), 7 patients had multicanalolithiasis BPPV (2.3%), 52 patients simultaneously had BPPV, other vestibular disease, and central lesion (20.3%).

• 수면정신생리
• /
• 제19권1호
• /
• pp.22-26
• /
• 2012

목 적 : 체위성 수면무호흡은 폐쇄성수면무호흡증으로 진단된 환자에서 앙와위 수면시 apnea-hypopnea index(AHI)가 비앙와위 수면시 AHI에 비해 2배 이상인 경우로 정의하며, 일반적으로 전체 폐쇄성수면무호흡 환자의 56%로 알려져 있다. 본 연구는 수면 클리닉을 방문하여 폐쇄성수면무호흡을 진단 받은 환자 중 체위성 수면무호흡의 발생빈도를 알아보고, 체위 의존성에 따른 수면무호흡의 임상 소견 및 수면다원검사를 비교 분석하였다. 방 법 : 코골이 및 목격되는 무호흡으로 내원하여 AHI가 5 이상이면서 앙와위 및 비앙와위 수면 시간이 15분 이상이고, 앙와위 시 AHI가 비앙와위시 AHI에 비하여 2배 이상인 경우를 체위성 수면무호흡으로, 그렇지 않은 경우를 비체위성 수면무호흡으로 분류하였다. 체위 의존성 여부에 따라 인구학적 특성과 수면다원검사에서 나타난 수면 변인 및 호흡 변인을 분석하였다. 결 과 : 폐쇄성수면무호흡으로 진단된 101명 중에서 체위성 수면무호흡 환자는 76명(75.2%), 비체위성 수면무호흡 환자는 25명(24.8%)이었다. 폐쇄성수면무호흡의 중증도별로 체위성 수면무호흡의 유무에 따라 발생빈도가 통계적으로 유의하게 차이가 있었으며, 특히 비체위성 수면무호흡 환자군에서는 중증 환자의 비율이 높았다. 비체위성 수면무호흡환자군이 체위성 환자군에 비하여 체중, 허리둘레, 엉덩이 둘레, 허리-엉덩이 둘레비, 체질량 지수 및 목둘레가 유의하게 더 높았다. 수면다원검사상에서는 체위성 수면무호흡군에서 비교적 수면구조가 잘 유지되었으며 주관적인 졸림도 덜하였다. 비체위성 수면무호흡군에서 체위성 수면무호흡군에 비해 평균산소포화도 및 최저산소포화도가 유의하게 낮았으며 AHI는 통계적으로 유의하게 더 높았다. 결 론 : 폐쇄성수면무호흡 환자중 체위성 수면무호흡 환자의 비율은 75% 정도였으며, 비체위성 수면무호흡 환자에 비해 체위성 수면무호흡 환자는 비만도가 덜 하고 경증 및 중등도의 폐쇄성수면무호흡의 양상을 보이는 것으로 관찰되었다.