Verification of Hearing Aids by Comparing Real Ear Measurements and Word Recognition Scores / 대한이비인후과학회지

Background and Objectives@#In this study, we introduce our method of hearing aid (HA) verification using real ear measurement (REM). We verified HAs that have gone through the fitting program using speech mapping REM; we then compared the outcome with word recognition scores (WRS) to evaluate functional gain. Subjects and Method Fifty-six patients of sensorineural hearing loss (81 ears) were enrolled in the study. In REM, if the gap between the target gain of HA and real ear aided response (REAR) was less than 10 dB SPL, fitting was considered successful. In speech audiometry, unaided maximum discrimination score (PB max), unaided WRS at 65 dB HL and aided WRS at 65 dB HL were measured. By comparing PB max and aided WRS at 65 dB HL, patients were sorted into best (n=15), good (n=57), and poorly (n=9) aided groups and analyzed for the successes of fitting. Fitting was deemed unsuccessful if REAR was ≥10 dB SPL lower than the target value of HA. @*Results@#The mean aided WRS at 65 dB HL of best, good and poorly aided groups were 85.6%, 77.3%, and 54.2%, respectively. There were statistically significant differences between all groups (p=0.019, 0.001, 0.002). The success rates of HA fitting showed significant differences at 0.5, 0.75, 1, 4 kHz of 55 dB SPL (p=0.023, 0.005, 0.003, 0.014), and at 4 kHz of 65 and 75 dB SPL (p=0.004, 0.001). The high WRS group showed sufficient gain at many frequencies. @*Conclusion@#Well fitted HAs can provide sufficient increase in speech intelligibility. Using the speech mapping REM is a great method to verify fitting of HA.

Changes of Temporal Processing and Hearing in Noise after Use of a Monoaural Hearing Aid in Patients with Sensorineural Hearing Loss: A Preliminary Study

Background and Objectives@#The relationship between hearing aid (HA) use and improvement in cognitive function is not fully known. This study aimed to determine whether HAs could recover temporal resolution or hearing in noise functions. @*Materials and Methods@#We designed a prospective study with two groups: HA users and controls. Patients older than 45 years, with a pure tone average threshold of worse than 40 dB and a speech discrimination score better than 60% in both ears were eligible. Central auditory processing tests and hearing in noise tests (HINTs) were evaluated at the beginning of the study and 1, 3, 6, and 12 months after the use of a monaural HA in the HA group compared to the control group. The changes in the evaluation parameters were statistically analyzed using the linear mixed model. @*Results@#A total of 26 participants (13 in the HA and 13 in the control group) were included in this study. The frequency (p<0.01) and duration test (p=0.02) scores showed significant improvements in the HA group after 1 year, while the HINT scores showed no significant change. @*Conclusions@#After using an HA for one year, patients performed better on temporal resolution tests. No improvement was documented with regard to hearing in noise.

Does Rapid Eye Movement Sleep Aggravate Obstructive Sleep Apnea?

OBJECTIVES.: To investigate the apnea-hypopnea index (AHI) according to the sleep stage in more detail after control of posture. METHODS.: Patients who underwent nocturnal polysomnography between December 2007 and July 2018 were retrospectively evaluated. Inclusion criteria were as follows: age >18 years, sleep efficacy >80%, and patients who underwent polysomnography only in the supine position (100% of the time). Patients were classified into different groups according to the methods: the first, rapid eye movement (REM)-dominant group (AHIREM/AHINREM >2), non-rapid eye movement (NREM)-dominant group (AHINREM/AHIREM >2), and non-dominant group; and the second, light sleep group (AHIN1N2>AHISWS) and slow wave sleep (SWS) group (AHISWS>AHIN1N2). RESULTS.: A total of 234 patients (mean age, 47.4±13.9 years) were included in the study. There were 108 patients (46.2%) in the REM-dominant group, 88 (37.6%) in the non-dominant group, and 38 (16.2%) in the NREM-dominant group. The AHI was significantly higher in the NREM-dominant group than in the REM-dominant group (32.9±22.9 events/hr vs. 18.3±9.5 events/hr, respectively). There were improvements in the AHI from stage 1 to SWS in NREM sleep with the highest level in REM sleep. A higher AHISWS than AHIN1N2 was found in 16 of 234 patients (6.8%); however, there were no significant predictors of these unexpected results except AHI. CONCLUSION.: Our results demonstrated the highest AHI during REM sleep stage in total participants after control of posture. However, there were 16.2% of patients showed NREM-dominant pattern (AHINREM/AHIREM >2) and 6.8% of patients showed higher AHISWS than AHIN1N2. Therefore, each group might have a different pathophysiology of obstructive sleep apnea (OSA), and we need to consider this point when we treat the patients with OSA.

Prognostic Factors for Recovery from Sudden Sensorineural Hearing Loss: A Retrospective Study

BACKGROUND AND OBJECTIVES: This study aimed to investigate prognostic factors in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). SUBJECTS AND METHODS: From January 2007 to December 2011, a retrospective chart review identified 494 consecutive patients with ISSNHL. Demographic, audiometric, and clinical data were analyzed using a logistic regression test. RESULTS: Hearing recovery from ISSNHL was significantly associated with factors such as age, duration from onset of symptoms to commencement of treatment, severity of the initial pure tone threshold, and the treatment method. Intratympanic (IT) steroid administration alone showed a comparable efficiency to oral steroid administration with or without IT steroid injection. In patients who received IT steroid injection, the duration from onset to treatment, severity of initial hearing loss, and sequential IT steroid injection following systemic steroid administration were statistically associated with hearing improvement. CONCLUSIONS: Age, severity of initial pure tone threshold, duration from onset to treatment, initial speech discrimination, and initial pure tone threshold are statistically significant prognostic factors related to hearing improvement in ISSNHL. IT steroid injection as an initial single treatment is comparable to systemic oral steroid administration.

Effectiveness of Rapidrhino® Packing in Patients Who Visited Emergency Room due to Anterior Epistaxis

PURPOSE: Although there are many treatment options for managing epistaxis, little is known about their outcomes in the emergency department (ED). In this study, we evaluated the management of epistaxis, especially comparing the efficacy between Rapidrhino® and Merocel®. METHODS: A retrospective review of patients with epistaxis visiting the ED between January 2010 and June 2016 was performed. Haemostatic properties of packs were initially measured in the ED, and after the removal of packs in the otorhinolaryngology clinic. Subgroup analyses were performed in a similar fashion for patients receiving and not receiving anticoagulants or the antiplatelet. RESULTS: The initial success rates for Rapidrhino® and Merocel® were both high (90.3%, 86.3%, respectively). Rebleeding rates for Rapidrhino® and Merocel® were 41.4% and 56.3%, respectively. Overall, there was a significant difference between the two types of packs in recurrence (p=0.032). Particularly, in patients with anticoagulants, the initial success rates of Rapidrhino® were higher than that of Merocel® (88.6%, 76.2%, respectively, p=0.222). The rebleeding rate of Rapidrhino® was much lower than that of Merocel® (54.3%, 85.7%, respectively, p=0.016). In the Rapidrhino® group, the rebleeding rate varied according to the packing removal date (p=0.001). CONCLUSION: Rapidrhino® and Merocel® are equally effective in the initial arrest of epistaxis in the ED. Rapidrhino® may be more effective in controlling haemorrage on removal, particularly in patients with anticoagulants. Patients with epistaxis could be treated with Rapidrhino® in the ED, which could be removed in the outpatient clinic one day later.

A Case of Squamous Cell Carcinoma in the External Auditory Canal Previously Treated for Verrucous Carcinoma

Carcinoma in the external auditory canal (EAC) is a rare malignancy with an annual incidence of one per one million people, accounting for less than 0.2% of all head and neck cancers. The most common histopathological type of EAC cancer is squamous cell carcinoma. Verrucous carcinoma is a well-differentiated, low-grade variant of squamous cell carcinoma. It is a locally destructive, invasive, and slow growing tumor that rarely metastasizes. Verrucous carcinoma occurs predominantly in the oral cavity and larynx, and its occurrence in the EAC is extremely rare. In this report, we present a histologically confirmed case of verrucous carcinoma in the EAC and temporal bone, which for several years had been classified as epithelial hyperplasia. Two-and-a-half years after diagnosis of verrucous carcinoma, a recurrent mass was found and the lesion was then confirmed to be squamous cell carcinoma.

Recordings of Cortical Auditory Evoked Potentials in Cochlear Implant Listeners: A Preliminary Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There is a need for fast and reliable objective measures of cochlear implant (CI) performance, especially in young children. The aim of the study was to investigate the detection and characterization of cortical auditory evoked potentials (CAEP) of different types of sound stimulation in CI listeners using a commercially available system, HEARLab™. SUBJECTS AND METHOD: Sound field CAEPs were obtained from 10 CI listeners, using three natural speech sounds (/m/, /g/, and /t/) presented at 55, 65, and 75 dB SPL. Detection rates, the latencies and amplitudes of CAEP waves were analyzed and compared with those of the normal hearing (NH) group. RESULTS: It was possible to detect CAEP responses in all CI listeners. Of the three stimuli (/m/, /g/, /t/), /g/ was the most robust waveform, although this was not statistically significant. Latencies for the /m/ stimulus were relatively longer than those for /t/ and especially for /g/, suggesting that CI listeners hear high-frequency sounds better than low-frequency sounds. When compared to the NH group, CAEP of CI listeners tended to show smaller amplitudes of various waves and longer latencies especially at P1 wave. CONCLUSION: CAEP responses could be obtained in all CI listeners and normal adults successfully, indicating that CAEP can be applied clinically as an objective assessment tool of hearing. Further studies are needed for CI listeners especially in infants and toddlers using this protocol to assess its clinical usefulness.

A Case of Superior Semicircular Canal Dehiscence Syndrome with Coexisting Otosclerosis / 대한이비인후과학회지

Superior semicircular canal dehiscence (SSCD) syndrome and otosclerosis have overlapping clinical manifestations that can be difficult to distinguish. Audiovestibular symptoms are caused by noise or straining in SSCD, which is associated with the presence of an air-bone gap that overlaps with the characteristic of otosclerosis. We recently examined a 51-year-old woman presenting with unilateral pulsatile tinnitus and ipsilateral hearing loss in the left ear. Computerized tomography, audiometry and vestibular function test confirmed the diagnosis of ipsilateral SSCD syndrome with coexisting ipsilateral otosclerosis. The patient underwent surgical repair of dehiscence by middle fossa approach and stapes surgery for otosclerosis sequentially. She has not had pulsatile tinnitus postoperatively, and hearing improved with the closure of air-bone gap at most frequencies. In conclusion, when SSCD syndrome and otosclerosis coexist and patient has representative symptoms of both ear pathologies, a sequential surgery can be an effective treatment option.

Usefulness of Endoscopic Removal of Congenital Cholesteatoma in Children / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The use of endoscope has led to new treatment options for middle ear pathologies. The aim of this study is to report on endoscopic ear surgeries for the removal of middle ear cholesteatoma and discuss about the usefulness of endoscopic approach to congenital cholesteatoma in children. SUBJECTS AND METHOD: Five pediatric patients with congenital cholesteatoma were enrolled in this study. Cholesteatoma was removed via transcanal endoscopic approach in all patients. Medical records were reviewed retrospectively. We analyzed the clinical characteristics, surgical management and treatment outcomes. RESULTS: The average age of patients was 3.7 years. Cholesteatoma was observed in the anterior portion of tympanic membrane in four patients, and in the posterior portion in one patient. Endoscopic techniques were used exclusively in four patients, but one patient was treated by microscopic approach using a combined technique. Cholesteatoma was fully removed and we confirmed by endoscopic examination that no remnant lesions remained. Surgical complications such as vertigo, sensorineural hearing loss, infection, or bleeding were not seen postoperatively. Average hospital stay was 1.2 days. CONCLUSION: Results showed that this technique was beneficial for treating cholesteatoma in limited cases. Endoscopic surgical techniques produced good intraoperative and postoperative results in removing pediatric congenital cholesteatoma and will gain importance in the otological surgery in the future.

Influences of Diabetes on Hearing Recovery in Noise-Exposed Mice

BACKGROUND AND OBJECTIVES: Many studies have reported an association between diabetes and hearing loss. However, these reports were mainly abstractive correlations between common hearing loss and the incidence of diabetes. Therefore, we evaluated the impact of diabetes on the occurrence of and recovery from noise-induced hearing loss. MATERIALS AND METHODS: We used 5-week-old C57BLKS/J-m wild type (+/+) and C57BLKS/J-db/db male mice as the control and diabetic groups, respectively. In one set of experiments, the hearing levels of control and diabetic mice were measured weekly for 7 weeks. In a second set of experiments, control and diabetic mice were exposed to broadband white noise of 110 dB SPL for 3 hours; hearing levels were analyzed before and immediately after exposure, 1, 3, and 5 days, and 1, 2, 3, and 4 weeks after the noise exposure. RESULTS: The hearing levels of the control group were better than those of the diabetic group at each weekly revision for 7 weeks at all auditory brainstem response frequencies (4, 8, 16, and 32 kHz). After noise exposure, both groups of mice showed an immediate increase in the hearing level threshold at all frequencies. Subsequent threshold recovery was seen in both groups with no difference in the hearing level recovery rates between the two groups. CONCLUSIONS: Hearing level with aging becomes significantly impaired earlier in diabetic mice but hearing recovery after noise exposure is similar between diabetic and control mice.

Usefulness of Septodermoplasty in Hereditary Hemorrhagic Telangiectasia / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Epistaxis is the most common symptom in patients with hereditary hemorrhagic telangiectasia (HHT). The aim of this study is to report treatment of severe epistaxis related to HHT with the septodermoplasty and to assess patient outcomes. SUBJECTS AND METHOD: Six patients with HHT who underwent septodermoplasty from 2009 to 2013 were reviewed retrospectively. We analyzed the clinical characteristics, surgical management and treatment outcomes. RESULTS: Three patients had been diagnosed with definite HHT and three patients with possible HHT. Three patients had combined abnormal vascular structures in visceral organs. The mean preoperative and postoperative hemoglobin were 7.2 g/dL and 12.8 g/dL, respectively, and visual analogue scale score for frequency and intensity of nasal bleeding remarkably decreased after septodermoplasty in all patients. CONCLUSION: Septodermoplasty was a safe and efficacious procedure for reducing the frequency and severity of bleeding in most patients with intractable epistaxis and HHT.