Combined Bifrontal Transcranial Direct Current Stimulation and Tailor-Made Notched Music Training in Chronic Tinnitus

BACKGROUND AND OBJECTIVES: We evaluated the short-term treatment outcomes of combined bifrontal transcranial direct current stimulation (tDCS) and tailor-made notched music training (TMNMT) in tinnitus patients. The associations of patient characteristics with treatment responsiveness were investigated. SUBJECTS AND METHODS: Four sessions of bifrontal tDCS (F4: anode, F3: cathode) and TMNMT were conducted over a 2-week period in tinnitus patients. For tDCS, the stimulation intensity was 1.5 mA and the duration was approximately 20 min. During tDCS, patients listened to music lacking the frequency band within 1 octave of the tinnitus frequency. Patients were also instructed to listen to this music at home for at least 2 hours per day. One month after the final tDCS session, loudness (LD), awareness (AW), annoyance (AN), and effect on life (EL) of tinnitus were assessed subjectively using a visual analog scale. RESULTS: A total of 14 patients were enrolled in this study. After treatment, a 50% or greater improvement in AN, AW, EL, and LD was observed in 57.1, 42.9, 35.7, and 28.6% of patients, respectively. Furthermore, 78.6% of patients showed a 50% or greater improvement in their tinnitus handicap inventory scores. For AN, the absence of sleep disturbance was significantly associated with treatment responsiveness (p=0.041, OR=24.0). CONCLUSIONS: Combined bifrontal tDCS and TMNMT is a promising treatment for chronic tinnitus. To maximize the treatment outcomes of this therapy, sleep disturbances should also be addressed in candidate patients.

The First Case of Vestibulocochlear Neuritis in a Patient with Acquired Immunodeficiency Syndrome in Korea / 감염과화학요법

The incidence of human immunodeficiency virus (HIV) infections continue to increase throughout the world. Although neurologic complications are frequent in individuals with HIV infection or acquired immunodeficiency syndrome (AIDS), vestibulocochlear neuritis is still a relatively rare manifestation. We report the first case of vestibulocochlear neuritis occurring in an AIDS patient in Korea.

Clinical Application of the Threshold Equalizing Noise Test in Patients with Hearing Loss of Various Etiologies: A Preliminary Study

BACKGROUND AND OBJECTIVES: We aimed to make a preliminary assessment of the prevalence of cochlear dead regions (DRs) and the factors affecting the results of the threshold-equalizing noise (TEN) test in patients with hearing loss of various etiologies. SUBJECTS AND METHODS: Between May and July 2014, 109 patients (191 ears) with hearing loss who visited our outpatient clinic were prospectively enrolled. Pure tone audiometry and TEN (HL) test were performed for all the patients. DR at each frequency was indicated by masked thresholds of > or =10 dB above the TEN level and > or =10 dB above the absolute threshold. RESULTS: DR was present in 15.7% (n=30) of the 191 ears. According to disease entity, 16.6% of patients with sensorineural hearing loss had a DR. However, DR was absent in patients with chronic otitis media. According to audiometric configurations, DR was most common in moderately severe, flat hearing loss. Significantly worse hearing thresholds for both mean hearing level and hearing threshold at each frequency were found in the presence of DR (p<0.001). Logistic regression analysis showed that only the mean hearing level (odds ratio: 1.053, 95% confidence interval: 1.021-1.085) affected the presence of DR. CONCLUSIONS: Although performance of the TEN test is limited by frequencies and hearing levels, it provides additional information regarding DRs and may therefore have the potential to be used as a prognostic tool for diverse diseases causing hearing loss.

Therapeutic Effect of Zinc and Lipoprostaglandin E1 for Idiopathic Sudden Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We aimed to analyze the therapeutic effect of zinc, lipoprostaglandin E1 in addition to systemic steroid therapy on hearing improvement for the treatment of idiopathic sudden hearing loss. SUBJECTS AND METHOD: Retrospective medical chart reviews of 500 patients who had been diagnosed with unilateral idiopathic sudden hearing loss between May 2006 and April 2014 were performed. Then, we conducted a multiple linear regression analysis using the data of individual patients. RESULTS: Better hearing gain was associated with low tone hearing loss (p<0.001), better initial contralateral hearing (p<0.001), and the absence of dizziness (p=0.015). Patients who underwent intratympanic steroid treatment as salvage treatment showed a lower hearing gain (p<0.001). Zinc supplementation was effective for the treatment of patients with mild hearing loss (p<0.001). On the contrary, significant improvements in hearing gain were found in patients with profound hearing loss who were treated with an additional lipoprostaglandin E1 (p<0.001). CONCLUSION: An additional use of zinc and lipoprostaglandin E1 may enhance hearing improvement for the treatment of idiopathic sudden hearing loss.

Clinical Study of the Intranasal Hemangioma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Hemangioma of the nasal cavity is an uncommon benign vascular tumor. This study aimed to analyze the clinical manifestations, radiologic findings, treatment modalities, and outcomes of intranasal hemangiomas. SUBJECTS AND METHOD: Retrospective reviews of the medical record were performed on 13 patients, who were treated for intranasal hemangioma from 2005 to 2014. RESULTS: Of the 13 patients identified, there were seven males and six females ranging from 11 to 80 years of age (mean age of 48.1+/-21.5). Epistaxis was the most common presenting symptom. Most common site of origin was the inferior turbinate. CT scans showed variable enhancement of the nasal mass without bony erosion. Preoperative diagnosis accuracy rate was 76.9%. The tumor was histopathologically classified as follows: capillary hemangioma (n=6, 46.1%), cavernous hemangioma (n=3, 23.1%), venous hemangioma (n=2, 15.4%), and mixed hemangioma (n=2, 15.4%). Endoscopic excisional surgery (n=11, 94.6%) and local excision (n=2, 15.4%) were performed for complete removal of the hemangioma. Preoperative selective embolization was performed on one patient. No evidence of recurrence after the surgery was observed. CONCLUSION: Intranasal hemangioma was usually found to occur in the inferior turbinate and the most common symptom was epistaxis. Capillary hemangioma was the most common type. Complete excision was recommended to prevent recurrence.

Selective Arterial Embolization in Intractable Recurrent Epistaxis: A Clinical Analysis with Literature Review / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Epistaxis usually responds to conservative therapy such as nasal packing or electrocauterization. But sometimes more invasive techniques such as selective embolization is justified. We report our experience of 10 patients with selective endovascular embolization for refractory epistaxis. SUBJECTS AND METHOD: Ten patients were referred for selective arterial embolization for refractory epistaxis. Medical records were reviewed for clinical data, recurrence, and complication. RESULTS: Early rebleeding requiring treatment occurred in 1 patient (10%) and initial success rate of embolization was 90%. There was no major complication. Minor complications such as mild fever, groin pain, and voiding difficulty occurred in 2 patients (20%). CONCLUSION: Selective arterial embolization for refractory epistaxis is safe and effective for treatment of refractory intractable epistaxis.

Idiopathic Sudden Sensorineural Hearing Loss With Minimal Hearing Impairment

OBJECTIVES: The aim of the study was to determine the characteristics of patients who did not match the audiometric criteria of idiopathic sudden sensorineural hearing loss (SSNHL) but complained of acute hearing loss. METHODS: By thorough medical chart reviews, historical cohort study was performed with consecutive data of 589 patients complaining of acute unilateral sensorineural hearing loss without identifiable causes between 2005 and 2013. Those patients demonstrating a hearing loss of at least 30 dB at three consecutive frequencies based on pure tone audiometry were classified as group I; the others were classified as group II. Patients' characteristics, final hearing, and hearing improvement rate (HIR) between the two groups were compared. RESULTS: Group II exhibited distinctive characteristics, including an early age of onset of the hearing loss (P0.05). CONCLUSION: Patients who did not meet the audiological criteria of SSNHL exhibited distinctive characteristics compared to SSNHL patients.

Unidentified Bright Objects on Brain Magnetic Resonance Imaging Affect Vestibular Neuritis

OBJECTIVES: The aim of this study was to investigate the differences in clinical manifestations of in two groups of vestibular neuritis (VN) patients with or without unidentified bright objects (UBOs). METHODS: A prospective, observational study with 46 patients diagnosed with VN between May 2013 and November 2013 was executed. A caloric test, a cervical vestibular-evoked myogenic potentials (cVEMPs) test, brain magnetic resonance imaging (MRI), spontaneous nystagmus test, head impulse test, and head-shaking nystagmus test were performed. RESULTS: Of the patients, 56.5% (n=26) were classified as UBO-positive by MRI. These showed lower caloric weakness and more prominent cVEMP asymmetry compared with the UBO-negative group (P0.05). CONCLUSION: UBOs on T2-weighted or fluid attenuated inversion recovery MRI may affect the patterns of the vestibular nerve in patients with VN.

Clinical Characteristics and Prognostic Factors in Pediatric Chronic Rhinosinusitis with Polyps / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Chronic rhinosinusitis with nasal polyps is an uncommon pathology in the pediatric population and a challenging problem to otolaryngologists. In this study, we aimed to assess the clinical characteristics and postoperative results of children who underwent sinus surgery due to nasal polyps. SUBJECTS AND METHOD: We retrospectively reviewed medical records of 45 pediatric patients who had sinus surgery from 2009 to 2012. We studied the relationship between clinical parameters and postoperative results. RESULTS: Forty-five patients (18 women and 27 men with an age range of 8 to 17 years) were treated surgically in our hospital. We found statistically significant correlation between the preoperative CT scores (p=0.043), the nasal obstruction symptom scores (p=0.032) and postoperative recurrence, but not between other parameters. CONCLUSION: In this study, prognostic factors affecting the postoperative outcome were preoperative CT score and nasal obstruction symptom score.

Clinical and Histological Analysis of Oral Mucocele / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Mucoceles usually occur as asymptomatic, dome-shaped, translucent cysts in the lower lip and oral cavity containing mucin. Mucoceles are usually associated with the minor salivary glands and are classified histologically into the extravasation type and the retention type. The objective of the present study was to establish the prevalence of these lesions according to age, gender, histologic type, and site of occurrence. SUBJECTS AND METHOD: We retrospectively reviewed the medical records from January 2008 to February 2013 pertaining to age, sex, clinical history, and other findings of 52 patients who underwent operation and confirmed as mucocele histologically. We re-evaluated all mucocele cases by an experienced pathologist. RESULTS: Of the 52 cases analyzed, 32 (61.5%) were females and 20 (38.5%) were males. Age ranged from 2 to 77 years (mean age 20.6 years), with 78.8% occurring between the ages of 0 and 30 years with peak incidences in the twenties for female patients and in the thirties for male (34%). There was a more predominance among women (61.5%). The lower lip was the site most frequently affected by the lesions (59.6%), whereas the lowest prevalence was observed for the soft palate (2%), and buccal mucosa (2%). Tongue (15.4%) and floor of mouth (21.2%) were not uncommonly affected sites. Histologically mucous extravasation type (96.2%) was more predominant than the retention type (3.8%). CONCLUSION: In this study, mucocele was found predominant in younger age groups, with the lower lip being the most frequently affected site. Histologically, the mucus extravasation type was the most common.

Estimate Hearing Recovery Rate Using Statistical Analysis of Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sudden deafness is not rare but its pathophysiology has not been fully determined and treatment is controversial at present. There is much debate regarding the prognostic factors in sudden deafness patients. Various studies have been done to find out factors concerned with the recovery of sudden deafness, but there are still many unknown components as the probability of recovery from sudden deafness depends on many factors. The aim of this study is to identify an expectation of recovery by regression formula. SUBJECTS AND METHOD: We reviewed the records of 241 patients who were admitted for treatment between 2002 and 2005 under the initial diagnosis of idiopathic sudden hearing loss. The patients were treated with steroid, vasodilator and plasma expander. Improvement of hearing was measured by Siegel's criteria and correcting rate. Prognostic factors that might be associated with the degree of hearing recovery were classified and analyzed by the optimal scale regression analysis method using SPSS ver. 12.0. RESULTS: Siegel's criteria and correcting rate have statistical correlation with respect to age, initial hearing level, patterns of pure tone audiogram and duration of initial treatment from onset to hearing improvement after treatment. Vertigo is not associated with hearing improvement. CONCLUSION: The initial hearing level, patterns of pure tone audiogram and duration of initial treatment from onset are associated with the degree of hearing recovery. We produced a calculating model of hearing improvement based on factors affecting hearing improvement.

Availability of Spectral Gradient Acoustic Reflectometry / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Spectral gradient acoustic reflectometry (SGAR) determines the probability of middle ear fluid by measuring the response of the tympanic membrane to a sound. To assess the sensitivity and specificity of SGAR for the diagnosis of otitis media with effusion (OME) in the Korean population, we compared accurate diagnostic rates of OME obtained from SGAR and tympanometry. Pneumatic otoscope was used for diagnostic standard of OME. SUBJECTS AND METHOD: SGAR and tympanometry were performed on 488 ears from May 27th, 2008 to July 30th, 2008. Exclusion criteria were the presence of tympanic membrane perforation, and/or pressure equalization tubes, noncompliance, otorrhea, external auditory canal stenosis and signs of acute inflammation such as fever or otalgia. In all cases, pneumatic otoscopic examination was conducted and diagnostic accurate rates of OME were calculated in SGAR and tympanogram. RESULTS: Using spectral gradients of 3 or higher as breakpoints for indicating OME, in the case of pediatrics under 2 years old, with the sensitivity of 58.3%, specificity of 94.7%, positive predictive value (PPV) of 77.8% and negative predictive value (NPV) of 87.8%. In the case of the pediatrics between 2 and 12 years old, it showed the sensitivity of 67.2%, specificity of 90.3%, PPV of 74.5% and NPV of 86.8%. In the case of the pediatrics over 12 years old, they showed sensitivity of 87.3%, specificity of 88.8%, PPV of 67.6% and NPV of 96.3%. CONCLUSION: SGAR has the higher tendency of specificity and NPV, and will be a useful screeningtest with good portability and economical efficiency.

Change of Middle Ear Mechanics after Tympanoplasty Type I with Thin Sliced Cartilage Island / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cartilage offers the advantage of higher mechanical stability compared with membranous transplants but it may alter the acoustic transfer characteristics, which could depend on its thickness. So, author attempted to design the thin sliced cartilage island for grafting material by tragal cartilage. The purpose of this study is to understand the usefulness of the thin sliced cartilage technique by comparing with conventional temporalis fascia technique with the method of tympanometry. SUBJECTS AND METHOD: From March 2002 to August 2005, 101 cases of tympanoplasty type I using the thin sliced cartilage island technique and 50 cases of tympanoplasty type I using the temporalis fascia performed by one surgeon had been followed up for 6 months and reviewed. Static compliance, tympanometric width and tympanometric pattern were followed up after 6 month. RESULTS: The static compliance in the thin sliced cartilage island technique group was 72% and temporalis fascia group was 66% at normal compliance (0.2-1.6 ml). The tympanometric width in the thin sliced cartilage island technique group was 59% and temporalis fascia group was 54% at normal tympanometric width (60-150 mmH2O). The tympanometric pattern in the thin sliced cartilage island technique group was 67% and temporalis fascia group was 62% at normal tympanometric pattern (A type). CONCLUSION: There is no significant statistical difference between the thin sliced cartilage island and temporalis fascia observed in the impedence audiometry. The thin sliced cartilage island technique is suggested to be good for tympanoplasty.

The Morphological Changes of the Cochlea in the Guinea Pig after Single Blast Wave Stimulation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The mechanism of the noise damage to the cochlea is not fully understood in spite of many studies. The morphological changes in a noise stimulated model show various features relating to the duration of the exposure and sound intensity. Until now there had been a lot of the morphological studies on noise induced hearing loss models, but only a few reports of single blast injury of more than 150 dB. MATERIALS AND METHOD: We observed with a transmission electron microscope by using the microslicing technique for minimizing the tissue injury and successful hair cell counting in resin embedded cochlea of the guinea pig, stimulated by a 178 dB single blast wave. RESULTS: The area of hair cell damage in L.M. showed stereocilia bending at 24 hours, proliferation of Hensen's body, subsurface cistern in outer hair cell and mitochondria proliferation in inner hair cell within 2wks. The area of no hair cell damage in L.M. showed minimal changes in E.M., as well. CONCLUSION: These results suggest that the 178 dB single blast wave injury may not cause severe distortion of the organ of Corti in the guinea pig and thus the compensation process can be advanced gradually.

Immune-mediated Inner Ear Dysfunction Caused by Histones, as Planted Target Antigens / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Histones, a set of highly cationic proteins essentially involved in the binding and packing of DNA in the cell nucleus chromatin, have five subclasses (H1, H2a, H2b, H3, H4) in mammalian animals. These components play the most important role in producing autoantibody in SLE and etc. Some studies proposed that there were a relationship between the activity of the disease and the titer of these autoantibody. Recently, histones were revealed to be involved in the immune deposit on GBM in MRL/lpr mice, and cause immune-mediated glomerulonephritis in normal animals. MATERIALS AND METHODS: We examined IgG deposition on the basement membrane of strial capillaries and recorded the endocochlear potential from the basal turn by an electrode inserted though the round window in guinea pigs which was injected by histone(H2a) and anti-histone antisera. RESULTS: IgG depositions were seen on the basement membrane of stria capillaries. IgG was also found to be accumulated on the extravascular side of the basement membrane. However, C3 was almost never observed in the stria vascularis of histone and the anti-histone antisera injected group. In these animals, intracellular edema was evident in the stria vascularis especially at the second and more apical turns but no inflammatory cell infiltration was present. The signifcant decrease in EP was observed just after the injection of anti-histone antisera in the animals receiving an intra-arterial injection of histones. CONCLUSION: This study indicated that cationic antigen could be trapped on the negatively charged basement membrane of strial capillaries, leading to the in situ immune complex formation, and eventually causing immune-mediated hearing loss.

Management of otitis media

No Abstract Available.

The Generation of Superoxide Radicals and Activities of Antioxidant Enzymes in Influenza A Virus-Induced Maxiliary Sinusitis of Rabbits / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Oxygen free radicals are generated markedly in various infected condition, and these molecular species were identified as potent pathologic agents. The activities of various antioxidant enzymes have close relationships to genereration and metabolism of oxygen free radicals. The purpose of this study was to investigate the changes in the generation of superoxide radicals and activities of antioxidant enzymes and to compare histopathological changes in influenza A virus-induced maxillary sinusitis. MATERIALS AND METHODS: The experimental viral infection was induced in New Zealand white rabbits by inoculating 0.3 ml of influenza A virus. Maxillary sinus mucosa were examined with a light microscope and the generation of superoxide radicals and activity of antioxidant enzymes were measured at the intervals up to 28 days after inoculation. RESULTS: The mucosal changes deteriorated and reached maximum at seven days after inoculation. The first day of inoculation, mononuclear phagocytes and neutrophils began to be found in subepithelial layer. We also found that capacity of oxygen generation increased about one and a half fold compared with the non-infected control group. The activity of SOD, GSH-Px and CAT, which are specific scavengers of oxygen radicals, peaked at three, five, and seven days after viral inoculation, respectively. CONCLUSIONS: These results suggest that oxygen free radicals play an improtant role in the histopathologic damage in the early stage of influenza A viral infection, and the activities of antioxidant enzymes are enhanced by the generation of superoxide radicals. It is also indicated that antioxidant enzymes may have a therapeutic potential for this viral infection and other conditions associated with free radicals.

Effect of Steroid Administration on Immune-Mediated Sensorineural Hearing Loss in MRL/MP-lpr/lpr Mice / 대한이비인후과학회지

In our daily clinical practice, we have come across several patients suffering from a fluctuating sensorineural hearing loss of unknown origin. Such patients were sometimes treated with sucess by steroid administration. Some kinds of immune injury in the inner ear have been proposed as a possible pathogenesis. However, the minute mechanisms of immune injury in the inner ear and the way in which steroids improve the hearing loss remained obscure. We have previously reported that the MRL/MP-lpr/lpr(MRL/lpr) autoimmune strain of mice showed IgG deposition in the stria vascularis with elevated thresholds of auditory brainstem response. This strain of mice though to be a good model for studying immune mediated inner ear dysfunction. The purpose of this study was to evaluated the therapeutic efffects of prednisolone on the hearing impairment in MRL/lpr mice, morphologically and electrophysiologically.

Changes of the Sialoglycoconjugates in the Maxillary Sinus Mucosa of theRabbits after Inoculation of Influenza a Virus / 대한이비인후과학회지

The present study was carried out in order to observe the changes in the expression of the sialoglycoconjugates of the rabbit sinus mucosa after inoculation of influenza A virus utilizing a biotin labeled lectins for light microscopy with four different lectins; Maackia amurensis(MAA), Wheat germ agglutinin(WGA), Sambucus nigra(SNA), and Peanut(PNA). A comparison of the affinity of these lectins demonstrated the different distribution of sialoglycoconjugates in the ciliary layer and goblet cells. The normal sinus mucosa stained with four types of lectins showed that the sialoglycoconjugates were mainly distributed in the ciliary layer and goblet cells. Moreover, the main sugar residues of the sialoglycoconjugates were figured out to be consisted of Neu5Ac(alpha2,3)Gal, GlcNAc and Neu5Ac. Influenza A virus infection decreased the staining intensity of the mucosa with MAA, but not with WGA. The staining intensity of PNA, however, was highly increased in the viral infected mucosa. These results suggest that Neu5Ac(alpha2,3)Gal sugar residues may be required as protecting factor or modulator for Influenza A virus infectivity.

Ultrastructure of Temporalis Muscle Fascia Used as Molded Ear Drum Graft / 대한이비인후과학회지

Molded tympanic graft is beneficial in the difficult cases of middle ear surgery, for instance, total perforation of ear drum or revision surgery. For producing molded graft, it is essential to treat the graft material with physico-chemical methods. However, morphological change by influence to the epithelial migration by treatment of graft have not been clarified. To evaluate the morphological effects of molding process on the graft, human temporalis muscle fascias were taken and molded through drying, heating or treatment with chemical preservatives. Their ultrastructures were also evaluated using scanning electron microscope. In molding process, drying of fascia produced widening of interfiber space as well as flattening and fusion of fibers. Heating of fascia produced crater-like defects with amorphous matrix. Formaldehyde preservation induced more remarkable changes of fascia than alcohol.