Threshold Mismatches between Pure-Tone Audiometry and Auditory Steady State Response in Non-Auditory Neuropathy Adults / 대한이비인후과학회지

Background and Objectives@#To evaluate mismatches between pure-tone audiometry (PTA) and auditory steady-state response (ASSR) tests in non-auditory neuropathy adults and investigate brain lesions that may explain the mismatches, especially in cases where the ASSR threshold was worse than the estimated PTA threshold.Subjects and Method PTA, speech audiometry, auditory brainstem response, ASSR, and neuroimaging tests were carried out on individuals selected. Among them, medical records of 30 subjects (16 males, 14 females; mean age=54.4±13.2 years) with significant mismatches between PTA and estimated ASSR thresholds were analyzed retrospectively. All neuroimaging tests were reviewed to identify any neurologic abnormalities. @*Results@#Pathologic brain lesions were found in 19 cases (63.3%) in the study group, all of which showed significant mismatch in hearing threshold between PTA and ASSR. Seven case of ischemic brain lesions (23.3%), five tumorous lesions (16.6%), and four brain vessel anomalies (13.3%) were found. Brain hemorrhage due to trauma were found in two cases (6.6%) as well as one case (3.3%) of unruptured aneurysm. Central auditory pathway disorder was suspected in two cases. The 11 cases showing normal results in the imaging studies included one mental retardation, one brain concussion, and seven cases (23.3%) with no specific causes. Six tinnitus cases included two subjects showing discrepancies between frequency matching in the tinnitogram. @*Conclusion@#In adults with a mismatch between PTA thresholds and estimated ASSR thresholds, especially for those with moderate to profound hearing loss, additional neuroimaging tests and other audiologic tests may reveal other possible causes of hearing loss.

The Effect of Limited Counseling Time on Hearing Aid Uptake / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To determine appropriate counseling time for the first hearing aids user, we measured the effectiveness of first counseling time limit of 20 minutes for those who need hearing aids and collected predictive parameters during history taking. SUBJECTS AND METHOD: We reviewed the medical records of 956 patients (age 66.5±12.1) with hearing impairment who needed hearing aids. We divided patients into two groups, those who had counseling time limited to 20 minutes and others who had no time limitation. Job status, working condition of noise status, social activity and audiological variables were analyzed as probable predicting factors influencing the purchasing of the hearing aid (penetration rate). RESULTS: Of the total 956 patients, 48.64% of subjects decided to purchase hearing aids at first counseling. The two groups showed no significant difference (p=0.396): 49.81% of the group without time limitation purchased the hearing aid and 47.04% of those with time limitation purchased the aid. The social status, right side pure tone threshold and right side tinnitus were significant for calculating the explanation power (64.15%) in the hearing aid uptake probability equation. CONCLUSION: The level of social activity, hearing threshold and tinnitus were predictive variables obtained during the counseling. The time limitation of 20 minutes did not affect the rate of decision to purchase hearing aids. These results might help hearing clinics improve efficient time management at hearing aid clinics.

Binaural Electric-Acoustic Interactions Recorded from the Inferior Colliculus of Guinea Pigs: The Effect of Masking Observed in the Central Nucleus of the Inferior Colliculus

OBJECTIVES: To investigate the electric-acoustic interactions within the inferior colliculus of guinea pigs and to observe how central masking appears in invasive neural recordings of the inferior colliculus (IC). METHODS: A platinum-iridium wire was inserted to scala tympani through cochleostomy with a depth no greater than 1 mm for intracochlear stimulation of electric pulse train. A 5 mm 100 microm, single-shank, thin-film, penetrating recording probe was inserted perpendicularly to the surface of the IC in the coronal plane at an angle of 30-40degrees off the parasagittal plane with a depth of 2.0-2.5 mm. The peripheral and central masking effects were compared using electric pulse trains to the left ear and acoustic noise to the left ear (ipsilateral) and to the right ear (contralateral). Binaural acoustic stimuli were presented with different time delays and compared with combined electric and acoustic stimuli. The averaged evoked potentials and total spike numbers were measured using thin-film electrodes inserted into the central nucleus of the IC. RESULTS: Ipsilateral noise had more obvious effects on the electric response than did contralateral noise. Contralateral noise decreased slightly the response amplitude to the electric pulse train stimuli. Immediately after the onset of acoustic noise, the response pattern changed transiently with shorter response intervals. The effects of contralateral noise were evident at the beginning of the continuous noise. The total spike number decreased when the binaural stimuli reached the IC most simultaneously. CONCLUSION: These results suggest that central masking is quite different from peripheral masking and occurs within the binaural auditory system, and this study showed that the effect of masking could be observed in the IC recording. These effects are more evident and consistent with the psychophysical data from spike number analyses than with the previously reported gross potential data.

How Does Speaking Clearly Influence Acoustic Measures? A Speech Clarity Study Using Long-term Average Speech Spectra in Korean Language

OBJECTIVES: To investigate acoustic differences between conversational and clear speech of Korean and to evaluate the influence of the gender on the speech clarity using the long-term average speech spectrum (LTASS). METHODS: Each subject's voice was recorded using a sound level meter connected to GoldWave program. Average long-term root mean square (RMS) of one-third octave bands speech spectrum was calculated from 100 to 10,000 Hz after normalizing to 70 dB overall level using the MATLAB program. Twenty ordinary Korean were compared with 20 Korean announcers with equal numbers of men and women in each group. RESULTS: Compared with the LTASS of ordinary men, that of ordinary women was lower at low frequencies, but higher at 630, 800, 1,600, 5,000, and 10,000 Hz. Compared with the LTASS of male announcers, that of female announcers was lower at low frequencies. Compared with the LTASS of ordinary men, that of male announcers was significantly lower at 100, 125, 200, and 250 Hz. Compared with the LTASS of ordinary women, that of female announcers was lower at 100, 125, 160, 200, 250, 500, and 10,000 Hz. The LTASS of announcer showed lower levels at 100, 200 Hz and higher at 500, 630, 800, and 1,000 Hz that that of ordinary Koreans. CONCLUSION: This study showed that the drop-off of the LTASS in the low frequency region might make the ratings of women and announcers more clearly than those of men and ordinary persons respectively. This drop-off in the low frequency might result in less upward spread of masking and clearer speech. This study reduced an error resulting from a wide variability of clear speech strategies and intelligibility gains, because this study recruited professional speakers. We hope that our results demonstrate the difference in acoustic characteristics of the speech of ordinary Korean persons.

Development of Compact Disks in Speech Audiometry and First Stage Verification for the New Speech Materials / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To standard test method of Korean speech audiometry, we developed an audio compact disk, the KsoM-07 (Korean Society of Otolaryngolgy, Monosyllabic, 2007) word lists and evaluated them for clinical usage. SUBJECTS AND METHOD: The monitored live voice (MLV) of a female talker was digitally recorded with a Beltone audiometer and the GoldWave program. The calibration for each word was done by calculating the root-mean-square (RMS) at the moving time of 300 ms using MATLAB(R) (7.0 version, The MathWorks, Inc. Natick, Massachusetts, USA) and the GoldWave (v 5.25 GoldWave Inc. St. John's, NL, Canada) program. The discrimination score was measured in 20 normal subjects to obtain psychometric function curve of each word and to compare the homogeneity of two lists. The first verification methods for new speech materials were done by comparing the discrimination scores of the flat type and the descending types at 150 sensorineural hearing loss with similar pure tone threshold. RESULTS: 44% of MLV recording was above +/-3 dB deviation and had to be recalibrated. Two lists showed equal difficulty or homogeneity in normal subjects. Discrimination scores were statistically different among the groups with respect to hearing level and the slope of audiogram. CONCLUSION: KsoM-07 word lists were relatively homogeneous and showed differences between the descending type and the flat type of hearing loss. Therefore, KsoM-07 word lists can be useful in evaluating the impairment found in the descending type of sensorineural hearing loss as well as in serving as a new speech test material for Korean monosyllabic words.

Rehabilitation for the Elderly or Presbycusis Using Hearing Aids / 대한이비인후과학회지

No abstract available.

Change of Subjective Visual Vertical (SVV) in Patients of Vestibular Neuritis

BACKGROUND AND OBJECTIVES: Measurement of subjective visual vertical (SVV) in darkness with the head upright is one of the static function test of the otolithic system and is simple to perform in the patients. Changes of SVV were measured during the recovery period of vestibular neuritis to investigate the relation between SVV and the subjective improvements reported by the patients. MATERIAL AND METHODS:Sixty-two patients with unilateral vestibular neuritis were investigated. All the patients were diagnosed by physical examination with electronystagmography and the SVV were assessed during the acute period and sequentially followed during the recovery period. At the same time, the subjects were questioned in five scale of symptom improvement which were "Level 5: I am so dizzy to open my eyes", "Level 4: I am dizzy not moving my head", "Level 3: I am not dizzy if I don't move my head", "Level 2: I am not dizzy with head moving", "Level 1: I am not dizzy at all". RESULTS: The calibrated mean values were 5.72+/-4.77 degree in vertical deviated toward the lesion side. There was no relation between the canal paresis and the tilt of SVV. As the SVV reaches the normal value, the symptom scale improved to level 2 (p=0.018). The mean recovery time could be obtained by calculating the regression curve of the well compensated groups. CONCLUSION: These results show that SVV correlated with clinical improvement of dizziness symptoms in vestibular neuritis. Therefore, this method can be used to evaluate vestibular neuritis during the follow up.

Antrochoanal Polyp's Variant, the Angiomatous Nasal Polyp: A Case Report / 대한이비인후과학회지

Angiomatous nasal polyps are a rarely reported subtype of inflammatory sinonasal polyps that are characterized by extensive vascular proliferation and ectasia. The blood vessels present in these sinonasal polyps may be subjected to compromise at certain areas within the nasal cavity, leading to venous stasis, thrombosis and infarction. Recently, we experienced a case of angiomatous nasal polyp that caused significant diagnostic difficulty at the time of her presentation in a 12-year-old girl. Although entirely benign, angiomatous nasal polyps may simulate neoplastic process, thus awareness of their existence is of considerable importance. Especially, differential diagnosis between angiomatous polyp and angiofibroma is important for evaluation and treatment. In the present paper, the clinical, radiological and pathological features of angiomatous nasal polyps is also discussed.

Causative Pathogens and Therapeutic Assessment of Cefprozil in Acute Otitis Media

PURPOSE: AOM is the most common bacterial URI in children. The bacteriology and antibiotic Tx of AOM in children has been studied in many countries. But, there is few study of causative pathogens and antibiotic Tx of AOM in our country. In this aspect, we performed prospective clinical study to confirm the causative pathogens and assess the clinical responses of cefprozil in AOM patients. METHODS: Thirty three AOM patients enrolled in this study. Tympanocentesis for isolation of causa tive pathogens were performed before Tx of cefprozil. The study patients received cefprozil with dose of 15 mg/kg/bid.po/day for 10-12 days, and initially assessed the clinical response at 4-5 days after receiving cefprozil and finally at the end visit. In vitro susceptibility tests of cefprozil to isolated pathogens were done by disc diffusion method, and in vitro susceptibility tests of cefaclor and cefixime to isolated pathogens were simultaneously performed. RESULTS: Bacterial pathogens[S. pneumoniae(10), H. influenzae(5), S. aureus(2), M. catarrhalis(1) and Group A stretococcus(1)] were isolated from 19 patients. Clinically, all patients had history of abrupt high fever except one. Tympanic perforation was dominant in pathogens isolated cases, and otalgia was significantly developed in non-pathogens isolated cases. The ages of pathogens isolated cases were usually below 2 years. Eighty four point nine percent of the patients including two cases with isolation of intermediate resistant S. pneumoniae were clinically improved. Antimicrobial in vitro activity to S. pneumoniae of cefprozil were superior than that of cefacor and cefixime. CONCLUSION: We confirm that bacteria has the causative role in about 60% cases, and S. pneumoniae is the most common pathogen. Clinically, there were some differences in symptoms, signs and ages between pathogens isolated and non-pathogens isolated cases. The clinical responses of cefprozil in our patients revealed similar outcomes to other countries. And we reconfirm that cefprozil may be clinically effective in cases of AOM due to intermediate resistant S. pneumoniae.

Acoustic analyses of monosyllabic words which are difficult to discriminate in the high frequency hearing loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Speech discrimination testing has been used to evaluate the communication disability, select hearing aid candidacy and appropriate amplification, plan and evaluate aural rehabilitation programs and assist in the determination of the site of lesion. Since the words of speech discrimination tests were made on the basis of the linguistic aspects and used till now, they underestimate the disability of high frequency hearing loss (HFHL). To ameliorate this problem, we analysed the words which were difficult to discriminate in FHL in a commonly used speech testing material using the acoustic analysis method. Also, the words were assorted to establish a basic data for a new speech material which could estimate the disability of HFHL. METHODS: 20 HFHL subjects (age 20-70), selected on the basis of pure tone audiometry, were found to be the descending type. They were tested to repeat the monosyllabic words at 10-15dB HL above the puretone threshold of 1000Hz and checked with the error responses. These words were sorted out according to the error response or the confusion rate and analyzed by consonants and vowels. The words were recorded with an audiologist's voice using a GSI 10 audiometer connected to the personal computer. This was analyzed by the acoustic analysis program that has the MATLAB function. With this program, a word was analyzed by an initial consonant, a vowel, and a final consonant for the intensity, the formant peak frequency and the time course. RESULTS: The words which were difficult to discriminate for HFHL were sorted out by the confusion rates. The words of articulation score 15-50% were revealed to have low intensity with short duration, and the peak frequency spectrum above 3 kHz. Also the consonant-vowel transition frequency was located above 3 kHz. CONCLUSION: These results could be used as a basic clinical data to make a new speech discrimination material which evaluates the disability of HFHL more accurately.

Short Term Hearing Results of Assembled Allograft Septal CartilageOssiculoplasty of PORP and TORP Configuration / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Various techniques of ossicular reconstruction have been advocated for hearing restoration in the chronic otitis media and cholesteatoma. Although cartilage has good biocompatibility to minimize extrusion or displacement, and is readily available, versatile to use, the hearing results with cartilage graft are poorer than that with plastic materials. The author believed this was due to the sculpturing problem of cartilage, and has devised an assembled type of cartilage ossiculoplasty of PORP and TORP configuration. The technique and short term results are reviewed. METHODS: Of the patients who underwent ossiculoplasty between 1998 and 2000, 103 ears of 95 patients, aged 3-66 years (mean 38.9) were analysed retrospectively. The follow-up period was from 3 to 30 months (mean 9.5). Fifty-one ears were found to be in the second stage and 52 ears were in the first stage. Allograft septal cartilage was sculptured separately and assembled as head and shaft. The average threshold in the frequencies of 500, 1000 and 2000 Hz was used for determination of results. RESULTS: The preoperative mean air-bone gap (ABG) was 42.86+/-8.79 dB and postoperative ABG was 21.22+/-11.33 dB. Gain of ABG was 21.63+/-11.11 dB. Closure of the ABG to within 10 dB, 20dB and 30 dB were achieved in 25.24%, 55.34% and 83.50% respectively. Gain of the ABG did not differ between the one staged and the two staged ossiculoplasty. Patency of eustachian tube orifice and presence of superstructure of stapes did influence the hearing results of this type of ossiculoplasty. CONCLUSION: The assembled type of cartilage ossiculoplasty of PORP and TORP configuration with allograft septal cartilage ossiculoplasty shows satisfactory short term hearing results and represents an excellent alternative to biocompatible prosthesis for ossicular recon-struction.

Normal variation of subjective visual vertical and horizontal in human / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Otolithic system which senses the head position and linear movement according to gravity acceleration force, plays an important role in maintaining the position of eyeball by otolith-ocular reflex. Measurement of subjective visual vertical and horizontal in darkness with the head upright is one of the static function test of the otolithic system and is simple to perform in man. Several papers reported that perceptual visual vertical and horizontal stays within small range in normal person but numbers of test subjects were limited. Furthermore the effect of age and sex are unknown. MATERIAL AND METHODS: One hundred forty normal subjects(male:70, female:70 ; age 5-70) were selected on the basis of medical history and neurologic examination. The subject was seated upright 100 cm from LED bar(1 mm width , 80 cm length)in the dark. The supporting frame of LED bar was motor driven with minimum rotating angle of 0.01 degree in both directions. After several practice, each subject set the LED bar from random position to subjective vertical or horizontal twice in one session with a motor control switch. Five sessions were repeated with a minimum interval of 5 minutes. RESULTS: The calibrated mean values were 1.06+/-0.45 degree in vertical and 1.00+/-0.52 degree in horizontal and did not demonstrate any difference in plane and direction of adjustment. Age under 10 and over 60 had a significant higher mean value compared with the mean of all subjects but the difference between over 10 and below 60 was not noted. Female had higher mean values than male. Five repeated tests showed high reproducibility. The direction of adjustment did not show any significant difference. CONCLUSION: These results would be a useful clinical data for evaluating the static otolith-ocular reflex.