Cochlear Implantation in the Elderly: Speech Performance, Associated Factor, Complication, and Surgical Safety

Background and Objectives@#The guidelines for cochlear implantation (CIs) are expanding, and the number of CI procedures performed on the elderly is increasing. The purpose of this study was to analyze the results and safety of cochlear implantation in the elderly, as well as to evaluate the predictive factors on CI outcomes. @*Subjects and Methods@#The study included 56 patients aged ≥40 years, who received CIs between 2009 and 2020. They were divided into two groups: 27 younger adults (40-64 years) and 29 elderly (>64 years). The study compared their pre- and postoperative speech perception and category of auditory performance (CAP) scores, surgical complications, and hospitalization periods. It also evaluated associated factors in the elderly group by examining categorical and continuous variables and postoperative CAP score. @*Results@#There was a significant improvement in speech recognition tests (both word and sentence) and CAP scores in both groups compared to the pre-implantation scores (p<0.001). Postoperative results were slightly lower in the elderly group than in younger adults for sentence recognition and CAP scores, except for word recognition. No significant associated factors were found on postoperative CAP scores, except for etiology. Postoperative CAP significantly improved in the sudden hearing loss group compared to the groups with other etiologies (p=0.045). The elderly group had more comorbidities than that in the younger adult group (p=0.026), but there were no significant differences in postoperative complications and hospitalization periods. @*Conclusions@#While speech recognition and CAP scores were relatively lower in the elderly group compared to the younger adults, the elderly group showed significant improvements in audiological results after CI. Moreover, CI was safe and well tolerated in elderly patients.

Enhancing Mural Nodules in the Main Pancreatic Duct of Main and Mixed Types of Intraductal Papillary Mucinous Neoplasms: Does Size Matter in Malignancy Risk?

Background/Aims@#Most guidelines recommend surgical resection of all main duct (MD) and mixed-type (MT) intraductal papillary mucinous neoplasms (IPMNs) in suitable patients. However, there is little evidence regarding the malignancy risk of enhancing mural nodules (EMNs) that are present only in the main pancreatic duct (MPD) in patients with MD- and MT-IPMNs.Therefore, this study aimed to identify the clinical and morphological features associated with malignancy in MD- and MT-IPMNs with EMNs only in the MPD. @*Methods@#We retrospectively enrolled 50 patients with MD- and MT-IPMNs with EMNs only in the MPD on contrast-enhanced magnetic resonance imaging. We evaluated the clinical characteristics and preoperative radiologic imaging results of MPD morphology and EMN size and analyzed the risk factors associated with malignancy. @*Results@#Histological findings of EMNs were low-grade dysplasia (38%), malignant lesions (62%), high-grade dysplasia (34%), and invasive carcinoma (28%). On the receiver operating characteristic curve, the cutoff value of EMN size on magnetic resonance imaging for best predicting malignancy was 5 mm (sensitivity, 93.5%; specificity, 52.6%; area under the curve, 0.753).Multivariate analysis showed that only EMN >5 mm (odds ratio, 27.69; confidence interval, 2.75 to 278.73; p=0.050) was an independent risk factor for malignancy. @*Conclusions@#EMNs of >5 mm are associated with malignancy in patients with MD- and MTIPMNs with EMNs that are present only in the MPD, in accordance with the international consensus guidelines.

Secondary migration of a pre-existing central venous catheter due to a Swan-Ganz catheter insertion – A case report –

The entanglement of multiple central venous catheters is a rare and seriouscomplication. The Swan-Ganz catheter is a responsible for various cases.Case: A 66-year-old male patient was under general anesthesia for a coronary artery bypassgraft surgery. As he had a pre-existing Perm catheter in the right subclavian vein, a SwanGanz catheter was inserted into the left internal jugular vein. Chest radiograph after catheterplacement revealed that the Perm catheter had migrated to the left brachiocephalic vein.The surgeon attempted to reposition it manually, but postoperative radiograph showed thatit had rolled into a loop. On postoperative day 1, radiological intervention was performed tountangle the loop, which was successful.Conclusions: After placing a Swan-Ganz catheter in patients with a pre-existing central venous catheter, the presence of entanglement should be assessed. In such cases, radiology-guided correction is recommended, as a blind attempt to disentangle can aggravate thecondition.

Successful Medical Treatment for Peritonitis Resulting from a Large Pyogenic Liver Abscess Rupture / 대한소화기학회지

The rupture of a pyogenic liver abscess (PLA) with peritonitis is a rare occurrence but a surgical emergency with a high mortality rate in the case of gas-forming PLA. Rare cases of ruptured PLA that recovered completely with only medical treatment have been reported.This paper reports a case of a large PLA rupture with peritonitis. In this case, surgical intervention was too risky because of the patient’s age and poor general condition. The patient recovered fully with appropriate antibiotic therapy and sufficient percutaneous drainage. Therefore, medical treatment may be considered an alternative option in cases of a ruptured large PLA with peritonitis if surgical intervention is too risky.

Physicochemical properties of different phases of titanium dioxide nanoparticles

The physicochemical properties of crystalline titanium dioxide nanoparticles (TiO2 NPs) were investigated by comparing amorphous (amTiO2 ), anatase (aTiO2 ), metaphase of anatase-rutile (arTiO2 ), and rutile (rTiO2 ) NPs, which were prepared at various calcination temperatures (100℃, 400℃, 600℃, and 900℃). X-ray diffraction (XRD) and scanning electron microscopy (SEM) analyses confirmed that the phase-transformed TiO2 had the characteristic features of crystallinity and average size. The surface chemical properties of the crystalline phases were different in the spectral analysis. As anatase transformed to the rutile phase, the band of the hydroxyl group at 3,600–3,100 cm –1decreased gradually, as assessed using Fourier transform infrared spectroscopy (FT-IR). For ultraviolet-visible (UVVis) spectra, the maximum absorbance of anatase TiO2 NPs at 309 nm was blue-shifted to 290 nm at the rutile phase with reduced absorbance. Under the electric field of capillary electrophoresis (CE), TiO2 NPs in anatase migrated and detected as a broaden peak, whereas the rutile NPs did not. In addition, anatase showed the highest photocatalytic activity in an UV-irradiated dye degradation assay in the following order: aTiO2 > arTiO2 > rTiO2 . Overall, the phases of TiO2 NPs showed characteristic physicochemical properties regarding size, surface chemical properties, UV absorbance, CE migration, and photocatalytic activity.

Successful Medical Treatment for Peritonitis Resulting from a Large Pyogenic Liver Abscess Rupture / 대한소화기학회지

The rupture of a pyogenic liver abscess (PLA) with peritonitis is a rare occurrence but a surgical emergency with a high mortality rate in the case of gas-forming PLA. Rare cases of ruptured PLA that recovered completely with only medical treatment have been reported.This paper reports a case of a large PLA rupture with peritonitis. In this case, surgical intervention was too risky because of the patient’s age and poor general condition. The patient recovered fully with appropriate antibiotic therapy and sufficient percutaneous drainage. Therefore, medical treatment may be considered an alternative option in cases of a ruptured large PLA with peritonitis if surgical intervention is too risky.

Physicochemical properties of different phases of titanium dioxide nanoparticles

The physicochemical properties of crystalline titanium dioxide nanoparticles (TiO2 NPs) were investigated by comparing amorphous (amTiO2 ), anatase (aTiO2 ), metaphase of anatase-rutile (arTiO2 ), and rutile (rTiO2 ) NPs, which were prepared at various calcination temperatures (100℃, 400℃, 600℃, and 900℃). X-ray diffraction (XRD) and scanning electron microscopy (SEM) analyses confirmed that the phase-transformed TiO2 had the characteristic features of crystallinity and average size. The surface chemical properties of the crystalline phases were different in the spectral analysis. As anatase transformed to the rutile phase, the band of the hydroxyl group at 3,600–3,100 cm –1decreased gradually, as assessed using Fourier transform infrared spectroscopy (FT-IR). For ultraviolet-visible (UVVis) spectra, the maximum absorbance of anatase TiO2 NPs at 309 nm was blue-shifted to 290 nm at the rutile phase with reduced absorbance. Under the electric field of capillary electrophoresis (CE), TiO2 NPs in anatase migrated and detected as a broaden peak, whereas the rutile NPs did not. In addition, anatase showed the highest photocatalytic activity in an UV-irradiated dye degradation assay in the following order: aTiO2 > arTiO2 > rTiO2 . Overall, the phases of TiO2 NPs showed characteristic physicochemical properties regarding size, surface chemical properties, UV absorbance, CE migration, and photocatalytic activity.

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.

Antitumor effects of octyl gallate on hypopharyngeal carcinoma cells

The antitumor effects of octyl gallate (OG) were investigated on FaDu human hypopharyngeal squamous carcinoma cells. At various concentrations, OG inhibited the proliferation of FaDu cells by suppressing cell cycle regulators and induced apoptosis by activating caspase 3 and its downstream poly (ADP-ribose) polymerase, thereby damaging DNA. Immunoblotting demonstrated that OG significantly suppressed the expression of integrin family proteins (integrin α4, αv, β3, β4), hindering cell adhesion. The reduced expression of integrins subsequently mediated the mitogen- activated protein kinase signaling pathway to stimulate the activation of extracellular signal-regulated kinases and c-jun N-terminal kinases, leading to apoptosis. Thus, OG demonstrated antitumor activity on hypopharyngeal squamous carcinoma cells by suppressing cell proliferation and inducing apoptosis.

Novel alternative for submental intubation - A case report -

Background@#Submental intubation is commonly used during general anesthesia for maxillofacial surgeries as it provides a safe unrestricted surgical access compared to tracheostomy. During submental intubation, soft tissues and blood clots can become lodged in the endotracheal tube. To overcome this problem, we used a laparoscopic trocar.Case: A 52-year-old man with maxillofacial injury was scheduled to undergo an open reduction and internal fixation. We performed submental intubation using laparoscopic trocar, which created sufficient space for the insertion of the endotracheal tube. Unlike conventional methods, our method did not require any blunt dissection and caused significantly less soft tissue damage and required significantly less time. @*Conclusions@#Submental intubation with laparoscopic trocar is a one-step method and is quick and easy-to-perform technique with less complications.

Antitumor effects of octyl gallate on hypopharyngeal carcinoma cells

The antitumor effects of octyl gallate (OG) were investigated on FaDu human hypopharyngeal squamous carcinoma cells. At various concentrations, OG inhibited the proliferation of FaDu cells by suppressing cell cycle regulators and induced apoptosis by activating caspase 3 and its downstream poly (ADP-ribose) polymerase, thereby damaging DNA. Immunoblotting demonstrated that OG significantly suppressed the expression of integrin family proteins (integrin α4, αv, β3, β4), hindering cell adhesion. The reduced expression of integrins subsequently mediated the mitogen- activated protein kinase signaling pathway to stimulate the activation of extracellular signal-regulated kinases and c-jun N-terminal kinases, leading to apoptosis. Thus, OG demonstrated antitumor activity on hypopharyngeal squamous carcinoma cells by suppressing cell proliferation and inducing apoptosis.

A Case of Pulsatile Tinnitus Related to Idiopathic Intracranial Hypertension / 대한이비인후과학회지

Idiopathic intracranial hypertension (IIH) is a disorder that commonly occurs in obese young women of childbearing age and is characterized by symptoms such as pulsatile tinnitus, dizziness, headache, nausea, vomiting, and visual loss without any structural or vascular abnormalities in the intracranial cavity. We recently experienced a case of a 33-year-old obese woman who presented with right-sided pulsatile tinnitus, which is an early symptom for IIH. The patient was successfully treated with weight reduction and carbonic anhydrase inhibitor (acetazolamide). Pulsatile tinnitus requires thorough diagnosis and examination because it can be cured if the anatomical or functional cause is identified and treated. When obese women of childbearing age present with pulsatile tinnitus at the otorhinolaryngology outpatient department, treatment for IIH should be initiated after appropriate examination and diagnosis as pulsatile tinnitus may be the only symptom for IIH.

Comparison among Three Different Steroid Therapies for Idiopathic Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

Background and Objectives@#The optimal dose or type of systemic steroid for treating idiopathic sudden sensorineural hearing loss (ISSNHL) is unclear. Herein, we compare the efficacy of three steroid treatment protocols.Subjects and Method We reviewed the medical records of 140 adult ISSNHL patients from a tertiary medical center. The patients were divided into three groups based on their treatment regimen: Group 1 received intravenous 10 mg/day dexamethasone combined with intratympanic (IT) steroid injection, followed by prednisolone for 5 days after discharge; Group 2 received 10 mg/day dexamethasone for 5 days, followed by 5 mg/day for 5 days over a 10-day hospitalization period; and Group 3 received 10 mg/day dexamethasone combined with IT steroid injection during a 5-day hospital stay, followed by 5 mg/day dexamethasone for 5 days after discharge. The hearing thresholds were measured using an automatic audiometer at 0.5, 1, 2, 3, 4, and 8 kHz. Hearing recovery on Day 90 was categorized according to Siegel’s criteria. @*Results@#Univariate and multivariate analyses showed that patients in Group 3 had the lowest hearing thresholds, and the best results for speech reception threshold and speech discrimination scores. The impact of favorable thresholds in Group 3 was better among patients with a baseline average hearing threshold of ＜70 dB. Complete recovery was more likely in Group 3 than in the other groups, based on the odds ratios. @*Conclusion@#Administration of dexamethasone-based systemic steroid combined with IT steroid injection and a relatively long hospitalization period produced the most favorable result.

A Case of Temporal Bone Cholesterol Granuloma Extending to Posterior Cranial Fossa without Middle Ear Involvement / 대한이비인후과학회지

Cholesterol granulomas of the temporal bone can occur in the petrous apex, middle ear, and mastoid cavity. Although cholesterol granulomas in the petrous apex often extend to the middle cranial fossa, cholesterol granulomas in the middle ear and mastoids rarely invade the cranial cavity with bony erosion. We report a case of a large cholesterol granuloma involving the posterior cranial fossa with pneumatic mastoid and not affecting the middle ear. The patient had no otologic or neurologic symptoms, and the mass was found incidentally on a brain MRI included in a regular medical checkup. The mass was removed via a combined transmastoid and suboccipital approach without complications, and characteristic pathology findings demonstrated a cholesterol granuloma.

Clinical Application of Video Head Impulse Test in Acute Vestibular Syndrome / 대한이비인후과학회지

Acute unilateral vestibulopathy (AUV) is the recommended term [rather than the more widely used ‘vestibular neuritis (VN)’] for all pathologies involving sudden impairment of the unilateral peripheral vestibular function regardless of the exact location of the lesion. Acute vestibular syndrome (AVS) is an upper-level entity of AUV, which is the most common cause of AVS, and includes acute central vertigo. AVS typically presents with the symptoms of new onset continuous vertigo, gait instability, and nausea/vomiting lasting several days to weeks. The video head impulse test (vHIT) was recently developed and has been widely adopted at clinics and emergency centers. In this study, we will review the differential diagnosis of AVS using vHIT. In addition, we will describe the subtypes of VN and the use of vHIT for follow-up testing in AVS.

The Influence of Education Level on Tinnitus and Quality of Life in Korean Adults / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#We aimed to evaluate the effect of the level of education on the prevalence of tinnitus and quality of life (QoL) in the Korean population. SUBJECTS AND METHOD: Our study included 3155 participants from a representative sample. Tinnitus was measured using questionnaires that evaluated perception of ringing, buzzing, roaring, or hissing sounds. Participants were asked to indicate “Yes” or “No” to these questions. Participants who felt that the sensation was “A little annoying” or “Very annoying” were considered to have moderate or severe tinnitus, respectively. Hearing thresholds were measured using an automatic audiometer. QoL was evaluated using the EuroQoL (EQ) scale. @*RESULTS@#The number of participants in the low, middle, and high education groups were 1521, 967, and 667, respectively. Participants with any degree of tinnitus or moderate to severe tinnitus increased as the level of education decreased. Multivariate logistic regression analysis showed that the low education group had significantly higher odds ratios compared to the middle or high education groups for moderate to severe tinnitus. Abnormal EQ 5-dimensions (EQ-5D) were higher in participants with tinnitus and a low level of education. For participants, univariate and multivariate analyses showed EQ-5D index and EQ-visual analog scale in the low education group were lower than that in the other groups. @*CONCLUSION@#Our study showed that low education level was associated with moderate to severe tinnitus in the Korean adult population. Participants with tinnitus and a low level of education had poorer QoL than those with tinnitus and a high level of education.

Preparation and characterization of rutile phase TiO₂ nanoparticles and their cytocompatibility with oral cancer cells

In the present study, rutile phase titanium dioxide nanoparticles (R-TiO₂ NPs) were prepared by hydrolysis of titanium tetrachloride in an aqueous solution followed by calcination at 900℃. The composition of R-TiO₂ NPs was determined by the analysis of X-ray diffraction data, and the characteristic features of R-TiO₂ NPs such as the surface functional group, particle size, shape, surface topography, and morphological behavior were analyzed by Fourier-transform infrared spectroscopy, scanning electron microscopy and energy dispersive X-ray spectroscopy, transmission electron microscopy, dynamic light scattering, and zeta potential measurements. The average size of the prepared R-TiO₂ NPs was 76 nm, the surface area was 19 m²/g, zeta potential was −20.8 mV, and average hydrodynamic diameter in dimethyl sulfoxide (DMSO)–H₂O solution was 550 nm. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay and morphological observations revealed that R-TiO₂ NPs were cytocompatible with oral cancer cells, with no inhibition of cell growth and proliferation. This suggests the efficacy of R-TiO₂ NPs for the aesthetic white pigmentation of teeth.

Tannic acid-induced apoptosis in FaDu hypopharyngeal squamous cell carcinoma

Tannic acid (TA) is a water-soluble polyphenol compound found in various herbal plants. We investigated the chemopreventive effects of TA on FaDu hypopharyngeal squamous carcinoma cells. In an 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, TA showed dose-dependent cytotoxicity with a half maximal inhibitory concentration (IC50) of 50 µM. Cell cycle analysis and immunofluorescence imaging demonstrated that under low-dose (25 µM) treatment, FaDu cells were arrested in G2/M phase, and as the dose of TA was increased, apoptosis was induced with the increase of cell population at sub-G1 phase. The expressions of various cyclins, including cyclin D1 and cyclin-dependent kinases (CDK-1 and CDK-2), were down-regulated at low doses of TA, whereas apoptotic effectors such as cleaved caspase 3, cleaved caspase 7, and poly (ADP-ribose) polymerase (PARP) were expressed in a dose-dependent manner in Western blotting. In addition, TA-induced apoptosis of FaDu cells might be mediated by the extracellular signal-regulated kinase (ERK)/mitogen-activated protein kinase pathway, with the upregulation of p-AKT/p-PKB (phosphorylated protein kinase B) and p-ERK. Overall, our data support the hypothesis that TA is a potential candidate agent for the treatment of hypopharyngeal cancer.

Direction-Changing and Direction-Fixed Positional Nystagmus in Patients With Vestibular Neuritis and Meniere Disease

OBJECTIVES: Direction-changing positional nystagmus (PN) was considered to indicate the presence of benign paroxysmal positional vertigo involving lateral semicircular canal in most cases. We investigated the incidence of PN on the supine head-roll test and compared the characteristics of nystagmus in patients with vestibular neuritis (VN) and Meniere disease (MD). METHODS: A retrospective review of patients, who were diagnosed with unilateral VN or unilateral definite MD between September 2005 and November 2011, was conducted. Sixty-five VN patients and 65 MD patients were enrolled. Eye movements were recorded for 30–60 seconds at the positions of sitting, head roll to the right, and head roll to the left, and maximum slow-phase eye velocity was calculated. PN was classified as direction-fixed (paretic or recovery) and direction-changing (geotropic or apogeotropic). RESULTS: Spontaneous nystagmus was observed in 57 patients (87%, the slow-phase eye velocity of 7°/sec±5°/sec) with acute VN, 39 (60%, 2°/sec±1°/sec) with follow-up VN, and 32 (49%, 2°/sec±2°/sec) with MD. Direction-fixed PN was the most common type. Direction-fixed paretic type was most common in acute VN (80%) and follow-up VN (42%), and direction-fixed recovery type was most common in MD (31%). Paretic type was significantly more common in acute VN (80%) than in follow-up VN (42%) and MD (26%), and the recovery type was significantly more common in MD (31%) than in acute VN (3%) and follow-up VN (14%). Direction-changing PN was more common in MD (22%), followed by follow-up VN (14%) and acute VN (9%). CONCLUSION: Though direction-fixed paretic PN was most common in VN and MD patients, direction-changing PN could be observed in a few patients (9%–20%) with peripheral vestibular disorders regardless of the duration from the onset of dizziness, suggesting the presence of otolith-related dizziness.