Clinical and Audiologic Characteristics of Acute Low-Tone Sensorineural Hearing Loss: Therapeutic Response and Prognosis

OBJECTIVES: This study was designed to observe the clinical and audiologic characteristics of patients diagnosed as low tone hearing loss (LHL) and to evaluate the treatment response and prognosis. SUBJECTS AND METHODS: A retrospective chart review of 61 patients who were diagnosed with LHL was performed. Result of various audiologic studies and therapeutic responses of medication have been evaluated. Data were statistically analyzed with variables such as age, sex, interval between onset and treatment, initial hearing levels, findings of electrocochleargraphy, and initial concomitant symptoms according to their treatment response. RESULTS: Frequent chief complaints of LHL were tinnitus and earfullness. Tinnitus was usually matched at lower frequencies. Treatment with low-dose steroids, diuretics, and betahistine produced a high response rate of 79.4%. Complete response occurred in 49 of the 68 ears (72.1%) and partial response occurred in five of the 68 ears (7.4%). Fourteen of the 68 ears (20.6%) were in the non-responder group. Patients treated within 7 days after the onset of symptoms all showed complete response. Statistically significant prognostic factors affecting treatment response were age and intervals between onset and treatment (p<0.05). CONCLUSION: Patients with acutely onset tinnitus or ear fullness should be carefully evaluated and promptly treated under the diagnosis of LHL.

Frequency-Specific Hearing Results After Surgery for Chronic Ear Diseases

OBJECTIVES: To analyze frequency-specific hearing results after surgery for chronic ear diseases while considering pathological findings and various surgical factors. METHODS: Patients who underwent surgical management of chronic otitis media were reviewed retrospectively (n=559). Using pure tone audiometry, air conduction (AC), bone conduction (BC), and air bone gap (ABG) change between pre- and post-operative tests were calculated for the frequencies of 250, 500, 1,000, 2,000, 3,000, 4,000 (AC and BC), and 6,000 Hz (AC). Frequency-specific results were investigated, considering various surgical factors, such as type of surgery, type of ossiculoplasty and pathological findings. RESULTS: AC results in the intact canal wall mastoidectomy showed improvement at each frequency except 4,000, 6,000 Hz. AC results in the tympanoplasty showed improvement at each frequency except 6,000 Hz. AC and ABG results in the open cavity mastoidectomy showed improvement only at the frequencies of 250, 500, 2,000 Hz. AC and ABG improved at low and mid frequencies but not in high frequencies above 3,000 Hz when ossicular reconstruction was conducted. AC and ABG results also improved at low and mid frequencies in the cholesteatoma, and ABG results improved at all frequencies except 3,000 Hz in the non-cholesteatoma. CONCLUSION: After chronic ear surgery, AC and ABG changes improved, primarily in the low and mid frequencies. Further evaluation and studies for post-operative hearing loss at high frequencies are recommended for rehabilitation of hearing ability after surgery.

Expression of HSP70 and Its Relation with Other Cytokines in Human Middle Ear Effusion

OBJECTIVES: While other cytokines are known to be associated with otitis media with effusion (OME), the involvement of heat shock protein 70 (HSP70) in middle ear effusion (MEE) is unknown. This study was undertaken to investigate the possibility of there being a HSP70 expression in human MEE and to determine its potential role as a cytokine in OME. METHODS: The levels of HSP70, tumor necrosis factor-alpha and interleukin-1beta were measured by enzyme-linked immunosorbent assay in the effusion of different groups of OME patient following collection of the MEE using our new collection system. The clinical characteristics of the OME patients and the MEE status were analyzed. RESULTS: HSP70 was expressed in all the types of MEE. The mucous and seromucous effusions showed higher HSP70 levels than that of the serous effusion. The HSP70 level was correlated with the levels of tumor necrosis factor (TNF)-alpha and interleukin (IL)-1beta in the effusions. The positive correlations between HSP70, TNF-alpha and IL-1beta were statistically significant (P<0.05). CONCLUSION: The highly elevated level of HSP70 in the seromucous and mucous effusions implicates this protein in the chronicity of OME.

Changes in the Regional Cerebral Blood Flow in Postlingual Deaf Patients Measured by ECD-SPECT: Preliminary Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cochlear implantation improves hearing ability in adults with profound deafness. Using non-invasive functional brain imaging methods, it is now possible to assess regional blood flow and activity of auditory cortex which might be correlated to the outcome of cochlear implantation. The aim of this study was to measure the regional cerebral blood flow in patients with postlingual deafness utilizing controls in a variety of methods. SUBJECTS AND METHOD: Six postlingual deaf adults who were planned to undertake cochlear implantation and 12 normal controls were examined with technetium-99m-labeled ethyl cysteinate dimer single-photon emission computed tomography (99mTc-ECD-SPECT). Images of the regional cerebral blood flow were processed by statistical parametric mapping and analyzed by unpaired t-test. RESULTS: The analysis of the SPECT images of the 6 deaf patients showed decreased cerebral blood flow in both superior, middle temporal and inferior prefrontal lobes compared with controls (p<0.001). Also this decreased auditory cortical blood flow was greater in left hemisphere in all patients. CONCLUSION: The degree of remaining activity of auditory cortex and the lateralization of the dominant auditory hemisphere, which may influence on the outcome of cochlear implantation, could be measured by ECD-SPECT.

Treatment Response of Modified Tinnitus Retraining Therapy with Medical Therapy in the Patients with Tinnitus / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: According to the neurophysiologic model of tinnitus, emotion and autonomic nervous systems are closely related to generation of tinnitus. We performed this study to evaluate the treatment response of modified tinnitus retraining therapy (TRT) with medication in the patients with sensorineural tinnitus. SUBJECTS AND METHOD: Forty-three tinnitus patients who were diagnosed as sensorineural tinnitus through audiologic evaluation and have normal hearing in speech frequency were included in this study. Tinnitus and psychological status were measured by tinnitus questionnaire, Korean version of Brief Encounter Psychosocial Instrument (BEPSI) scale, Beck Depression Inventory (BDI), Spielberger State Trait Anxiety Inventory (STAI). Patients treated with anxiolytics and microcirculation enhancer were Group 1 and those treated with modified TRT and medications were Group 2. Short-term therapeutic response was analyzed and compared between two groups. RESULTS: Loudness, awareness, annoyance and effect on life of tinnitus and tinnitus handicap score were significantly decreased in Group 2. Relief of tinnitus in more than 2 of 4 subjective parameters was achieved in 4 patients (30.7%) in Group 1 and 15 patients (75%) in Group 2. Stress score was also decreased significantly after treatment in Group 2. CONCLUSION: Tinnitus patients in Group 2 treated with medication and modified TRT showed the higher compliance and the response rate of treatment than the patients in Group 1 treated with medication alone. Modified TRT, in addition to medical therapy, should be considered to increase the therapeutic response in patients with sensorineural tinnitus.

A Case of Extramedullary Plasmacytoma of the Nasopharynx / 대한이비인후과학회지

Multiple myeloma, solitary bone plasmacytoma, extramedullary plasmacytoma, plasmablastic sarcoma, and multifocal form of multiple myeloma belong to plasma cell tumors. Among them, extramedullary plasmacytoma consists of 4% of all plasma cell tumors and is found predominantly in the head and neck region. This tumor is a solitary tumor consisting of monoclonal plasma cell proliferation that occurs in soft tissues other than bone. The frequent sites in the upper aerodigestive tract are the paranasal sinus and the nasal cavity. Because the diagnosis is based on immunophenotypical finding of monoclonal plasma cells and there are many differential diagnoses, the exact diagnosis is difficult. To our knowledge, extramedullary plasmacytoma originating in the nasopharynx has rarely been reported. We experienced a case of nasopharyngeal extramedullary plasmacytoma which was treated with combined therapy. So we report this case with a review of literatures.