A Case of the Vibrant Soundbridge Stapes Coupler in Patients with Mixed Hearing Loss

The Vibrant Soundbridge (VSB) with stapes clip coupler placement at the stapes head has been used successfully to treat mixed hearing loss. Coupling between the floating mass transducer of the VSB and the stapes head is technically less demanding than incus vibroplasty and is more likely to generate a positive outcome without significantly changing residual hearing or resulting in medical or surgical complications. A 65-year-old man with bilateral mixed hearing loss and chronic otitis media underwent vibroplasty with a stapes clip coupler. Speech discrimination scores in both quiet and noise environments showed better functional gain with the VSB than with the use of a conventional hearing aid. The results of the present case show the feasibility of implanting a VSB with a stapes coupler in patients with mixed hearing loss due to chronic otitis media.

Change in Tinnitus after Treatment of Vestibular Schwannoma: Microsurgery vs. Gamma Knife Radiosurgery

PURPOSE: Tinnitus is a very common symptom of vestibular schwannoma, present in 45 to 80% of patients. We evaluated changes in tinnitus after translabyrinthine microsurgery (TLM) or gamma knife radiosurgery (GKS). MATERIALS AND METHODS: Among 78 patients with vestibular schwannoma who underwent TLM or GKS at Severance Hospital from 2009-2012, 46 patients with pre- or postoperative tinnitus who agreed to participate were enrolled. Pure tone audiometry, tinnitus handicap inventory (THI), visual analogue scale (VAS) scores for loudness, awareness, and annoyance were measured before and after treatment. Changes of THI and VAS were analysed and compared according to treatment modality, tumour volume, and preoperative residual hearing. RESULTS: In the TLM group (n=27), vestibulocochlear nerves were definitely cut. There was a higher rate of tinnitus improvement in TLM group (52%) than GKS group (16%, p=0.016). The GKS group had a significantly higher rate of tinnitus worsening (74%) than TLM group (11%, p<0.001). Mean scores of THI and VAS scores significantly decreased in the TLM group in contrast to significant increases in the GKS group. Tumor volume and preoperative hearing did not affect the changes in THI or VAS. CONCLUSION: GKS can save vestibulocochlear nerve continuity but may damage the cochlea, cochlear nerve and can cause worsening tinnitus. In cases where hearing preservation is not intended, microsurgery with vestibulocochlear neurectomy during tumor removal can sometimes relieve or prevent tinnitus.

Botox Therapy for Deep Nasolabial Fold and Bitterness Furrow after Facial Nerve Paralysis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Facial sequelae after facial paralysis cause serious functional and aesthetical problems including facial asymmetry, symkinesis and facial crease. The most common aesthetical problem is facial furrow and crease induced by facial hyperkinestic movement due to incomplete facial recovery. The aim of this study is to investigate the efficacy of botulinum toxin A injection in patients with deep nasolabial fold and bitterness furrow after facial paralysis. SUBJECTS AND METHOD: Thirty-five patients who recovered partially from facial paralysis, had deep nasolabial fold and bitterness furrow with or without facial asymmetry. Botulinum toxin A intramuscular injection on perioral area for mouth corner deviation, subcutaneous injection on deepen nasolabial fold, and intramuscular injection on bitterness furrows had improved lower facial symmetry and cosmetic configuration without Pseudo Bell's palsy. RESULTS: Of 26 patients who had facial palsy side nasolabial fold before the injection, 21 patients improved. Of the 21 patients who had facial palsy side bitterness furrow, 16 patients improved after the injection. Of 11 patients who had contralateral nasolabial fold, 4 patients improved after the injection. Of 13 patients who had contralateral bitterness furrow, 7 patients improved after the injection. CONCLUSION: After botulinum toxin A injection, the patients showed marked improvement of nasolabial fold, bitterness furrow and lower facial asymmetry.

Expression of Nonsteroidal Anti-Inflammatory Drug-Activated Gene(NAG-1) as a Prognostic Marker in Oral Tongue Squamous Cell Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Our previous study showed that nonsteroidal anti-inflammatory drug-activated gene (NAG-1) induced apoptosis in tongue cancer cells. However, the NAG-1 expression in tongue cancer and normal tissues was not studied. The aim of this study was to investigate the expression of NAG-1 in oral tongue cancer and normal tissues and to identify the relationship between NAG-1 expression and the prognosis of tongue cancer patients to determine whether NAG-1 can be used as a valuable prognostic marker in tongue cancer. SUBJECTS AND METHOD: The medical records and pathologic reports of 42 tongue cancer patients who received surgery as primary treatment were surveyed. Tongue cancer and normal tissues, which were obtained during the operation, were stained with anti-NAG-1 antibody using the immunohistochemical method and the H-score was calculated. RESULTS: As a result, the higher expression of NAG-1 was observed in the cancer tissues than in the normal tissues. NAG-1 expression was noted to be higher in cases of tongue cancers with more invasion, positive lymph node metastasis, and poor prognosis. A 5-year survival rate was significantly decreased in cases showing higher NAG-1 expression in the cancer tissues than in the normal tissues. CONCLUSION: The higher NAG-1 expression in the cancer tissue suggests malignant changes in cancer tissue and poor prognosis. Therefore, NAG-1 may be a useful prognostic marker in tongue squamous cell carcinoma.

Three Cases of Epidermoid Cyst Associated with Sulcus Vocalis / 대한이비인후과학회지

Sulcus vocalis refers to a condition in which a furrow occurs along the upper medial edge of the vocal folds. The etiology of sulcus is controversial. Bouchayer et al. proposed that sulcus vocalis is congenital and there are what appeared to be transition forms between the cyst and sulcus. Sulcus vocalis is frequently associated with epidermoid cyst. Epidermoid cyst may rupture spontaneously. If the resulting opening is as large as the cyst, the resulting empty pocket becomes a glottic sulcus. In addition, mucosal invagination may proceed on the upper and lower margins of the cyst and then sulcus vocalis can be formed. We experienced 3 cases of epidermoid cyst associated with sulcus vocalis on the upper and lower margins of the cyst and thought that presenting them would be helpful to understand the pathogenesis of the sulcus vocalis from the epidermoid cyst.