Results of Active Middle Ear Implantation in Patients With Mixed Hearing Loss After Middle Ear Surgery: A Prospective Multicenter Study (the ROMEO Study)

Objectives@#. This study was conducted to evaluate the user satisfaction, efficacy, and safety of round window (RW) vibroplasty using the Vibrant Soundbridge (VSB) in patients with persistent mixed hearing loss after mastoidectomy. @*Methods@#. The study included 27 patients (mean age, 58.7 years; age range, 28–76 years; 11 men and 16 women) with mixed hearing loss after mastoidectomy from 15 tertiary referral centers in Korea. The VSB was implanted at the RW. The Korean translation of the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire and the Korean version of the International Outcome Inventory for Hearing Aids (K-IOI-HA) questionnaire were used to evaluate user satisfaction as the primary outcome. The secondary outcome measures were audiological test results and complication rates. @*Results@#. The mean scores for ease of communication (61.3% to 29.7% to 30.2%), reverberation (62.1% to 43.1% to 37.4%), and background noise (63.3% to 37.7% to 34.3%) subscales of the APHAB questionnaire significantly decreased after VSB surgery. The mean K-IOI-HA scores at 3 and 6 months after surgery were significantly higher than the mean preoperative score (18.6 to 27.2 to 28.1). The postoperative VSB-aided thresholds were significantly lower than the preoperative unaided and hearing aid (HA)-aided thresholds. There was no significant difference between preoperative unaided, preoperative HA-aided, and postoperative VSB-aided maximum phonetically balanced word-recognition scores. None of the 27 patients experienced a change in postoperative bone conduction pure tone average. One patient developed temporary facial palsy and two developed surgical wound infections. @*Conclusion@#. RW vibroplasty resulted in improved satisfaction and audiological test results in patients with mixed hearing loss after mastoidectomy, and the complication rate was tolerable.

Safety and Effectiveness of Endoscopic Ear Surgery: Systematic Review / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#This study aims to evaluate that usefulness of the endoscopic ear surgery (EES) through the systematic review.SUBJECTS AND METHOD: We searched literatures in literature databases (MEDLINE, EMBASE, Cochrane Library, etc.). Inclusion criteria is 1) studies of patients with chronic otitis media, otitis media with effusion, cholesteatoma, conductive hearing loss, mixed hearing loss etc. 2) studies in which a transcanal endoscopic surgery was performed; and 3) studies in which one or more of the appropriate medical outcomes have been reported. We excluded that 1) non-human studies and pre-clinical studies; 2) non-original articles, for example, non-systematic reviews; editorial, letter and opinion pieces; 3) research not published in Korean and English; and 4) grey literature. Finally, 65 articles were selected and those results were analyzed.@*RESULTS@#The safety of the EES was reported in 61 articles. Some studies reported damaged facial nerve or perilymph gusher but these are the complications that can arise due to the characteristics of the disease and not due to the EES and other reported complications were of similar or lower level in the intervention group rather than the microscopy group. The effectiveness of the EES was reported in 23 articles. The EES tended to show improved effects in terms of graft uptake status, cholesteatoma removal, and hearing improvement although effective outcomes of most studies reported no significant difference between EES and microscopic ear surgery.@*CONCLUSION@#EES is a safe and effective technique and as it is less invasive than the microscopic ear surgery.

Feasibility of Revision Cochlear Implant Surgery for Better Speech Comprehension

BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate the efficacy of revision cochlear implant (CI) surgery for better speech comprehension targeting patients with low satisfaction after first CI surgery. SUBJECTS AND METHODS: Eight patients who could not upgrade speech processors because of an too early CI model and who wanted to change the whole system were included. After revision CI surgery, we compared speech comprehension before and after revision CI surgery. Categoies of Auditory Performance (CAP) score, vowel and consonant confusion test, Ling 6 sounds, word and sentence identification test were done. RESULTS: The interval between surgeries ranged from eight years to 19 years. Same manufacturer’s latest product was used for revision surgery in six cases of eight cases. Full insertion of electrode was possible in most of cases (seven of eight). CAP score (p-value=0.01), vowel confusion test (p-value=0.041), one syllable word identification test (p-value=0.026), two syllable identification test (p-value=0.028), sentence identification test (pvalue=0.028) had significant improvement. Consonant confusion test (p-value=0.063), Ling 6 sound test (p-value=0.066) had improvement but it is not significant. CONCLUSIONS: Although there are some limitations of our study design, we could identify the effect of revision (upgrade) CI surgery indirectly. So we concluded that if patient complain low functional gain or low satisfaction after first CI surgery, revision (device upgrade) CI surgery is meaningful even if there is no device failure.

Safety and Effectiveness of Endoscopic Ear Surgery: Systematic Review / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study aims to evaluate that usefulness of the endoscopic ear surgery (EES) through the systematic review. SUBJECTS AND METHOD: We searched literatures in literature databases (MEDLINE, EMBASE, Cochrane Library, etc.). Inclusion criteria is 1) studies of patients with chronic otitis media, otitis media with effusion, cholesteatoma, conductive hearing loss, mixed hearing loss etc. 2) studies in which a transcanal endoscopic surgery was performed; and 3) studies in which one or more of the appropriate medical outcomes have been reported. We excluded that 1) non-human studies and pre-clinical studies; 2) non-original articles, for example, non-systematic reviews; editorial, letter and opinion pieces; 3) research not published in Korean and English; and 4) grey literature. Finally, 65 articles were selected and those results were analyzed. RESULTS: The safety of the EES was reported in 61 articles. Some studies reported damaged facial nerve or perilymph gusher but these are the complications that can arise due to the characteristics of the disease and not due to the EES and other reported complications were of similar or lower level in the intervention group rather than the microscopy group. The effectiveness of the EES was reported in 23 articles. The EES tended to show improved effects in terms of graft uptake status, cholesteatoma removal, and hearing improvement although effective outcomes of most studies reported no significant difference between EES and microscopic ear surgery. CONCLUSION: EES is a safe and effective technique and as it is less invasive than the microscopic ear surgery.

Tumor Growth and Hearing Changes in the Natural Progress of Vestibular Schwannoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#Vestibular schwannoma is a benign neoplasm originating from the vestibular nerve, and the most common symptom caused by the tumor is unilateral hearing loss. This study is aimed to review the clinical outcomes of tumor growth and hearing changes in the natural progress of vestibular schwannoma.SUBJECTS AND METHOD: We retrospectively reviewed 28 patients who were diagnosed with vestibular schwannoma and treated with the ‘wait and scan’ modality for more than a year. We analyzed the patients' audiological changes and tumor growth by reviewing the temporal bone MR images. Patients were classified into an intrameatal group and extrameatal group according to the involvement of the cerebropontine angle.@*RESULTS@#The overall mean follow-up was 45.6±25.8 months. Among the 28 patients, 6 (21.4%) showed tumor growth after ‘wait and scan.’ Hearing thresholds and speech discrimination scores showed deterioration after ‘wait and scan’ in both groups. Among the 12 patients with serviceable hearing at initial diagnosis, 9 (75.0%) preserved serviceable hearing after ‘wait and scan.’ When the pure tone average and speech discrimination scores were applied to the scattergram, most values were positioned near the center of the scattergram, which implied slight changes after ‘wait and scan.’@*CONCLUSION@#The percentage of patients showing tumor growth after the ‘wait and scan’ policy was low. Patients with serviceable hearing at diagnosis would most likely preserve their hearing after ‘wait and scan.’ Considering the limited tumor growth and minimal hearing changes, rather than microsurgery or radiation surgery, the conservative ‘wait and scan’ policy can be an alternative treatment modality in patients with small-sized, non-growing vestibular schwannomas.

A Systematic Literature Review for Evaluating the Clinical Usefulness of the Customized Vestibular Exercise / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study aims to evaluate the usefulness of customized vestibular exercise through literature review. MATERIALS AND METHOD: We searched several literature database such as Ovid-MEDLINE, Ovid-EMBASE, and Cochrane Library etc., with the following inclusion criteria: 1) studies of patients with dizziness and balance disorders, 2) studies in which a customized vestibular exercise was performed, and 3) studies in which one or more of the appropriate medical outcomes have been reported. At the same time, we excluded the following: 1) non-human studies and pre-clinical studies, 2) non-original articles, for example, non-systematic reviews, editorial, letter and opinion pieces, 3) research not published in Korean and English, 4) grey literature (thesis, congress or conference materials, abstract etc.), and 5) case studies. Finally, 10 studies were selected and analyzed. RESULTS: The safety of customized vestibular exercise was reported in three documents which reported no side effects related to the procedure. The effectiveness of customized vestibular exercise was proven by the assessment of symptom change, functional change, and other physiological measures based on a total of 10 randomized clinical trial studies. CONCLUSION: For patients with vestibular dysfunction, a customized vestibular exercise can be a safe and effective technique for improving dizziness and balance function.

The Comparison of Short-Term Therapeutic Effects of Acute Low-Tone Sensorineural Hearing Loss according to Steroid Capacity / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Acute low-tone sensorineural hearing loss refers to a condition wherein thresholds increase only at low frequencies in pure-tone audiometry. Systemic steroid treatment is commonly used for acute low-tone sensorineural hearing loss without vertigo, but there has been no established treatment in most clinical researches. The purpose of this study is to compare and analyze the short-term effects of high- and half-dose oral steroid therapy on patients suffering from acute low-tone sensorineural hearing loss without vertigo. SUBJECTS AND METHOD: Forty-six patients diagnosed with acute low-tone sensorineural hearing loss were divided into two groups and treated with high-dose (24 patients) and half-dose (22 patients) steroids, respectively. A retrospective analysis was conducted on their medical records. RESULTS: There were no significant differences between the two groups in any of the following: age, sex ratio, duration of symptoms before treatment, pure-tone hearing thresholds, low frequency hearing thresholds and speech intelligibility. However, both groups showed significant differences in hearing thresholds before and after treatment. In addition, no significant difference was noted in the recovery and recurrence rate between the two groups. CONCLUSION: According to the results of this study, there is no difference in treatment effect between the high- and half-dose groups. Therefore, half-dose steroids may be used as a treatment option for acute low tone sensorineural hearing loss.

Usefulness of Centor Score to Diagnosis of Group a Streptococcal Pharyngitis and Decision Making of Antibiotics Use / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study aims to verify the usefulness of Centor scores to diagnose the Group A Streptococcal pharyngitis. SUBJECTS AND METHOD: The subjects of this study were 379 patients who had been examined by the rapid antigen detection test (RADT) for Group A Streptococcus. We analyzed their medical records and laboratory test results retrospectively and compared the results of Centor symptom scores with those of RADT. Then we analyzed the association of RADT, the Centor score and the laboratory test results statistically. RESULTS: There were no correlation between the RADT results and fever, cough, tonsillar enlargement, nasal symptoms, myalgia or chilling (p>0.05). In the RADT positive group, there were more patients with tonsillar exudate, neck lymph node enlargement, tenderness and pharyngeal abscess formation significantly (p<0.05). The Centor score and C-reactive protein were significantly higher in the RADT positive group (p<0.05). CONCLUSION: The results of this study suggest that Centor symptom scores can be used to determine which antibiotics to use. The Centor score system can help reduce medical costs and detect the problematic Group A Streptococcal pharyngitis.

Usefulness of Centor Score to Diagnosis of Group a Streptococcal Pharyngitis and Decision Making of Antibiotics Use / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#This study aims to verify the usefulness of Centor scores to diagnose the Group A Streptococcal pharyngitis.SUBJECTS AND METHOD: The subjects of this study were 379 patients who had been examined by the rapid antigen detection test (RADT) for Group A Streptococcus. We analyzed their medical records and laboratory test results retrospectively and compared the results of Centor symptom scores with those of RADT. Then we analyzed the association of RADT, the Centor score and the laboratory test results statistically.@*RESULTS@#There were no correlation between the RADT results and fever, cough, tonsillar enlargement, nasal symptoms, myalgia or chilling (p>0.05). In the RADT positive group, there were more patients with tonsillar exudate, neck lymph node enlargement, tenderness and pharyngeal abscess formation significantly (p<0.05). The Centor score and C-reactive protein were significantly higher in the RADT positive group (p<0.05).@*CONCLUSION@#The results of this study suggest that Centor symptom scores can be used to determine which antibiotics to use. The Centor score system can help reduce medical costs and detect the problematic Group A Streptococcal pharyngitis.

Valuation of Transient Evoked Otoacoustic Emissions and Distortion Product Otoacoustic Emissions in Tinnitus Patients with Normal Hearing / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study aims to verify that one of the causes of tinnitus is the malfunction of outer hair cells and, on the basis of this, to investigate the usefulness of otoacoustic emissions by performing transient evoked otoacoustic emissions (TEOAE) and distor-tion product otoacoustic emissions (DPOAE). SUBJECTS AND METHOD: Included in the study were forty-one patients who had normal hearing in the range from 0.5 to 8 kHz, and complained of unilateral tinnitus. In these patients, hearing in bilateral ears, TEOAE, DPOAE, as well as the frequency & amplitude of their tinnitus were measured. RESULTS: No statistically significant difference was found in bilateral hearing in patients who complained of unilateral tinnitus. However, TEOAE and DPOAE showed a statistically significant difference with their p-values at 0.04 and 0.004, respectively. CONCLUSION: The results of this study suggested that TEOAE testing and DPOAE testing provide an important clue for verifying that the loss of outer hair cells contributed to the development of symptoms suffered by tinnitus patients with normal hearing.

Relation between Stress-Related Hormone and Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The plasma stress-related hormonal [cortisol, growth hormone, prolactin, antidiuretic hormone (ADH), adrenocorticotropic hormone (ACTH)] levels have been reported to be elevated in sudden sensorineural hearing loss (SSNHL) patients. However, little is known regarding the mechanisms related with the elevation of stress-related hormonal levels in SSNHL. Therefore, we measured the level of plasma stress-related hormones in SSNHL patients and in normal persons to demonstrate the association between the stress-related hormones and SSNHL. SUBJECTS AND METHOD: Stress-related hormonal levels were measured from 68 patients who were diagnosed with SSNHL. These values were compared with the stress-related hormonal levels of 24 healthy control subjects. RESULTS: The plasma ADH levels was significantly higher in SSNHL group compared with that in their normal control group, as shown by their respective values, 4.46 [95% confidence interval (CI): 3.80-5.24 pg/mL] and 3.05 (95% CI: 2.34-3.98 pg/mL). The values for plasma cortisol, growth hormone, and ACTH levels whose values were 2.07 (95% CI: 1.65-2.61 microg/L), 0.20 (95% CI: 0.14-0.29 microg/L), and 12.79 (95% CI: 11.16-14.66 pg/mL), respectively, were significantly lower in the SSNHL group than those in the normal control group whose values were 7.86 (95% CI: 5.33-5.24 microg/L), 0.61 (95% CI: 0.36-1.04 microg/L), 18.48 (95% CI: 14.99-22.78 pg/mL), respectively. But there was no significant difference in prolactin between the two groups. CONCLUSION: This study demonstrates a possible role of stress-related hormones in the pathogenesis of SSNHL. However, only ADH level was higher than the control group. Furthermore, ACTH, growth hormone and cortisol levels were lower than the control groups. This means ADH, growth hormone, cortisol, ACTH levels are related with SSNHL. However, the impact of this hormone on the inner ear and endolymph homeostasis is still unknown. Further investigation is necessary to identify the action mechanism of these hormones in the inner ear.

A Clinical Analysis of Sudden Sensorineural Hearing Loss Cases

BACKGROUND AND OBJECTIVES: High-dose systemic steroid therapy is the mainstay treatment for sudden sensorineural hearing loss (SSNHL). Recovery rates from SSNHL range are about 47-63% and are influenced by various prognostic factors. To evaluate the prognostic value of specific clinical parameters, we reviewed 289 cases by clinical and statistical analysis. SUBJECTS AND METHODS: This study included 289 patients with SSNHL who visited the Department of Otolaryngology at Soonchunhyang University Hospital from January 2005 to December 2012. The cases were reviewed retrospectively based on clinical charts. Hearing improvement was evaluated in relation to pure-tone audiogram results, duration between SSNHL onset and time of initial treatment, seasonal incidence, dizziness, patient age, degree of hearing loss, patterns of initial pure-tone audiogram and presence of underlying disease. RESULTS: Hearing improvement was observed in 196 of 289 (67.8%) patients; such improvement began within 7 days in most patients, followed by rapid hearing recovery. Cases that failed to show improvement within 14 days were unlikely to achieve hearing recovery. The more severe the hearing loss during the early stage, the lower the hearing recovery rates. Patients aged less than 60 years appear to have better prognosis of hearing improvement compared to those who are over 60 years. CONCLUSIONS: Important prognostic factors for recovery in patients with SSNHL include the time of initiating treatment after symptom onset, the degree of early-stage hearing loss, and the age of the affected patient.

Short Term Follow-Up Result of Unilateral Hearing Loss Referred Patient by Newborn Hearing Screening / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Hearing screening is mandatory for newborns. The management of patients who fail hearing screening is important. This study examined the prognosis of patients who had hearing loss detected on the newborn hearing screening. SUBJECTS AND METHOD: The results of newborn hearing tests, follow-up hearing tests, and risk factors for hearing loss were analyzed retrospectively in prospectively collected data. Newborn hearing screening testing using an auto auditory brain stem (ABR) response was performed for 1296 newborns from January 2010 to December 2012 at Soonchunhyang University Bucheon Hospital. Follow-up hearing tests using ABR and otoacoustic emissions were performed 6 and 12 months after the newborn hearing screening. RESULTS: Of the 1296 newborns who underwent hearing screening tests, 63 were referred and 58 had confirmed hearing loss. The hearing loss was unilateral in 74.2% (43/58). During the 1-year follow-up, about half of the patients showed improved hearing function. Premature birth was related to hearing recovery. CONCLUSION: During the follow-up, some patients with unilateral hearing loss showed recovery. Some premature patients can expect hearing recovery during follow-up testing. Regular follow-up after newborn hearing screening is important to detect hearing changes in this period.

Effect of Prostaglandin E2 on Vascular Endothelial Growth Factor Production in Nasal Polyp Fibroblasts

PURPOSE: Angiogenesis is involved in the pathogenesis of chronic rhinosinusitis with nasal polyps. We aimed to investigate the effects of prostaglandin E2 (PGE2) on vascular endothelial growth factor (VEGF) production, the role of E-prostanoid (EP) 4 receptors, and the signal transduction pathway mediating VEGF production in nasal polyp-derived fibroblasts (NPDFs). METHODS: Eight primary NPDF cultures were established from nasal polyps, which were incubated with or without PGE2. Reverse transcription-polymerase chain reaction amplification of EP receptors (EP1, EP2, EP3, and EP4) and immunofluorescence staining for VEGF production were performed. VEGF production via the cyclic adenosine monophosphate (cAMP)-dependent protein kinase A (PKA) and phosphatidylinositol 3-kinase (PI3K) pathways was evaluated by enzyme-linked immunosorbent assay. RESULTS: All EP receptors were expressed in NPDFs. PGE2 significantly increased VEGF production concentration- and time dependently, and VEGF production was regulated by an EP4 receptor. Activation of intracellular cAMP regulated VEGF production. VEGF production was decreased by PKA and PI3K inhibitors via intracellular cAMP. CONCLUSIONS: PGE2 stimulates VEGF production via the EP4 receptor in NPDFs. These results indicate that PGE2-induced VEGF production is mediated, at least partially, through cAMP-dependent signaling pathways. Therapies targeting the EP4 receptor may be effective in inhibiting the development of nasal polyps.

Development of Animal Models of Otitis Media

Otitis media is defined as inflammation of the middle ear, including the auditory ossicles and the Eustachian tube. Otitis media is a major health problem in many societies. The causes of otitis media includes infection and anatomic/physiologic, host, and environmental factors. In general, otitis media is a childhood disease, and anatomic and physiologic changes have great effects on its development. Thus, in vitro or human experimental studies of otitis media are difficult. Several experimental animal models have been introduced to investigate the pathogenesis and treatment of otitis media. However, none are ideal. The aim of this review is to provide a brief overview of the current status of animal models of otitis media with effusion, acute otitis media, and cholesteatoma. This review will assist determination of the most appropriate animal models of otitis media.

Vestibular Function Test of Dizziness Patients by Vestibular Evoked Myogenic Potential / 대한평형의학회지

BACKGROUND AND OBJECTIVES: Because the saccule, next to the cochlea, is the second most frequent site of hydrops formation, we evaluated whether vestibular evoked myogenic potential (VEMP) responses can reflect the diagnosis and the stage of Meniere's disease. And we studied about other vestibular disease such as vestibular neuritis and benign paroxysmal positional vertigo. MATERIALS AND METHODS: Retrospectively, we analyzed the results of VEMP in 22 patients (12 men and 10 women) with unilateral definite Meniere's disease, 21 patients (5 men and 16 women) with vestibular neuritis, and 23 patient (4 men and 19 women) with benign paroxysmal positional vertigo (BPPV). All subjects underwent VEMP testing using ipsilateral 1 KHz-tone burst sound with 105 dB nHL. RESULTS: VEMP was present in 86% of Meniere affected ear. The latency of p13 of affected ears in patients with Meniere's disease, vestibular neuritis (VN), BPPV was not significantly prolonged than that of normal ears in the control group except left n23 latency in meniere's disease. In the patients with Meniere's disease, the amplitude-ratio was larger than that of the control group, statistically (p=0.006). And relationship was found in amplitude ratio among groups classified by the stage of Meniere's disease. CONCLUSION: This study shows that amplitude ratio of VEMP response is useful method to determine the severity and prognosis of Meniere's disease. We recommend VEMP to explain to the patient about severity of Meniere's disease quantitatively.

Institutional Review Boards and Bioethical Issues for Otologists and Audiologists

Otologists and audiologists care for patients and conduct clinical research to find more effective treatments that benefit patients. Institutional Review Board (IRB) permission is necessary for conducting clinical trials on humans. Furthermore, many bioethical conflicts are encountered while conducting research. However, few otologists and audiologists in Korea know bioethics and the principles and regulations of IRBs in detail. This paper reviews the history of ethics in clinical research and current bioethical principles and IRB regulations. We outline what you need as otologists or audiologists to get IRB approval while considering the principles of bioethics.

Combination Therapy with Systemic Steroids, an Antiviral Agent, Anticoagulants, and Stellate Ganglion Block for Treatment of Sudden Sensorineural Hearing Loss

BACKGROUND AND OBJECTIVES: Sudden sensorineural hearing loss (SSNHL) is commonly defined as a loss of at least 30 dB in three contiguous frequencies occurring within 3 days. Systemic steroid administration has become the most widely accepted treatment option for SSNHL. Since viral infection and vascular compromise are considered specific causes of SSNHL, antiviral agents, anticoagulants, and stellate ganglion block have been used for its treatment, although the evidence of their effectiveness is weak. The present study evaluated the hearing recovery rate in the combination therapy group (systemic steroids, antiviral agent, anticoagulants, and stellate ganglion block) in comparison with patients treated with systemic steroids alone. SUBJECTS AND METHODS: A total of 85 patients diagnosed with SSNHL were treated with combination therapy (group A, 46 patients) or systemic steroids only (group B, 39 patients). Hearing improvement was defined as a hearing gain of more than slight improvement using Siegel's criteria. All patients were treated with a 10-day course of systemic steroids (10-mg dexamethasone for 5 days, followed by tapering for 5 days). Acyclovir, heparin, and stellate ganglion block were included in the group A treatment regimen. RESULTS: The overall rate of hearing improvement was 60.9% (28/46 patients) in group A, which was significantly higher than that (38.5%, 15/39 patients) in group B. The distribution of prognostic factors was not significantly different between the two groups with the exception of the degree of initial hearing loss, which was more severe in group A. Upon analysis according to prognostic factors, group A showed a better hearing improvement recovery rate than group B in patients with hearing loss >70 dB, age >41 years, dizziness, and early treatment (<1 week). CONCLUSIONS: Thus SSNHL patients treated with combination therapy have a higher likelihood of hearing improvement than those treated with systemic steroids alone.

Clinical Characteristics of Tinnitus in Elderly / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tinnitus is commonly known to occur in the elderly, while presbytinnitus is not known as well. This study compared the clinical characteristics of tinnitus between the elderly and adults. SUBJECTS AND METHOD: This prospective case-control study enrolled 148 patients who had subjective tinnitus. Demographic data, otologic history, tinnitus questionnaires, the tinnitus handicap inventory (THI), a visual analogue scale, and audiological examinations were evaluated. RESULTS: The effect of tinnitus on the quality of life and the severity of tinnitus in the elderly were not different from those in adults. The elderly were more annoyed with the tinnitus than adults. The elderly had louder and longer tinnitus. Nevertheless, the elderly had a lower THI score. The effect of tinnitus on the quality of life was not correlated with tinnitus loudness, duration, or hearing threshold. In the elderly, the effect of tinnitus on the quality of life was correlated more with the emotional score of the THI than the other subscales of the THI. CONCLUSION: Tinnitus has a great effect on the quality of life of the elderly. This is related more to psychological factors than to otological factors.

Clinical Usefulness of Viral IgM Antibody Test in Sudden Sensorineural Hearing Loss Patient / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There are many possible causes of sudden deafness such as viral infection, vascular occlusion, immune-mediated mechanism and abnormal cellular stress response in the cochlea. Viral hypothesis is one of the potential mechanisms for explaining sudden deafness. The aims of this study were to investigate the usefulness of viral IgM antibodies to evaluate the clinical findings and prognosis in sudden sensorineural hearing loss and to identify the more useful viral IgM antibodies. SUBJECTS AND METHOD: A retrospective study was carried out for 283 patients with sudden deafness. The results of serologic tests performed for the following were studied: Ebstein barr virus (EBV), Measles, Mumps, Toxoplasma, Rubella, Cytomegalovirus, Varicella zoster virus, Herpes simplex virus, and human immunodeficiency virus. Results of blood tests and audiologic tests taken initially and 2 months after the onset of sudden deaf were studied as well. RESULTS: Positive ratio of Viral IgM antibodies was 4.9% (13/283). Clincial findings and prognosis of viral IgM positive patients were not different from other sudden deafness patients except for the age factor. EBV Viral capsid antigen, EBV Early antigen-diffuse and restrict complex were common positive viral markers in sudden hearing loss patients. One third of the patients (4/13) had viral markers for Measles, Mumps and Toxoplasma. CONCLUSION: In sudden deafness, the positive ratio of serologic tests for viral IgM antibodies was less than 5% and viral IgM positive patients had similar clinical findings and prognosis to viral IgM negative patients. However, viral origins of Measles, toxoplasam and Mumps as well as EBV should be considered in sudden deafness patients with the symptoms and signs of viral infection.