Non-pharmacological therapy for tinnitus

Tinnitus is often difficult to treat because it is closely related to hearing loss, central nervous system disorders, and emotional problems. Although various drug treatments have been attempted for patients with tinnitus, there is no drug that has been clearly proven to be effective. On the other hand, there are some studies showing the effectiveness of various non-pharmacological treatments for tinnitus.Current Concepts: Tinnitus is classified into subjective and objective tinnitus. Representative non-pharmacological treatments for chronic subjective tinnitus include sound therapy, hearing aids or implantable hearing rehabilitation devices, tinnitus retraining therapy, neuropsychiatric therapy, and neuromodulatory treatment. When objective tinnitus does not improve with conservative treatment, surgical treatment can be selected depending on the cause. Acupuncture treatment for tinnitus is not recommended due to lack of evidence on its effectiveness and safety.Discussion and Conclusion: Despite many studies, the mechanisms of tinnitus remain unknown. Thus, it is difficult to cure the cause of tinnitus. Because subjective responses to tinnitus vary according to the patient’s psychological state, a variety of approaches would be needed for the treatment of tinnitus.

Relationship Between Dizziness With Cognitive Impairment / 대한이비인후과학회지

Dizziness is one of the most common symptoms in the elderly. Various vestibular disorders, such as benign paroxysmal positional vertigo, vestibular neuritis, Meniere’s disease, vestibular migraine, can cause dizziness. The vestibular system consists of the peripheral vestibular organs in the inner ear and the extensive central nervous system from the cerebellum and brainstem to the thalamus to cortex. In particularly, vestibular sensory input plays a important role in spatial cognitive abilities such as spatial memory and spatial navigation. In the elderly, cognitive decline, such as mild cognitive impairment, Alzheimer’s disease and other dementia, is a very frightening disease that worsens the quality of life. It is possible to evaluate vestibular dysfunction through vestibular function test, and there are various evaluation methods for cognitive function. The evidence has been gradually accumulating to suggest that the balance organs or ‘vestibular system,’ might also be important in the development of cognitive dysfunction and dementia. Animal studies, pathologic and imaging evidence, and behavioral assays on the relationship between various diseases related to dizziness and cognitive dysfunction are supporting that. Given that vestibular dysfunction can be treated through physical-therapy such as vestibular rehabilitation, identifying and treating dizziness in older adults with and without cognitive impairment may provide potential benefits in preventing, mitigating cognitive decline.

Bilateral Sudden Sensorineural Hearing Loss Associated with Sepsis: A Case Report and Literature Review / 대한이비인후과학회지

Bilateral sudden sensorineural hearing loss (SSNHL) is rare and usually indicates a serious systemic pathology. We describe an unusual case of bilateral SSNHL caused by sepsis. A 28-year-old female complained of acute-onset bilateral hearing impairment; in addition to otological symptoms, she had a systemic condition that met the criteria for sepsis. We performed a physical examination and laboratory tests to diagnose sepsis. Pure tone audiogram and videonystagmography were performed to evaluate the otological symptoms. Intravenous antibiotics and high-dose methylprednisolone were prescribed for treatment, and audiogram was repeated during that period. The fever subsided and the vital signs were stabilized. The electrolyte imbalance and abnormal urine parameters became normal. Hearing gradually recovered to a normal level on day 7 of hospitalization. In conclusion, sepsis should be considered as a cause of SSNHL. When conducting a detailed examination of patients with bilateral SSNHL, the clinician should consider systemic disease.

Underlay Versus Modified Circumferential Subannular Graft Technique in Endoscopic Tympanoplasty / 대한이비인후과학회지

Background and Objectives@#To describe and evaluate modified circumferential subannular tympanoplasty (MCST) via endoscopic approach, we compared the results of MCST to those of the underlay technique and the results of previous studies.Subjects and Method A retrospective comparative study was conducted of 31 patients who underwent endoscopic transcanal tympanoplasty. Patients were classified into the MCST group (n=11) and the underlay group (n=20) according to the graft technique. Demographic data, size and location of the perforation, pre- and postoperative hearing, operating time, complication rate, and graft success rate were analyzed in each group. @*Results@#No significant differences between the two groups were observed in the demographic data or the locations of the perforations. The sizes of the perforations were 31.4±14.3% and 25.0±18.1%, respectively. The average operating times were 68.6±16.5 min and 64.9±9.3 min, respectively, and canaloplasty was not required in any patient. The postoperative hearing improvement and air-bone gap were not significantly different. No postoperative complications were observed in either group. @*Conclusion@#MCST is a feasible and effective technique for endoscopic transcanal tympanoplasty. The postoperative results and operating times of MCST were comparable to those of other graft techniques. MCST showed more stable results in anterior perforation than in underlay graft.

Arnold-Chiari Type 1 Malformation Mimicking Benign Paroxysmal Positional Vertigo / 대한평형의학회지

Arnold-Chiari malformation type 1 is a congenital disease characterized by herniation of the cerebellar tonsils through the foramen magnum. Most common clinical symptom is pain, including occipital headache and neck pain, upper limb pain exacerbated by physical activity or valsalva maneuvers. Various otoneurological manifestations also occur in patients with the disease, which has usually associated with dizziness, vomiting, dysphagia, poor hand coordination, unsteady gait, numbness. Patients with Arnold-Chiari malformation may develop vertigo after spending some time with their head inclined on their trunk. Positional and down-beating nystagmus are common forms of nystagmus in them. We experienced a 12-year-old female who presented complaining of vertigo related to changes in head position which was initially misdiagnosed as a benign paroxysmal positional vertigo.

A Case of Desmoid-Type Fibromatosis Occurring Around the Transverse Process of Cervical Vertebra / 대한이비인후과학회지

Fibromatosis is generally a benign tumor that arises from the musculoaponeurotic tissues of the body, rarely occurring in the head and neck region. This can be treated with a good prognosis, but sometimes recurs as a local invasion. Preoperative core needle biopsy and MR images are necessary to diagnose preoperatively and outline the tumor extent. The mainstay of treatment is complete surgical excision. Nonetheless, an excision is often difficult because of the complex anatomy or proximity of the tumor to vital structures in the head and neck region. We report a rare case of desmoid-type fibromatosis that occurred in the neck, closely attached to the transverse process of the cervical vertebra. The present article covers an extensive analysis of the case with a review of the related literature.

Long-Term Results of CyberKnife Radiosurgery for Vestibular Schwannoma / 대한평형의학회지

OBJECTIVE: Since the 2000s, CyberKnife radiosurgery (CKRS) is either a primary or an adjunct management approach used to treat patients with vestibular schwannoma (VS). The goals of CKRS are prevention of tumor growth, preservation of cranial nerve function and prevention of new neurologic deficiencies. The aim of this study was to assess the efficacy and safety of CKRS, in terms of tumor control, hearing preservation, and complications. METHODS: Forty patients with VS underwent CKRS as a treatment modality for from January 2010 to February 2016. The long term results of 32 patients were evaluated who received CKRS as primary treatment. 8 patients presented with previously performed surgical resection. Information related to clinical history, Brain MRI and outcomes of patients with VS collected retrospectively by reviewing patient's chart and telephone survey. RESULTS: The mean tumor volume was 3.3 cm³ and the mean follow-up was 41 months. The most recent follow-up showed that tumor size decreased in 17 patients (42.5%), displayed no change in 19 patients (47.5%), and increased in 4 patients (10%). Progression-free survival rates after CKRS at 1, 3, and 5 years were 95%, 90%, and 90%. After CKRS, 13 patients experienced hearing degradation. The overall rate of preservation of serviceable hearing at the long-term follow-up was 60%. Vertigo, ataxia, and headache were improved after CKRS compared with pretreated status. But, facial weakness, trigeminal nerve neuropathy, and tinnitus were worsen. CONCLUSION: CKRS provide an excellent tumor control rate and a comparable hearing preservation rate in VS patients. Also CKRS is associated with low rate of cranial neuropathy, other complications.

Epstein-Barr Virus Positive Primary Lymphoepithelial Carcinoma of the Parotid Gland with Hot Uptake of the Nasopharynx at Positron Emission Tomography-Computed Tomography / 대한이비인후과학회지

Lymphoepithelial carcinoma (LEC) is a rare histological type of cancer of the salivary glands. LEC is characterized histologically as non-keratinizing, undifferentiated squamous cell carcinoma with lymphocytic infiltration. According to several in-situ hybridization studies, LEC is strongly associated with Epstein-Barr virus (EBV) infection. We report, along with a review of literature, a rare case of EBV positive primary LEC of the parotid that excluded the possibility of coexisting or metastatic nasopharyngeal carcinoma.