Effect of Hearing Rehabilitation Therapy Program in Hearing Aid Users: A Prospective Randomized Controlled Study

Objectives@#. Despite sufficient hearing gains, many patients with hearing loss have difficulty using hearing aids due to poor word recognition ability. This study was performed to introduce our hearing rehabilitation therapy (HRT) program for hearing aid users and to evaluate its effect on hearing improvement. @*Methods@#. In this prospective randomized case-control study, 37 participants with moderate or moderate-severe sensorineural hearing loss who had used bilateral hearing aids for more than 3 months with sufficient functional hearing gain were enrolled in this study. Nineteen participants were randomly assigned to the control group (CG) and 18 patients were assigned to participate in our HRT program once a week for 8 consecutive weeks (hearing rehabilitation therapy group [HRTG]). Their hearing results and questionnaire scores for hearing handicap and hearing aid outcomes were prospectively collected and compared between the two groups. @*Results@#. After completing 8 weeks of the HRT program, the HRTG showed a significantly greater improvement in scores for consonant-only and consonant-vowel sound perception than the CG (P<0.05). In addition, the HRTG showed a significant improvement in hearing ability as measured by two questionnaires (p<0.05), while no differences were observed in the CG. However, word and sentence recognition test results did not show significant differences between the two groups. @*Conclusion@#. Even after short-term HRT, patients had subjectively better hearing outcomes and improved phoneme perception ability; this provides scientific evidence regarding a possible positive role for HRT programs in hearing aid users. Further validation in a larger population through a long-term follow-up study is needed.

Safety and Effectiveness of Peramivir in Korean Adult Influenza Patients: Prospective Observational Study Based on Post-Marketing Surveillance Data

BACKGROUND: The safety and clinical effectiveness data of peramivir in the real clinical field are limited. A prospective observational study was conducted based on the post-marketing surveillance data to evaluate the post-marketing safety and effectiveness of peramivir in Korean adults with seasonal influenza. METHODS: Among adults aged 20 years or older who were diagnosed with influenza A or B, patients who started peramivir within 48 hours from the initial symptoms of influenza were enrolled. All adverse events (AEs) that occurred within 7 days after administration of peramivir were checked. For the evaluation of effectiveness, changes in the severity of influenza symptoms and daily living performance were examined before and 7 days after the administration of peramivir. The date on which influenza related symptoms disappeared was checked. RESULTS: A total of 3,024 patients were enrolled for safety evaluation and 2,939 patients were for effectiveness evaluation. In the safety evaluation, 42 AEs were observed in 35 (1.16%) patients. The most common AE was fever. AEs were mostly rated as mild in severity. Serious AEs were observed in 10 patients and two of them died. However, both deaths were considered to be less relevant to peramivir. In the effectiveness evaluation, the severity of influenza symptoms decreased by 10.68 ± 4.01 points and daily living performance was improved 5.59 ± 2.16 points. Influenza related symptoms disappeared on average 3.02 ± 2.39 days after peramivir administration. CONCLUSION: Peramivir showed a tolerable safety profile and acceptable effectiveness in Korean adult patients with seasonal influenza.

Microbiological Results From Middle Ear Effusion in Pediatric Patients Receiving Ventilation Tube Insertion: Multicenter Registry Study on the Effectiveness of Ventilation Tube Insertion in Pediatric Patients With Chronic Otitis Media With Effusion: Part

OBJECTIVES: The aim of this multicenter registry study was to investigate the effectiveness of ventilation tube insertion and the microbiology of otitis media with effusion (OME) in children. This part I study was conducted to evaluate the microbiological profile of children with OME who needed ventilation tube insertion. METHODS: Patients < 15 years old who were diagnosed as having OME and received ventilation tube insertion were prospectively enrolled in 16 tertiary hospitals from June 2014 to December 2016. After excluding patients with missing data, the data of 397 patients were analyzed among a total of 433 enrolled patients. The clinical symptoms, findings of the tympanic membrane, hearing level, and microbiological findings were collected. RESULTS: In 103 patients (25.9%), antibiotics were used within 3 weeks before surgery. Ventilation tube insertion was performed in a total of 710 ears (626 in both ears in 313 patients, 55 in the left ear only, and 29 in the right ear only). Culture of middle ear effusion was done in at least one ear in 221 patients (55.7%), and in a total of 346 ears. Only 46 ears (13.3%) showed positive results in middle ear effusion culture. Haemophilus influenzae (17.3%, followed by coagulase-negative Staphylococcus and Staphylococcus auricularis) was the most common bacteria detected. CONCLUSION: H. influenzae was the most commonly found bacteria in middle ear effusion. Relatively low rates of culture positivity were noted in middle ear effusion of patients with OME in Korea.

Swing-Door Overlay Tympanoplasty: Surgical Technique and Outcomes

OBJECTIVES: The classical overlay tympanoplasty is technically difficult with some disadvantages and thus less popular. However, it is particularly useful for large, anterior perforations. In this study, we describe the technique of a modified overlay graft in the tympanoplasty coined as the swing-door overlay tympanoplasty and report its outcomes. METHODS: Retrospective review of patients undergoing the swing-door overlay tympanoplasty at a tertiary referral center between 2003 and 2016 was performed. Patient who had ossicular abnormality, previous tympanoplasty, and profound hearing loss were excluded. The surgical technique is described in detail. The outcomes were evaluated by the graft success rate, complication rate, and hearing results. The hearing level was determined by four pure-tone average at 0.5, 1, 2, and 4 kHz. Air-bone gap closure was mainly assessed. RESULTS: A total of 306 patients (110 males and 196 females) were included. The mean age was 49.1±16.6 years. Follow-up periods ranged from 6 to 108 months with an average of 18.4 months. The overall graft success rate reached 98.4%. Five graft failures occurred with reperforation in three cases and lateralization in two cases. Postoperative complications occurred in 12 cases (3.9%). Air-bone gap changes (closures) were 7.8±12.8, 5.2±12.2, 5.7±10.2, and 6.0± 12.8 dB at 0.5, 1, 2, and 4 kHz, respectively (all P < 0.001) with an average improvement of 6.2 dB. Postoperative airbone gap was closed to ≤20 dB in 86.9%. CONCLUSION: The swing-door overlay tympanoplasty is a highly successful surgical technique suitable for all types of tympanic membrane perforations. This approach is technically easier than classical overlay tympanoplasty and affords an excellent graft success rate with satisfying hearing results.

Intra-Tympanic Steroid Treatment Alone as an Initial Treatment for the Patients with Severe or Profound Sudden Sensorineural Hearing Loss and Medical Problems in Steroid Use / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We investigated the feasibility of intra-tympanic steroid injection (ITS) treatment alone for patients with severe or profound sudden sensorineural hearing loss (SSNHL), who have medical problems in systemic steroid use. SUBJECTS AND METHOD: Medical records of 43 patients from March 2012 to March 2014 were investigated. Patients who did not have any medical problems in steroid use were treated by systemic steroid but patients with medical problems were treated by ITS alone. RESULTS: Systemic steroid was used in 32 patients, and 11 patients were treated by ITS alone. The mean follow up periods were 6.5±1.4 weeks for ITS only, and 6.5±2.6 weeks for the systemic steroid group. In the final audiometry results, the mean hearing level and the mean gain of affected ear in the two groups were not different, and the mean differences with unaffected ear in the two groups showed no differences. However, five patients of systemic steroid group recovered completely by Siegel's criteria. CONCLUSION: ITS only therapy for SSNHL is considered a great alternative for patients whose condition does not allow systemic steroid therapy.

Single-Center 10-Year Experience in Treating Patients With Vascular Tinnitus: Diagnostic Approaches and Treatment Outcomes

OBJECTIVES: Vascular tinnitus is the most common form of pulsatile tinnitus, particularly when the tinnitus corresponds with the pulse of patients. In this study, we reviewed the 10-year clinical data on vascular tinnitus of our tinnitus clinic to investigate the frequency of the underlying etiologies, to introduce a diagnostic protocol, and to evaluate the treatment outcomes. METHODS: We retrospectively collected the data of 57 patients who were diagnosed as vascular tinnitus between April 2001 and December 2011. Careful history taking, otoscopy, thorough physical examinations, audiometry, laboratory tests, as well as radiologic examinations were performed according to our diagnostic protocol to find the origin of pulsatile tinnitus. Treatment options were individualized based on the specific etiology, and the outcomes were assessed using patient's subjective reports at the follow-up interviews. RESULTS: High jugular bulb was the most common cause (47.4%) of vascular tinnitus, and venous hum was the next (17.5%). Dural arteriovenous fistula, intracranial aneurysm, atherosclerotic carotid artery disease, and hypertension were less common causes. Vascular tinnitus was alleviated in most patients after the appropriate treatment: surgical intervention, tinnitus retraining therapy, reassurance, and medications. CONCLUSION: Vascular tinnitus can be successfully diagnosed by the regular use of the suggested protocol. Many patients with vascular tinnitus have treatable underlying etiologies. Treatment of those etiologies or at least counseling about the tinnitus itself can benefit the patients with troublesome vascular tinnitus.

Small-Group Counseling in a Modified Tinnitus Retraining Therapy for Chronic Tinnitus

OBJECTIVES: The authors have treated chronic tinnitus patients using a combination of a simplified tinnitus retraining therapy (TRT) and medications, which we called modified TRT. In this clinical setting, we have attempted small-group counseling to find a time-effective equivalent of individual counseling. The aim of the present study was to evaluate the effectiveness of small-group counseling by comparing the treatment outcomes between individual and small-group counseling. METHODS: The patients who had distressing chronic tinnitus with normal hearing or mild hearing loss were included. The subjects were placed into the small-group (group 1:4) or the individual (group 1:1) counseling group, and underwent a modified TRT composed of a single session of directive counseling and ambient sound stimulation. In addition, alprazolam (0.25 mg) and ginkgo biloba extract (80 mg) were administered orally to the subjects for 3 months. The 3- and 6- month outcomes were assessed using the follow-up rates and tinnitus severity scores: awareness, tinnitus handicap inventory (THI), loudness, annoyance, and effect on life. The treatment responses were classified as improvement, no changes, and worsening. RESULTS: Of the total 149 patients (77 in group 1:1; 72 in group 1:4), 104 patients completed the protocol at 3 months, and 55 patients at 6 months. The follow-up rates were similar in both groups. Over the period of 6 months, all scores declined significantly except the loudness score at 3 months in both groups. Treatment responses showed no between-group differences. The success rate based on THI was 70% in group 1:1, and 64% in group 1:4 at 6 months. CONCLUSION: The small-group counseling of our modified TRT was comparable to the individual counseling for tinnitus relief. We suggest that this protocol can be implemented effectively in any crowded otolaryngology clinics.

Pulsatile Tinnitus as the Sole Manifestation of an Internal Carotid Artery Aneurysm Successfully Treated by Coil Embolization

Pulsatile tinnitus is tinnitus that coincides with the patient's heartbeat. It constitutes a small portion of all tinnitus, but it is often the first or sole manifestation of a serious disease in the nervous system. Aneurysm of the internal carotid artery is known as a rare cause of pulsatile tinnitus and, in the main, aneurysms of the petrous portion have been reported as a cause of pulsatile tinnitus. We present an interesting case of pulsatile tinnitus that was caused by a paraclinoid aneurysm in this report and discuss clinical features and treatment of paraclinoid aneurysm.

Incidence and Clinical Characteristics of Patients with Tinnitus According to Diagnostic Classification / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Knowledge about the incidence and clinical characteristics of tinnitus can be useful for diagnostic approach and treatment plan. We analyzed the incidence and clinical characteristics of each case of tinnitus according to the classification of tinnitus. SUBJECTS AND METHOD: The study recruited 211 tinnitus patients who visited tinnitus clinic from March 2009 to August 2009. First, patients were diagnosed and classified as sensorineural tinnitus and somatosounds. Somatosounds were subdivided to vascular tinnitus, muscle origin tinnitus and patulous Eustachian tube. Patients were evaluated by history taking by means of having them fill out tinnitus questionnaires and psychoacoustic questionnaires. Audiologic findings of each type of tinnitus have also been analyzed. RESULTS: Incidences of sensorineural tinnitus and somatosounds were 82.9% and 17.1% respectively. Among somatosounds, vascular tinnitus occupied 7.6%, muscle origin tinnitus, 4.3% and patulous Eustachian tube, 5.2%. The mean age of the patients with sensorineural tinnitus was older than somatosounds. Patients with muscle origin tinnitus had higher scores of tinnitus loudness, effect on life, tinnitus handicap inventory, stress and depression than those with other types of tinnitus. Overall compliance of the treatment was 66.7% and their tinnitus had been significantly improved after treatment. CONCLUSION: With the knowledge of incidence, clinical characteristics and treatment approach for each tinnitus, clinicians can be more confident in providing proper diagnosis and management of patients with tinnitus. Somatosounds, which showed relatively high incidence in this study, should not be neglected but properly treated with early diagnosis.

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.

A Case of Endolymphatic Sac Tumor Removal with Modified Translabyrinthine Approach / 대한이비인후과학회지

Endolymphatic sac tumor (ELST) is a very rare tumor arising from the epithelium of the endolymphatic sac. Pathologically, ELST shows papillary growth patterns with extensive bony and soft tissue destruction. ELST commonly shows symptoms of endolymphatic hydrops such as hearing loss, vertigo and tinnitus by blocking the endolymphatic duct. As the tumor enlarges, patients experience various symptoms that include multiple cranial nerve palsy. Ten to thirty percents of ELST are related to Von Hippel Lindau (VHL) diseases. Also, bilateral tumors can develop when a patient has VHL-related ELST. The goal of treatment for ELST is total tumor eradication. The type of surgical approach is chosen by the surgeon in consideration of the tumor grade and the hearing status of the patient. In this report, we present a patient with ELST who was successfully treated with the modified translabyrinthine approach. We have also reviewed relevant literatures.

A Case of Large Intradiploic Epidermoid Cyst of the Temporal Bone / 대한이비인후과학회지

Intradiploic epidermoid cysts of the skull are benign lesions that are derived from the ectodermal cells of the cranium. They are rare tumors and they represent less than 1% of all intracranial tumors. The frontal and parietal bones are the most common sites for the cysts, but the temporal bone is rarely involved. They are slowly growing tumors, and may often reach an enormous size without producing neurological symptoms. For treatment, it is important to completely remove the capsule of the cysts to avoid recurrence. Malignant transformations of the cysts, which are very rare, are generally found in cases which have repeated recurrences or infections. We present a patient with an intradiploic epidermoid cyst of the temporal bone, which is located behind the left mastoid cavity. We removed the cyst successfully through transmastoid approach.

Tinnitus in the Patients with Cochlear Implantation: Preliminary Report / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: With the wide use of cochlear implants, there have been many published studies which report that cochlear implants have a suppressive effect on tinnitus in profoundly deaf patients. The aim of this study was to understand the clinical and audiologic characteristics of the tinnitus in patients with cochlear implantation and to observe changes of their tinnitus after cochlear implantation. SUBJECTS AND METHOD: A total 23 patients who had undergone cochlear implants in our hospital from August 2003 to December 2006, were included in this study. The patients were divided into tinnitus (n=11) and non-tinnitus groups (n=12) according to the presence of tinnitus at the time of surgery. We compared clinical and audiologic features between the two groups. We also studied changes in tinnitus after surgery in the tinnitus group using validated self-report measures [tinnitus handicap inventory (THI), tinnitus handicap score (THS), and visual analogue scale]. RESULTS: There were significant differences between the two groups with respect to the age of cochlear implant recipients, whether or not the subjects had impaired hearing or were wearing hearing aids. Tinnitus was rarely observed in patients under 20 years of age with cochlear implantation (11.1%) in contrast to the higher rates in the patients of 20 years old and over (71.4%). Marked reduction of THI, THS and visual analogue scale of tinnitus were observed in all patients. CONCLUSION: For the adult patients who had undergone cochlear implant surgery and had tinnitus preoperatively, cochlear implants had shown suppressive effect on their tinnitus. Considering the significant prevalence of tinnitus in profoundly deaf patients, tinnitus of these patients should not be overlooked and further studies should be made to define relationship between cochlear implant and tinnitus.

A Case of Chronic Invasive Fungal Sinusitis Invading Pterygopalatine Fossa / 대한이비인후과학회지

Chronic invasive fungal sinusitis is a slowly destructive process that most commonly affects the ethmoid and sphenoid sinus, but may involve any paranasal sinus. The disease typically has a time course over 12 weeks. Pathologically, it is characterized as a dense accumulation of hyphae, occasional vascular invasion and sparse inflammatory reaction with involvement of local structures. Aspergillus fumigates is the most common pathogen. In this report, we present a patient with chronic invasive fungal sinusitis invading pterygopalatine fossa, which was presented as only mild thickening of posterior wall of maxillary sinus at initial CT scan.

Comparison of Cochlear Morphology and Apoptosis in Mouse Models of Presbycusis

OBJECTIVES: Morphological studies on presbycusis, or age-related hearing loss, have been performed in several different strains of mice that demonstrate hearing loss with auditory pathology. The C57BL/6 (C57) mouse is a known model of early onset presbycusis, while the CBA mouse is characterized by relatively late onset hearing loss. We performed this study to further understand how early onset hearing loss is related with the aging process of the cochlea. METHODS: We compared C57 cochlear pathology and its accompanying apoptotic processes to those in CBA mice. Hearing thresholds and outer hair cell functions have been evaluated by auditory brainstem response (ABR) recordings and distortion product otoacoustic emission (DPOAE). RESULTS: ABR recordings and DPOAE studies demonstrated high frequency hearing loss in C57 mice at P3mo of age. Cochlear morphologic studies of P1mo C57 and CBA mice did not show differences in the organ of Corti, spiral ganglion, or stria vascularis. However, from P3mo and onwards, a predominant early outer hair cell degeneration at the basal turn of the cochlea in C57 mice without definitive degeneration of spiral ganglion cells and stria vascularis/spiral ligament, compared with CBA mice, was observed. Additionally, apoptotic processes in the C57 mice also demonstrated an earlier progression. CONCLUSION: These data suggest that the C57 mouse could be an excellent animal model for early onset 'sensory' presbycusis in their young age until P6mo. Further studies to investigate the intrinsic or extrinsic etiologic factors that lead to the early degeneration of organ of Corti, especially in the high frequency region, in C57 mice may provide a possible pathological mechanism of early onset hearing loss.

Temporal Bone Myeloid Sarcoma

Myeloid sarcoma is a rare condition that's caused by the aggregation of immature myeloid cells in leukemic patients. Myeloid sarcoma occurring in the temporal bone more frequently involves the mastoid bone than is the case for metastatic lesions arising from non-systemic malignancies. The disease is difficult to diagnose when it presents with symptoms that mimic otomastoiditis. However, an early diagnosis is important in order to achieve complete remission of the disease. Magnetic resonance imaging of the temporal bone is useful for making the diagnosis of myeloid sarcoma, and especially to evaluate the extent of disease. High-dose radio- or chemotherapies are the first-line approaches and possibly the only approaches to achieve complete remission and to cure the disease. With the aim of improving our understanding of myeloid sarcoma in the temporal bone, the present report describes our experience with 5 such cases and we compare the clinical features of these 5 patients with those clinical features of patients who have metastatic lesions.

Quality of Life of North Korean Defectors in South Korea / 신경정신의학

OBJECTIVES: This study was designed to evaluate the quality of life (QoL) of North Korean defectors in South Korean society and to identify factors influencing their quality of life. METHODS: Subjects consisted of 151 defectors. Instruments were Korean version of WHOQOL-Bref, a questionnaire for demographic data, Beck Depression inventory (DBI) and part of PTSD of Korean version of SCID. RESULTS: Generally QoL of the subjects was relatively higher in relations to domains of psychological and physical health, and facets of negative feeling, transportation, mobility, physical pain and discomfort, personal belief, health and social care, work capacity, self-esteem, and thinking ability. However, QoL was relatively lower in environment domain and lowest in facets of financial resource, leisure activities and opportunity for new information and skills. A higher QoL was related to living with a spouse, having a job, having higher income and religious faith. A lower QoL was related to older age, having larger family, physical diseases, depression and PTSD. Path analysis showed that physical health and psychological domains directly influenced overall QoL while other domains influenced overall QoL indirectly. CONCLUSION: These results suggest that, to improve QoL of defectors, support in providing job and leisure activities, health service, especially mental heath service, and education program for new information and skills are needed.

Genetic Association Analysis of Lipid Profiles Using Linear Mixed Model

BACKGROUND AND OBJECTIVES: Analyzing the association between multiple SNPs and the disease outcomes will provide new insight into the disease's etiology. However, this presents an analytic difficulty due to the large number of SNPs and the complex relationships among them. We proposed using the mixed model approach to identify the significant multi-locus genotypes and the high-order gene-to-gene interactions. SUBJECTS AND METHODS: We described the mixed effects model and applied this approach to real world data. For the purpose of these analyses, we examine the association of four types of SNPs (AGT5, APOB, CETP3 and ACE6) with the lipid profiles and the measures related with cardiovascular disease. We used data from 672 healthy individuals (283 males and 389 females) who were without cardiovascular diseases. RESULTS: The results of our analysis suggested that there were significant random genotype patterns and genotype groups according to the gender effect on the lipid profiles. In other words, there was significant variability across the genotype groups because of the effect of gender on the lipid profiles. CONCLUSION: The mixed model approach provided a flexible statistical framework for controlling potential confounding variables and for identifying a significant genetic contributions that may come about through the effects of multi-locus genotypes or through an interaction between the genotype and environmental variables (e.g. gender) with the variations in quantitative traits (e.g. lipid profiles). There were significant genetic contributions to the variability in the lipid profiles, and these were explained by the 4 SNPs described in our real data.

Gender Difference of Insulin Resistance in Obese Children and Adolescents / 대한소아내분비학회지

PURPOSE: It is known that insulin resistance is important because it may precede the development of Diabetes Mellitus. We evaluated the gender difference of insulin resistance in obese children & adolescents. METHODS: 92 obese children and 187 adolescents (age:5-16 y, >95th percentile of the body mass index [BMI] for age and sex) were included in this study. The abdominal fat, abdominal circumference, and intraabdominal fat depth (IAFD), plasma fasting insulin, leptin, adiponectin, lipid profiles and high sensitive-C reactive protein (hs-CRP) were measured, and a two-hour oral glucose tolerance test with insulin measurement were performed. RESULTS: The plasma total cholesterol, leptin, fasting insulin & HOMA-IR levels of obese females were higher than those of obese males. The sex, waist circumference, IAFD & adiponectin levels were strongly correlated with HOMA-IR by multiple linear regression analysis (P<0.05). CONCLUSION: Adolescent females may have specific fat distribution and were expressed to have higher leptin and relatively lower adiponectin concentration compared to adolescent males, developing higher insulin resistance, even though having lesser abdominal fat and waist size. Further investigation is required to verify the gender difference of insulin resistance in obese children and adolescents.

Relationship between Traumatic Events and Posttraumatic Stress Disorder among North Korean Refugees / 신경정신의학

OBJECTIVES: The purpose of this study is to find out the relationship between the traumatic experiences and the prevalence of PTSD among North Korean refugees in South Korea. METHODS: Two hundred North Korean refugees in South Korea were voluntarily participated. Researchers conducted face-to-face interviews and assisted defectors in performing a self-report assessment of this survey. The study questionnaire consisted of demographic characteristics, Traumatic Experiences Scale for North Korean Defectors, and PTSD part of the Structured Clinical Interview for DSM-III-R Korean version. RESULTS: Prevalence rate of PTSD in defectors was 29.5%, with a higher rate for women. In factor analysis, the 25 items of traumatic events experienced in North Korea were divided into three factors: physical trauma, political-ideological trauma, and family-related trauma. In addition, the 19 items of traumatic events during defection were grouped into four factors: physical trauma, discovery and capture-related trauma, family-related trauma, and betrayal-related trauma. In multi-factorial logistic regression analysis, family-related trauma in North Korea had a significant odds ratio. CONCLUSION: Family-related trauma experienced in North Korea is related to the prevalence of PTSD among North Korean refugees in South Korea.