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Balloon eustachian tuboplasty (BET), a surgical technique to expand the cartilaginous portion of the eustachian tube by ballooning via opening at the nasopharynx, has been introduced as a useful surgical modality for eustachian tube dysfunction patients. Although BET is known as a relatively safe procedure, we recently have experienced two cases of cardiac complications during balloon inflation. In one case, an asystole occurred for 13 seconds during this procedure; the heart rate was recovered after balloon deflation with an intravenous injection of glycopyrrolate and atropine. In the other case, bradycardia occurred and continued during BET. Heart rate was recovered immediately after deflation of balloon without drug injection. As far as we know, this is the first report of cardiac complications during BET, probably related with trigemino-cardiac reflex. In both cases, no other sequelae remained after the surgery. We report these two cases of cardiac complications that occurred during BET along with a review of literature.
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Background and Objectives@#The canal wall down mastoidectomy brings changes in the anatomy of the external auditory canal (EAC), causing potential problems, such as accumulated crust, vertigo attacks, and difficulties in wearing hearing aids (HAs). The objective of this study is to evaluate the safety and efficacy of mastoidoplasty using the demineralized bone matrix (DBM) to obliterate the mastoidectomized cavity and reconstruct EAC.Subjects and Method Medical records of patients with chronic otitis media with or without cholesteatoma who received mastoidoplasty using DBM by a single surgeon at Seoul St. Mary’s hospital between 2014 and 2021 were reviewed retrospectively. @*Results@#A total of 27 patients were included in this study. None of the patients showed any recurrence of cavity problem, wound infection, or any other complications during their followup period of 13.07±37 months. The average air and bone conduction hearing level of pure tone audiometry showed no significant change after surgery (p=0.50, p=0.54, respectively). Five patients indicated for hearing rehabilitation could adopt canal type HAs after surgery; six patients used completely-in-the canal type HAs, and one patient used in-the-canal type HAs. None of the patients using HAs complained of acoustic feedback or any other problem in wearing HAs. @*Conclusion@#Mastoidoplasty using DBM seems to be a very safe and effective surgical procedure that shows functionally acceptable EAC for hearing rehabilitation with canal type HAs and demonstrates no specific complication.
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Objectives@#. Sigmoid sinus resurfacing (SS-R) is one of the most effective surgical treatments for patients with pulsatile tinnitus (PT) originating from anatomical variants of the vascular walls in the temporal bone. This study aimed to provide updated information on the clinical outcomes of SS-R and evaluate the efficacy of the water occlusion test (WOT) as an additional diagnostic modality. @*Methods@#. We retrospectively reviewed medical records including tinnitus questionnaires, temporal bone computed tomography (TBCT) scans, audiologic tests, and preoperative WOT results from patients who underwent SS-R. @*Results@#. In total, 26 patients were included in the study. The mean age was 44 years, and the mean symptom duration was 3 months. Fourteen patients (53.8%) were completely cured, seven (26.9%) significantly improved, and five (19.2%) remained stable. The mean visual analog scale loudness score decreased from 5.26 to 1.34 (P<0.001) and the mean Tinnitus Handicap Inventory score also improved from 50.23 to 5.5 (P<0.001) after SS-R surgery. In 10 patients with discrepancies between the preoperative TBCT and intraoperative findings, WOT showed a significant additive effect in predicting surgical outcomes. No patients experienced severe intraoperative or postoperative complications during the entire follow-up period. @*Conclusion@#. SS-R provides significant symptom improvement in patients with sigmoid sinus dehiscence who had a positive WOT without other sigmoid sinus variants. A combined diagnostic approach with TBCT, WOT, and intraoperative findings is crucial for achieving better surgical outcomes in patients with PT caused by sigmoid sinus variants.
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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.
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Objectives@#. The aims of this study were to investigate the test-retest reliability of measurements of loudness discomfort levels (LDLs), to suggest cut-off values for diagnosing patients with hyperacusis, and to evaluate the clinical value of-LDL measurements as a test for monitoring hyperacusis. @*Methods@#. For the test-retest reliability of LDL measurements (study 1), a total of 68 patients who sought consultations at our clinic were subcategorized into four groups: patients with tinnitus (group 1), tinnitus and hearing loss (group 2), hyperacusis (group 3), and normal controls (group 4). Inter-hour and inter-day test-retest reliability values using different stimuli were investigated. For study 2, the clinical value of LDL measurements using pure tone stimuli was analyzed by comparing changes after sound generator use in patients with hyperacusis. @*Results@#. In study 1, the group 3 patients showed significantly lower LDLs than the other groups. High test-retest reliability of LDL tests was demonstrated, regardless of the type of stimulus used. The cut-off values for screening patients with hyperacusis were 90 dB HL using pure tone stimuli and 62 dB HL using white-band noise stimuli. In study 2, significantly increased LDLs were correlated with improved symptoms and improved scores on tinnitus questionnaires after sound generator use, indicating that LDL measurement is a reliable test for monitoring hyperacusis during an intervention. @*Conclusion@#. LDL measurement is a reliable diagnostic tool to reflect the condition of hyperacusis, especially during the course of treatment.
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Auricular hematoma is one of the most common problems among people who have got repetitive blunt trauma to the external ear. Prompt managements are drainage of hematoma and following prevention of re-accumulation (e.g. compression dressing). If the treatment is not successful, many complications can occur, including perichondritis, infection and necrosis. Especially long-lasting loss of blood supply to the ear cartilage and formation of neocartilage from disrupted perichondrium can result in cauliflower ear deformity. There were some studies trying to classify and to treat the cauliflower ear by the degree of deformities. And excision of deformed cartilage with reshaping of the auricle has been reported several times. In this article, we would like to introduce a successful drilling technique of otoplasty as a useful treatment option.
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Background and Objectives@#To introduce cold-knife dissection with adjunctive suction cauterization (CDASC) technique for pediatric adenotonsillectomy and to evaluate the advantages of this technique through short and long-term follow-up results.Subjects and Method Enrolled in the study were 492 subjects with a mean age of 6.5 years, who underwent adenotonsillectomy via the CDASC technique. Surgical outcomes were evaluated through the postoperative bleeding rate, days of normal diet (as a measure of pain), and improvement of obstructive symptoms at regular follow-up visits. Intraoral photography and lateral neck radiography were analyzed for long-term surgical outcomes. @*Results@#None of the enrolled patients revisited the hospital due to hemorrhage, indicating 0% immediate and delayed postoperative bleeding with this surgical technique. Most of the patients showed normal diet consumption and activity within 3 days. Postoperative intraoral photography after 6 and 12 months were graded as normal (grade 0) in 77.5% and 79.7% of the enrolled patients, respectively. Postoperative adenoid to nasopharyngeal ratios were significantly reduced (p<0.05) and no recurrence of snoring and adenoid regrowth were demonstrated during the follow-up period of 12 months. @*Conclusion@#Our CDASC technique seems to have several advantages including less postoperative pain, no postoperative bleeding, less scarring, and no recurrence of preoperative symptoms. We suggest that our CDASC technique is a very useful, safe, and effective method of surgery for pediatric adenotonsillectomy.
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Intralabyrinthine schwannoma (ILS) is a rare benign tumor that arises within the membranous labyrinthine. Since hearing loss is inevitable after tumor removal in most cases, an appropriate rehabilitation method should be considered. A 41-year-old male, who was diagnosed with ILS underwent tumor removal via translabyrinthine approach, has subsequently experienced right-side deafness as a result. Seventeen months after the tumor removal, a surgery for hearing rehabilitation was performed. Since cochlear implantation was not doable due to cochlear ossification, an active transcutaneous bone conduction implant (BonebridgeTM , MEDEL) was placed at the sinodural angle. To the best of our knowledge, this is the first report describing hearing rehabilitation with BonebridgeTM implantation after ILS removal.
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Objective@#To investigate the association between genetic polymorphisms of brain-derived neurotrophic factor (BDNF) or serotonin transporter gene-linked polymorphic region (5-HTTLPR) and tinnitus, and the mediating effects of psychological distress on this association. @*Methods@#Eighty-six patients experiencing tinnitus and 252 controls were recruited. The Tinnitus Handicap Inventory was used to assess the severity of tinnitus and the Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory-II (BAI-II), and the Korean version of the Brief Encounter Psychosocial Instrument (BEPSI-K) were used to assess psychological distress. We compared the association of BDNF rs6265 (Val66Met) and 5-HTTLPR variants in the two groups. The mediating effects of BDI-II, BAI-II, and BEPSI-K were examined using multiple regression analysis and validated by the Sobel test and bootstrapping. @*Results@#No significant differences were found between the groups regarding BDNF Val66Met and 5-HTTLPR, but the 5-HTTLPR variants trended toward association. Depressive symptoms appeared to act as a mediator on the relationship within the 5-HTTLPR s/s genotype and the severity of tinnitus. @*Conclusion@#Our findings provide a speculative idea on the association between the serotonergic system and tinnitus and suggest that depressive symptoms act as a mediator in tinnitus. Therefore, screening for depressive symptoms in patients with tinnitus is essential and intervention for depressive symptoms may help alleviate the severity of tinnitus.
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Objective@#To investigate the association between genetic polymorphisms of brain-derived neurotrophic factor (BDNF) or serotonin transporter gene-linked polymorphic region (5-HTTLPR) and tinnitus, and the mediating effects of psychological distress on this association. @*Methods@#Eighty-six patients experiencing tinnitus and 252 controls were recruited. The Tinnitus Handicap Inventory was used to assess the severity of tinnitus and the Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory-II (BAI-II), and the Korean version of the Brief Encounter Psychosocial Instrument (BEPSI-K) were used to assess psychological distress. We compared the association of BDNF rs6265 (Val66Met) and 5-HTTLPR variants in the two groups. The mediating effects of BDI-II, BAI-II, and BEPSI-K were examined using multiple regression analysis and validated by the Sobel test and bootstrapping. @*Results@#No significant differences were found between the groups regarding BDNF Val66Met and 5-HTTLPR, but the 5-HTTLPR variants trended toward association. Depressive symptoms appeared to act as a mediator on the relationship within the 5-HTTLPR s/s genotype and the severity of tinnitus. @*Conclusion@#Our findings provide a speculative idea on the association between the serotonergic system and tinnitus and suggest that depressive symptoms act as a mediator in tinnitus. Therefore, screening for depressive symptoms in patients with tinnitus is essential and intervention for depressive symptoms may help alleviate the severity of tinnitus.
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Background and Objectives@#Ototoxic sensorineural hearing loss causes permanent hearing loss in most cases. Recently there have been many reports describing cell base therapy with stem cells that has some effect on hearing recovery. We evaluated the efficacy of clinical grade, pre-made, human bone marrow derived mesenchymal stem cells (BM-MSCs) in ototoxic deaf animal model.Materials and Method BM-MSCs were cultured in a clinical grade laboratory. The animals were divided into 2 groups as follows: a saline injected control group and a stem cell injected group (MSC-group). Cultured MSCs were transplanted into the brachial vein of the deaf mice model. We recorded auditory brainstem response (ABR) and conducted immunohistochemistry at 1, 3, and 5 weeks. @*Results@#After the transplantation of MSC, a significant improvement in the hearing threshold of ABR was observed in the MSC transplanted group. Five weeks after transplantation of MSCs, hair cell regeneration was confirmed from the basal to the apex of the cochlea in fluorescent dyed image under the microscope compared to the control group. @*Conclusion@#BM-MSCs were effective in an acute ototoxic deaf animal model. These results show that stem cell transplantation mediate inner ear regeneration.
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Subtotal petrosectomy (STP) is an effective treatment modality for recurrent suppurative otitis media (CSOM) and cochlear implant (CI) may be combined for auditory rehabilitation. An active transcutaneous bone conduction implantation system, known as BonebridgeTM (BB) (MED-EL), is indicated for conductive or mixed hearing loss as well as for single-side deafness, but no cases of BB implantation during STP have been reported. A 37-year-old woman who had previously undergone radical mastoidectomy visited our clinic. The left side was deaf and the CT scan showed total ossification of the cochlea, indicating that CI was not possible. STP was performed and bone conduction-floating mass transducer was placed at a sinodural angle. A month later, the sound processor was applied successfully without any complications. This case suggests that BB implantation during STP may be another effective therapeutic option for CSOM patients who have difficulty undergoing CI procedure.
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Bioactivity-guided fractionation of MeOH extract of the dried fruits of Amomum tsao-ko led to isolation of nine compounds (1 – 9). Their structures were elucidated by spectroscopic methods including extensive 1D and 2D-NMR, as alpinetin (1), naringenin-5-O-methyl ether (2), naringenin (3), hesperetin (4), 2′,4′,6′-trihydroxy-4-methoxy chalcone (5), tsaokoin (6), boesenbergin B (7), 4-hydroxyboesenbergin B (8), and tsaokoarylone (9). Of these, compound 8 was isolated from a natural source for the first time, which was previously reported as a synthetic product. The isolated compounds (1 – 9) were tested for their inhibitory effects on LPS-induced nitric oxide production in RAW 264.7 macrophages. Among them, three chalcone derivatives (compounds 5, 7, and 8) and a diarylheptanoid (compound 9) exhibited significant inhibitory activity on the NO production with IC₅₀ values ranging from 10.9 to 22.5 µM.
Subject(s)
Amomum , Chalcone , Ether , Fruit , Macrophages , Nitric Oxide , ZingiberaceaeABSTRACT
Paranasal sinus mucoceles are an uncommon cause of isolated palsies of cranial nerves III, IV, and VI. The trochlear nerve has been reported to be less frequently affected than the abducens and oculomotor nerves. Isolated sphenoid sinus diseases may cause serious complications by involving adjacent vital structures such as the optic nerve, cavernous sinus, internal carotid artery, and cranial nerves III–VI. We report a case of a 76-year-old woman who presented to our emergency department with a chief complaint of acute double vision and headache. Her diplopia was diagnosed as left trochlear nerve palsy. Brain CT and MRI revealed expanding cystic lesions in both sphenoid sinuses with bony erosion of the left sinus wall. The patient underwent an endoscopic intranasal sphenoidotomy and recovered completely from diplopia at postoperative 2 months. The relationship between the trochlear nerve palsy and its anatomy is also discussed.
Subject(s)
Aged , Female , Humans , Brain , Carotid Artery, Internal , Cavernous Sinus , Cranial Nerves , Diplopia , Emergency Service, Hospital , Headache , Magnetic Resonance Imaging , Mucocele , Oculomotor Nerve , Optic Nerve , Paralysis , Sphenoid Sinus , Trochlear Nerve Diseases , Trochlear NerveABSTRACT
BACKGROUND AND OBJECTIVES: The agreement between pure-tone average (PTA) and speech recognition threshold (SRT) has become more important with the increasing demands for medical certification. The purpose of this study was to explore the relationships between the SRT and several variations of PTA, and to determine which PTA formula would provide the best agreement with SRT for different audiometric configurations. SUBJECTS AND METHOD: Audiological data on 783 ears were retrospectively collected. The air-conduction PTAs were calculated using five different formulas: three-frequency average (3FA), weighted three-frequency average (W3FA), four-frequency average (4FA), weighted four-frequency average (W4FA), and six-frequency average (6FA). The audiometric configuration was classified into five categories. The PTA-SRT relationships were analyzed using correlation and simple linear regression for each audiometric configuration. RESULTS: Highest correlation was observed between the SRT and W3FA for all audiometric configurations with the correlation coefficient of 0.964 as a whole. The SRT and 3FA were best-matched in the linear regression models for overall/flat/high frequency gently sloping/low frequency ascending; the SRT and W3FA were best-matched for high frequency steeply sloping (HFSS); the SRT and 4FA were best-matched for miscellaneous audiograms. CONCLUSION: The most stable PTA variations that make the best-matched pairs with SRT for any audiogram are the conventional 3FA and W3FA doubling 1 kHz threshold. The addition of frequencies higher than 2 kHz to a PTA formula seems to have impeded the PTA-SRT agreement, especially for HFSS audiograms. W3FA should be the method of choice in predicting SRT from PTA for HFSS audiograms.
Subject(s)
Certification , Ear , Hearing Loss, Functional , Linear Models , Methods , Retrospective StudiesABSTRACT
Verruca vulgaris of the larynx (VVL) is an extremely rare disease that can be easily misdiagnosed as papillary keratosis, squamous papilloma or verrucous carcinoma, which would have led to needless operation. We experienced a case of VVL in a 66-year-old man with 1-year history of progressive hoarseness. Whitish lesions in both vocal cords were observed by using indirect laryngoscopy and completely removed via microlaryngeal surgery with CO2 laser.