Treatment Efficacy of Various Maneuvers for Lateral Canal Benign Paroxysmal Positional Vertigo With Apogeotropic Nystagmus: A Randomized Controlled Trial

Objectives@#The aim of this study was to determine the most effective treatment approach by comparing the impacts of various otolith reduction techniques in patients with apogeotropic lateral semicircular canal benign paroxysmal positional vertigo (LC-BPPV). @*Methods@#We performed a multicenter randomized prospective study from January to December 2015, involving 72 consecutive patients with apogeotropic LC-BPPV. The patients were divided into three treatment groups: therapeutic head-shaking (group A), the Gufoni-Appiani maneuver (group B), and the cupulolith repositioning maneuver (CuRM; group C). Each group underwent evaluation and treatment up to the fourth week. Treatment success was defined as the disappearance of positional vertigo and nystagmus. @*Results@#This study included 72 patients (49 male and 23 female), with a mean (±standard deviation) age of 55.4±13.5 years. The mean duration of vertigo experienced prior to treatment was 3.9±4.4 days. The mean latency and duration of nystagmus were 2.7±3.0 seconds and 47.9±15.8 seconds, respectively. The overall treatment frequency was 2.0±0.9. The number of treatments differed significantly among the three groups (P0.05). However, CuRM was the only method with a 100% treatment success rate. @*Conclusion@#While no clear difference was observed among the three treatments for LC-BPPV, CuRM was found to be superior to the other approaches in the long term.

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.

Inner Ear Gene Therapy in Mouse Models of Genetic Hearing Loss / 대한이비인후과학회지

Hearing loss is the most frequent sensory disorder affecting newborns and children. About 1 newborn in every 500 suffer from congenital hearing loss, with approximately half of these having a genetic cause. In the last few decades, the study of genetic hearing loss and related mouse models has unveiled molecular, cellular, and physiological mechanisms of the disease. In addition, effective and safe viral vectors for gene delivery to the inner ear have been generated. A growing number of approaches, including gene replacement, gene silencing, and gene editing, have proved effective in mouse models. This article briefly introduces basic strategies of gene therapy, viral vectors used and surgical methods for gene delivery, and reviews the current works on mouse modes of genetic hearing loss.

Management of an Inappropriately Treated Case of Auricular Hematoma

Othematoma is a condition in which blood collects beneath the perichondral layer of the pinna. Recurrent auricular hematoma can be a challenging medical problem, with complications resulting in ear deformity, therefore, appropriate management is important. Improper treatment can result in a deformity known as ‘cauliflower ear’ or ‘wrestler’s ear.’ We report a case of othematoma that was inappropriately treated and present a review of current treatment options.

Clinical Characteristics of Temporal Bone Metastases

OBJECTIVES: The purposes of this study were to evaluate the clinical characteristics of temporal bone metastasis (TBM) and to determine whether the characteristics differed according to primary malignancy. METHODS: We retrospectively analyzed data on 20 patients diagnosed with TBM between January 2000 and January 2017. Demographics, the period from diagnosis of primary malignancy to TBM diagnosis, the period from TBM diagnosis to death, the type and staging of primary malignancy, otologic manifestations, and TBM sites were assessed. After the primary malignancies were divided into solid cancers and hematologic malignancies, each parameter was compared between the two groups. RESULTS: The most common primary malignancy with TBM was lung cancer (45%). The most common otologic symptoms and signs were facial palsy (30.5%) and hearing loss (30.5%). The temporal squama (23%) and the facial nerve (20%) were the most commonly involved. Most TBMs occurred late in the disease process after the primary malignancy first metastasized to other organs. Hematologic malignancies metastasized significantly more frequently to the external auditory canal and the middle ear/mastoid compared to solid cancers (P=0.001 and P=0.004, respectively). CONCLUSION: If otologic manifestations such as facial palsy and hearing loss are presented in patients at advanced stages of malignancy, TBM of primary malignancy should be suspected. In addition, hematologic malignancies tend to metastasize to the external auditory canal and the middle ear cleft more commonly than solid cancers do.

Translation and Linguistic Validation of Korean Version of Musical Background Questionnaire / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#The Musical Background Questionnaire (MBQ) has been developed to assess formal musical training and listening enjoyment. The aims of this study were to translate MBQ into Korean with subsequent linguistic validation and to evaluate the effectiveness of the Korean version of MBQ (K-MBQ).SUBJECTS AND METHOD: Between 2013 and 2014, a panel affiliated with the questionnaire committee of the Korean Audiological Society reconciled the first draft K-MBQ translated by a bilingual person. A separate bilingual translator, who had never seen the original MBQ, translated the draft K-MBQ back into English, and subsequently, the panel reviewed its equivalence to the original one. K-MBQ was administered to 29 adults (M:F=15:14; aged 21 to 76 years) for cognitive debriefing. Pure tone and speech audiometry were performed in all participants.@*RESULTS@#The translation of K-MBQ was completed through a multi-step process of forward translation, reconciliation, reverse translation, cognitive debriefing and proofreading. Thirteen (45%) of 29 subjects reported formal musical training, and 16 participants (55%) judged themselves as having no musical education and background. No significant correlation was found between musical background and hearing level, whereas self-perceived quality of music and self-perception of music elements quantified by K-MBQ were associated with hearing ability in terms of pure-tone and speech audiometry.@*CONCLUSION@#K-MBQ was translated and linguistically validated. The use of this questionnaire can provide further evaluation of musical background in patients with hearing loss or cochlear implant users.

Validation of the Korean Version of the Abbreviated Profile of Hearing Aid Benefit / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The quantification of hearing aid benefit is important in hearing aid fitting. The abbreviated profile of hearing aid benefit (APHAB) is a useful tool for measuring the benefit of using hearing aids. In this study, we developed a Korean version of APHAB (K-APHAB) and determined its validity and reliability. SUBJECTS AND METHOD: An expert panel translated the original version of APHAB into Korean language. Two bilingual translators back-translated the first translated version into English and it was compared with the original version. After cognitive debriefing, the translation of APHAB into the Korean version was completed. One hundred ninety-seven subjects using hearing aids participated in this study and completed K-APHAB. Reliability was assessed using Cronbach's alpha coefficient, and validity was evaluated by factor analysis and criterion validity. RESULTS: K-APHAB had a good internal consistency (α=0.80). Confirmatory factor analysis showed that K-APHAB is comprised of four subsections, namely ‘communication in daily life’, ‘aversiveness’, communication in ‘background noise’ or ‘reverberation’. CONCLUSION: The K-APHAB is a useful tool for evaluating the benefit of hearing aids in Korean hearing-impaired individuals.

Translation and Standardization for a Korean Version of the Client Oriented Scale of Improvement / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Client Oriented Scale of Improvement (COSI) has been designed to identify client needs, changes in listening ability, and final listening ability in situations important to each client. The aim of this study was to translate COSI into Korean with subsequent linguistic validation and to determine the reliability of the Korean version of the COSI (K-COSI). SUBJECTS AND METHOD: An expert panel translated the original version of COSI into the Korean language. A bilingual translator back-translated the translated version into English, which was subsequently compared with the original English version. K-COSI was administered at 14 referral hospitals, to 128 patients with hearing disability after cognitive debriefing. Reliability was assessed using correlation study. RESULTS: K-COSI showed an excellent test-retest correlation and high reliability in degree of change (Spearman correlation=0.89, interclass correlation coefficient=0.922). It also showed a fair test-retest correlation and high reliability in final hearing ability (Spearman correlation=0.49, interclass correlation coefficient=0.353) CONCLUSION: K-COSI proved to be highly reliable. The results suggest that the adapted Korean version of COSI is a reliable and valid measure for Korean-speaking patients with hearing loss.

Standardization for a Korean Version of the Speech, Spatial and Qualities of Hearing Scale: Study of Validity and Reliability / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The Speech, Spatial and Qualities of Hearing Scale (SSQ) was designed to measure self-reported auditory disability in a wide variety of listening situations. Its 49 items cover many aspects of speech perception, spatial hearing, and qualities of hearing, which constitute the three parts of SSQ. However, there has been no reliable and valid Korean version of SSQ (K-SSQ), which made the measurement of auditory disability difficult. The aim of this study is to develop a K-SSQ and to determine its reliability and validity for clinical or academic use. SUBJECTS AND METHOD: An expert panel translated the original SSQ into Korean. A bilingual translator back-translated the translated version into English, which was then compared with the original version. After cognitive debriefing, K-SSQ was administered to 400 patients with hearing disability in 14 referral hospitals. Reliability was assessed using Cronbach's alpha coefficient and correlation study. Validity was evaluated by factor analysis and criterion validity based on the results of pure tone audiometry. RESULTS: K-SSQ showed good reliability with high internal consistency (Cronbach's α=0.99), and strong positive correlations across all three parts of SSQ. Construct validity was confirmed by the results of factor analysis and criterion validity demonstrated positive correlations between each part of SSQ and the results of pure tone audiometry. CONCLUSION: The K-SSQ is a reliable and valid tool for use as a behavioral measure of hearing ability in Korean-speaking patients, and it will provide a very useful evaluation tool for both clinicians and researchers.

Left Side Otalgia Caused by Acute Myocardial Infarction / 대한이비인후과학회지

Otalgia consists of primary otalgia associated with disorders of the ear itself and referred otalgia due to disorders of organs that share the same innervation with the ear. Disorders of the oral cavity and laryngopharynx served by the glossopharyngeal and vagus nerves are common causes of referred otalgia. Chest pain from myocardial infarction spreads through the afferent pain pathway, especially through the sympathetic nerves in the cardiac plexus and the phrenic nerve, resulting in a typical chest pain or referred pain in the left upper extremity. However, pain spreading through the vagus nerve can theoretically cause referred otalgia. This association between the heart and ear has not been widely acknowledged, even though a referred otalgia can occasionally be the only symptom of the tragic disease, myocardial infarction, and should be taken seriously. We report a patient who complained of left otalgia as the only symptom of myocardial infarction.

A Case of Scala Vestibuli Cochlear Implantation in Tympanogenic Labyrinthitis Ossificans / 대한이비인후과학회지

Labyrinthitis ossificans (LO) is a pathologic formation of fibrosis and new bone within the lumen of the otic capsule. The LO is a challenging issue in cochlear implantation since obliteration and obstruction of the cochlea make electrode insertion through scala tympani (classic route) difficult. Moreover, tympanomastoidectomy for resolution of chronic otitis media is also simultaneously considered for tympanogenic LO with severe to profound hearing loss because ossification could progress in case of staged or delayed implantation after initial tympanomastoidectomy. We report a patient with tympanogenic LO, who received subtotal petrosectomy with simultaneous cochlear implantation via scala vestibuli instead of the scala tympani for hearing rehabilitation.

A Case of Free-Floating Endolymph Particle Found during Transmastoid Posterior Semicircular Canal Occlusion for Intractable Posterior Canal Benign Paroxysmal Positional Vertigo / 대한이비인후과학회지

Benign paroxysmal positional vertigo (BPPV) is a common inner ear cause of vertigo, most of which can be treated by particle repositioning maneuver (PRM). However, in rare cases, positional vertigo could persist or frequently recur after several PRM. In these intractable cases, surgical treatments including singular neurectomy and semicircular canal occlusion have been used. Posterior semicircular canal occlusion has some advantages over singular neurectomy in hearing preservation and feasible surgical technique. Also free-floating endolymph particles causing intractable BPPV are known to occur in about 20% of the cases during canal occlusion surgery. Nevertheless, to the best of our knowledge, there has not been any report on the identification of those particles in the Korean literature. In this paper, we report a case of free-floating endolymph particle found during transmastoid posterior semicircular canal occlusion for intractable posterior canal BPPV.

Facial Nerve Paralysis in Patients With Chronic Ear Infections: Surgical Outcomes and Radiologic Analysis

OBJECTIVES: The purpose of this study was to investigate the clinical features, radiologic findings, and treatment outcomes in patients of facial nerve paralysis with chronic ear infections. And we also aimed to evaluate for radiologic sensitivities on facial canal, labyrinth and cranial fossa dehiscences in middle ear cholesteatomas. METHODS: A total of 13 patients were enrolled in this study. Medical records were retrospectively reviewed for clinical features, radiologic findings, surgical findings, and recovery course. In addition, retrospective review of temporal bone computed tomography (CT) and operative records in 254 middle ear cholesteatoma patients were also performed. RESULTS: Of the 13 patients, eight had cholesteatomas in the middle ear, while two patients exhibited external auditory canal cholesteatomas. Chronic suppurative otitis media, petrous apex cholesteatoma and tuberculous otitis media were also observed in some patients. The prevalence of facial paralysis in middle ear cholesteatoma patients was 3.5%. The most common involved site of the facial nerve was the tympanic segment. Labyrinthine fistulas and destruction of cranial bases were more frequently observed in facial paralysis patients than nonfacial paralysis patients. The radiologic sensitivity for facial canal dehiscence was 91%. The surgical outcomes for facial paralysis were relatively satisfactory in all patients except in two patients who had petrous apex cholesteatoma and requiring conservative management. CONCLUSION: Facial paralyses associated with chronic ear infections were observed in more advanced lesions and the surgical outcomes for facial paralysis were relatively satisfactory. Facial canal dehiscences can be anticipated preoperatively with high resolution CTs.

Expression Changes of Endothelin-1, Endothelin Receptor A and B in the Cochlea after Noise Exposure / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There are several evidences of reduced cochlea blood flow after noise exposure in the cochlea. However, the pathophysiology of blood flow change is still obscure, and endothelins, proteins that constrict blood vessels and play a key role in vascular homeostasis using its receptors may have importance in this respect. In this study, we investigated the expression changes of endothelin-1 (ET-1), endothelin receptor A (ETAR) and B (ETBR) according to auditory threshold change after noise exposure. MATERIALS AND METHOD: Mice were exposed to different noise to generate transient (group 2) and permanent threshold shift (group 3), respectively. Auditory threshold shifts were evaluated with auditory brainstem response and expression changes of ET-1, ETAR and ETBR after noise exposure were evaluated by immunohistochemistry and real time RT-PCR. RESULTS: After noise exposure, the increased ET-1, ETAR and ETBR immunoreactivities were observe in stria vascularis, spiral ligament and spiral ganglion neuron. ET-1 mRNA expressions increased after noise exposure in both group 2 and group 3 compared to those of the control group. At 2 weeks after noise exposure, however, the ET-1 mRNA expressions in group 3 increased compared to that of the control but decreased compared to that of group 2. On the other hand, ETAR mRNA expression increased at 2 weeks after noise exposure in both groups, just after noise exposure in group 2 and at 2 weeks after noise exposure in group 3. CONCLUSION: These results suggest that expression changes of ET-1, ETAR and ETBR might be associated with hearing threshold shift and recovery after noise exposure in the cochlea.

Reliability of Air Caloric Response in Healthy Volunteers and Patients With Chronic Otitis Media / 대한평형의학회지

BACKGROUND AND OBJECTIVES: To investigate reliability of the air caloric test compared to the water caloric test and to determine whether anatomical alterations due to chronic otitis media (COM) influence air caloric response. MATERIALS AND METHODS: Fifty-six subjects without vestibulopathy (24 healthy individuals as control group and 32 patients with unilateral COM as experimental group) were included. The bithermal water and air caloric test were sequentially conducted in control group. The bithermal air caloric tests, high-resolution temporal bone computed tomography and endoscopic photography of the ear drum were obtained from experimental group. RESULTS: Although maximal slow phase velocities and time to reach peak velocity using water irrigation were significantly higher and shorter, respectively, than those by air irrigation in normal subjects, caloric parameters on air caloric test agreed well with those of water caloric testing. However, inverted nystagmus occurred in 16 ears of 16 subjects, which was predominantly presented during warm air stimulation in the com patient group. The large tympanic membrane perforation and asymmetrical mastoid pneumatization were significant parameters affecting caloric response. The presented prediction model for cold-induced mspvs corresponded with observed values according to mastoid pneumatization. CONCLUSION: Although the air caloric stimuli resulted in a reliable response in healthy subjects, air caloric results among com patients affected by anatomical alteration as well as irrigation temperature. Presented mathematical model for cold induced mspv could serve as a good reference in measuring true vestibular function in com patients.

Complete Laryngotracheal Separation Following Attempted Hanging

Laryngotracheal separation (LTS) is the most immediately life-threatening airway injury. LTS is so rare that very few otolaryngologists have experience with it. LTS is one of the diagnostic and therapeutic challenges in airway diseases and its management remains to be established. We experienced a patient with complete LTS after attempted hanging. A high index of suspicion, adequate imaging, prompt airway establishment and early surgical repair are the most vital factors in managing a patient with LTS.

Seborrheic Keratosis of Auricle: A Case Report and Literature Review / 대한이비인후과학회지

Seborrheic keratosis (SK) is a common benign lesion that develops from the proliferation of epidermal cells. Since SK usually occurs on the face, extremities, and upper trunk of the elderly, the finding of this lesion on the auricle is rare. Given the rarity of SK lesions of the auricle and the lack of familiarity with its presentation, otolaryngologists have difficulty diagnosing SK. Authors experienced a case of solitary SK that originated from the auricle in a 65-year-old man. We present this case with a review of the literature.

Role of Staphylococcus Aureus Exotoxins in Chronic Rhinosinusitis with Nasal Polyp / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Staphylococcal exotoxins (SEs) have been implicated in the pathogenesis of chronic rhinosinusitis with nasal polyp (CRSwNP). In the current study, we determined the prevalence of specific immunoglobulin E (IgE) antibodies to SEs in serum and polyp tissues of patients with CRSwNP and tried to find out whether there is an association between the presence of SEs-IgE antibody and eosinophilic inflammation. SUBJECTS AND METHOD: Blood, nasal polyp and mucosa samples were obtained from 43 patients undergoing endoscopic sinus surgery for CRSwNP and 11 controls undergoing septoplasty without CRS. Specimens were analyzed for the presence of specific IgE antibody to four SEs [staphylococcal enterotoxin A (SEA), staphylococcal enterotoxin B (SEB), staphylococcal enterotoxin C (SEC), toxic shock syndrome toxin 1 (TSST-1)] using ImmunoCAP assay. Eosinophil cationic protein (ECP) in serum and nasal polyp tissue were also analyzed using ImmunoCAP. Eosinophil counts were estimated in polyp tissue. RESULTS: SEs-specific IgE antibodies were detected in 13 (30.2%) patients of the CRSwNP group. In contrast, only one (9.1%) control patient had IgE to SEs. Serum ECP level was increased significantly in the CRSwNP group compared with controls. However, there were no significant differences in Lund-MacKay score, the ECP level in the serum and polyp tissue, and eosinophil count in the polyp tissue between the SEs-IgE antibody positive [SEs-IgE Ab (+)] group and the SEs-IgE antibody negative [SEs-IgE Ab (-)] group. CONCLUSION: SEs may play a certain role in the pathogenesis of CRSwNP. However, there is no close correlation between the presence of SEs-IgE antibody and eosinophilic inflammation.

The Demonstration of Bacterial Biofilm and It's Impact on Postoperative Course in Patients with Chronic Rhinosinusitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Bacterial biofilm is thought to contribute to the progression and persistence of chronic rhinosinusitis. There are many studies which demonstrate these structures on chronic rhinosinusitis (CRS), but the majority of the studies just focus on the documentation of their presence and the method for identification. There are also a few researches that show the impact of biofilm on postoperative surgical outcomes. In this study, we demonstrated bacterial biofilm in CRS patients and determined whether they affect clinical courses and outcomes after surgery. SUBJECTS AND METHOD: The mucosa of ethmoid bulla was obtained during endoscopic sinus surgery from 21 CRS patients. Fluorescent microscope and scanning electron microscopy (SEM) were used for the determination of biofilm. The outcomes of the surgery were evaluated by endoscope every two weeks for 6 months. Preoperative symptom scores, CT scores, and the post operative results were compared between patients with biofilm and patients without biofilm. RESULTS: Bacterial biofilm were seen in 13 (62%) of the 21 CRS patients. A statistical association existed between the presence of biofilm and the worsened preoperative symptom scores, but the preoperative CT scores were not related to the presence of biofilm. Patients with biofilm had long-lasting postoperative mucosal inflammation and a prolonged healing time, and these differences have statistical significance. CONCLUSION: This study showed that the presence of bacterial biofilm were significantly correlated with worsening preoperative symptom scores and the prolonged postoperative recovery time. Therefore, bacterial biofilm may play an important role in the recalcitrant and resistant nature of CRS.

Expression Patterns of Erythropoietin and Erythropoietin Receptor in the Spiral Ganglion of Guinea Pig after Noise Exposure / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Erythropoietin (EPO) is produced in the kidney and locally in the CNS and acts through binding to erythropoietin receptor (EPO-R). Apart from playing an essential role in erythropoiesis, recent research has shown that EPO has neurotrophic and neuroprotective functions in the CNS and found EPO and EPO-R in the inner ear. The aim of this study is to investigate distribution and expression of EPO and EPO-R in the inner ear after noise exposure. MATERIALS AND METHOD: Normal guinea pigs were exposed to noise. Ten of them were sacrificed at 1 hour of the noise exposure (group B) and another 10 animals were sacrificed at day 7 (group C). Four were normal controls that were not exposed to noise (Group A). Auditory function was evaluated by ABR for 7 days. Noise-induced morphological changes of cochlea were studied by phalloidin stain. The expression of EPO and EPO-R was examined by immunofluorescence. RESULTS: The hearing threshold shift reached a level of 40 dB SPL at 8 kHz at day 1 after noise exposure and underwent a partial recovery at day 7. Increased expression of EPO and EPO-R were observed at the level of spiral ganglion cells in the noise-exposed animals. CONCLUSION: It is suggested that noise exposure affects the distribution and expression of EPO and EPO-R in the inner ear.