Awareness Analysis of the National Support Policy for Newborns and Infants With Hearing Loss Who Performed National Infant Health Checkup / 대한이비인후과학회지

Background and Objectives@#It is well recognized that early detection and intervention are most important for the prevention of neonatal hearing loss. The national support policy in Korea for newborn hearing screening has been changed since October 2018; however, parent awareness of the change still needs to be increased. This study investigated how well parents, who have underwent national infant checkups of their children, were aware of the Korean national policy for neonatal and infant hearing loss in parents.Subjects and Method A survey of neonatal hearing tests and national support policies conducted for 353 parents was analyzed. The survey included questions about parent awareness of the neonatal hearing screening test period, confirmatory test period, national support for these expenses, and hearing aid support. Also evaluated were the necessity of national guidance and management system for neonatal hearing. @*Results@#The test time of neonatal hearing screening was correctly recognized by 82.2% of the parents. The percentage increased after the national insurance coverage started in October 2018 in Korea, and the rate was higher for parents who visited an otolaryngology clinic rather than a pediatric clinic. The test time of the confirmatory test was correctly recognized only by 20.4%. National support policy for neonatal hearing screening tests, confirmatory hearing tests, and hearing aids were acknowledged by 50.7%, 43.1%, and 56.1% of the parents, respectively. @*Conclusion@#These results indicate the necessity of efforts to increase the awareness of neonatal hearing tests and relevant support policies in Korea to ultimately achieve early hearing detection and intervention of neonates and infants in Korea.

Status of the Newborn Hearing Screening in the 4-Months Age National Infant Health Checkup in Korea: A Nationwide PopulationBased Study

Background@#The aims of this study are to review data on 4-months age National Health Screening Program for Infants and Children (NHSPIC) using a National Health Insurance Service (NHIS) database, and to analyze the newborn hearing screening (NHS) results and related characteristics of the 4-months NHSPIC for 7 years in South Korea. @*Methods@#We analyzed a NHIS database of infants who had participated in the 4-month age NHSPIC from 2010 to 2016. According to the results of hearing questionnaires and physical examination, we analyzed the outcomes of NHS and related infantile and socioeconomic factors. @*Results@#Among 3,128,924 of total eligible infants in Korea between the year 2010 and 2016, 69.2% (2,164,621 infants) conducted 4-months age NHSPIC, and 94.4% (2,042,577 infants) of which performed hearing questionnaires regarding NHS. Among the total hearing examinees, premature infants accounted for 3.6%, infants who were hospitalized in the neonatal intensive care unit (NICU) for more than 5 days accounted for 5.6%, and infants with head and neck abnormalities were 0.6%. The NHS performing rate was 79.1% for total hearing examinees in 2010, but gradually increased to 88.9% in 2016. The NHS performing rate in 2016 was 93.4% for premature infants, 91.7% for NICU hospitalized babies. The mean referral rate was 0.6% for total hearing examinees, 1.4% for premature infants, and 2.3% for NICU hospitalized babies. When we analyzed the NHS performing rate and the referral rate according to the household income level, the NHS performing rate of infants in Medical Aid programs was the lowest as 65.6%, and the NHS performing rates in other five levels of NHIS was higher ranging between 85.1% to 86.0%. The referral rate of infants in the Medical Aid program (3.8%) was significantly higher than those of infants in other classes (1.10–1.25%). @*Conclusion@#The estimated overall NHS performing rate in Korea gradually increased and was 88.9% in 2016. The overall referral rate was low as 0.6%, and it was significantly different depending on the infant’s health condition and household income levels. We assume that our finding would help to establish policies managing hearing impaired children, and to develop the customized hearing care service programs considering the household economic levels.

Hearing Impairment Increases Economic Inequality

Objectives@#. We evaluated changes in income levels in a hearing-impaired population. @*Methods@#. The study subjects were selected from the Korean National Health Insurance Service-Health Screening Cohort data from 2002 to 2015 of Koreans ≥40 years old. In total, 5,857 hearing-impaired subjects were matched with 23,428 comparison participants. Differences between the initial income level and income levels at 1, 2, 3, 4, and 5 years post-enrollment were compared between the hearing-impaired and comparison groups. The interaction of time and hearing impairment/comparison was estimated. @*Results@#. Both the hearing-impaired group and the comparison group showed increased income levels over time. In the hearing-impaired group, the income levels at 4 and 5 years post-enrollment were higher than the initial income level (each P<0.001). In the comparison group, the income levels of all the participants after 1–5 years were higher than the initial income level (each P<0.001). The interaction of time and hearing impairment was statistically significant (P=0.021). @*Conclusion@#. The increase in income over time was relatively lower in the hearing-impaired adult population; therefore, the income gap widened between this population and the normal-hearing population.

Hearing Impairment Increases Economic Inequality

Objectives@#. We evaluated changes in income levels in a hearing-impaired population. @*Methods@#. The study subjects were selected from the Korean National Health Insurance Service-Health Screening Cohort data from 2002 to 2015 of Koreans ≥40 years old. In total, 5,857 hearing-impaired subjects were matched with 23,428 comparison participants. Differences between the initial income level and income levels at 1, 2, 3, 4, and 5 years post-enrollment were compared between the hearing-impaired and comparison groups. The interaction of time and hearing impairment/comparison was estimated. @*Results@#. Both the hearing-impaired group and the comparison group showed increased income levels over time. In the hearing-impaired group, the income levels at 4 and 5 years post-enrollment were higher than the initial income level (each P<0.001). In the comparison group, the income levels of all the participants after 1–5 years were higher than the initial income level (each P<0.001). The interaction of time and hearing impairment was statistically significant (P=0.021). @*Conclusion@#. The increase in income over time was relatively lower in the hearing-impaired adult population; therefore, the income gap widened between this population and the normal-hearing population.

Extended Epitympanotomy for Facial Nerve Decompression as a Minimally Invasive Approach

For a minimally invasive approach to access the facial nerve, we designed an extended epitympanotomy via a transmastoid approach that has proven useful in cases of traumatic facial nerve palsy and pre-cholesteatoma. To evaluate the surgical exposure through an extended epitympanotomy, six patients with traumatic facial nerve palsy were enrolled in this study. The same surgical technique was used in all patients. Patients were assessed and the degree of facial nerve paralysis was determined prior to surgery, 1-week post-operatively, and 6-months post-operatively using the House-Brackmann grading system. In all cases, surgical exposure was adequate. All patients with traumatic facial nerve palsy were male and the age range was 13 to 83 years. In all cases, the location of the facial nerve damage was limited to the area between the first and second genu. Symptoms of all the patients improved by 6 months post-operation (p=0.024). There were no complications in any of the patients. Extended epitympanotomy is useful for safe, rapid surgical exposure of the attic area, sparing the patient post-operative dimpling, skin incision complications, and lengthy exposure to anesthesia. We suggest that surgery for patients with facial nerve palsy secondary to trauma be performed using this described technique.

Etiology and Clinical Characteristics of Pediatric Dizziness / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Dizziness is not uncommon in children. The etiology of dizziness varies according to different studies due to different methods of examination or characteristics of the dizziness center. To assess meaningful causes of dizziness in children, a multidisciplinary approach would be needed. The purpose of this study was to analyze the main pathologies associated with vertigo and dizziness in children, paying particular attention to recent diagnostic advances with a multidisciplinary approach. SUBJECTS AND METHOD: A total of 73 children, aged between 4-18 years, who visited the Pediatric Dizziness Clinic of the University Hospital from January 2016 to June 2016 were included in this study. Medical records were reviewed retrospectively. All of the subjects were examined by history, questionnaires, physical examinations, electrocardiogram, hematologic tests, brain MRI scan, audiogram and vestibular function tests. Patients who had orthostatic symptoms additionally underwent a tilt table test, and in selective cases, a caloric and vestibular evoked myogenic potential tests as well. RESULTS: Vestibular migraine (VM) and benign paroxysmal vertigo of childhood (BPVC) were found in 35.6% and 27.4% of the children with dizziness, respectively. The incidence of orthostatic hypotension and postural orthostatic tachycardia syndrome were 12.3% each, both of which are higher than other previous reports. Other causes were Meniere's disease, benign paroxysmal positional vertigo, vestibular neuritis and so on. CONCLUSION: VM and BPVC were the most common causes of pediatric dizziness. Also, the incidence of orthostatic dizziness was rather high in pediatric population. The evaluation of dizziness in children should include a thorough check of history (questionnaire), neurotological examination, vestibular function tests and a tilt table test.

Analysis of Eustachian Tube Dysfunction by Dynamic Slow Motion Video Endoscopy and Eustachian Tube Dysfunction Questionnaire in Chronic Otitis Media

OBJECTIVES: Eustachian tube dysfunction has been associated with most cases of middle-ear disease. We aimed to assess the effectiveness of dynamic slow motion video endoscopy (DSVE) as a test of eustachian tube dysfunction. Furthermore, we assessed the correlation of the test with the Valsalva maneuver, the seven-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7), and intraoperative findings of the eustachian tube. METHODS: We retrospectively reviewed medical records from April to September 2014 to identify patients who were diagnosed with chronic otitis media (COM) at Korea University Ansan Hospital. They all underwent surgery because of COM without cholesteatoma and were assessed via the DSVE and ETDQ-7 to determine eustachian tube function. RESULTS: We reviewed 46 COM patients and examined 46 ears with COM and 46 ears on the contralateral side to COM that were thought to be normal. The mean DSVE grade in COM ears was 1.57±0.96, while the mean DSVE grade in contralateral ears was 1.15±0.94. The difference in DSVE between COM ears and normal ears was statistically significant (P=0.006). In the ETDQ-7, a higher score was related to intraoperative obstruction of the eustachian tube (P=0.012). CONCLUSION: DSVE and ETDQ-7 can provide information regarding preoperative status of eustachian tube dysfunction by measuring dynamic structural changes of the eustachian tube in combination with other diagnostic tests.

Analysis of Effect of Eggshell Membrane Patching for Moderate-to-Large Traumatic Tympanic Membrane Perforation

BACKGROUND AND OBJECTIVES: To evaluate the effect of eggshell membrane (ESM) patching for tympanic membrane (TM) perforation, and to investigate correlations between healing time and age, gender, patching time, perforation size, and perforation location. SUBJECTS AND METHODS: One hundred and seventy-five patients diagnosed with traumatic TM perforation at the Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, between January 2008 and October 2013. Patients were divided into two groups, according to perforation edge approximation or ESM patching treatment. Healing time was compared between the group that received perforation edge approximation and the group that received ESM patching. Perforation grade, age, onset, and location were also compared between the two groups. RESULTS: ESM patching significantly improved healing time compared to spontaneous healing, especially in patients with moderate or large traumatic TM perforations (≥grade II). However, patient age, gender, perforation location, and especially timing of procedure, did not significantly affect healing time. CONCLUSIONS: ESM patching can be a good treatment choice to promote tympanic membrane healing in large traumatic TM perforations.

Development of a More Effective Hearing Screening Questionnaire for Infants and Children during Medical Check-Ups / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To improve hearing screening, we developed a more effective hearing screening questionnaire for infants and children to be utilized during medical check-ups. SUBJECTS AND METHOD: Through literature review and discussions with an advisory council, we selected 10 questions to ask parents at each of the seven screening periods for their infants and children. In total, 223 parents of infants and children with and without hearing impairment (119 normal hearing, 104 hearing impaired) answered questionnaires at seven university hospitals in Korea. The advisory council modified questions with regard to sensitivity, specificity, positive, and negative prediction rate, preventing duplication among screening periods, and to address other questions related to development. RESULTS: For hearing screens, we asked five questions per screening period. Collectively, these questions had 40-100% sensitivity and 45-90% specificity at each of the seven screening periods. CONCLUSION: Although we do not advise that hearing questionnaires replace hearing tests, we developed in this study a more effective questionnaire that we suggest could be utilized during medical check-ups to enhance the hearing screening process.

Usefullness of 1000 Hz Tympanometry in the Results of Newborn Hearing Screening / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study aimed to verify and compare the results of newborn hearing screening (NHS) with that of 1000 Hz tympanometry conducted for newborns. SUBJECTS AND METHOD: For the hospitalized group, NHS and the portable 1000 Hz tympanometry were performed for 148 newborns (296 ears) from June through October in 2015. For the outpatient group, 93 newborns (186 ears) who had been referred after the 1st NHS results were reviewed from 2009 to 2014. We conducted NHS with the automated otoacoustic emissions for healthy babies and automated auditory brainstem response for the babies in the neonatal intensive care unit (NICU). NHS and 1000 Hz tympanometry were performed for all newborns simultaneously. For the impedance audiometry, B type was categorized separately from A and C type. RESULTS: There was a significantly higher incidence of B type of tympanometry in the referred newborns compared to the other newborns in both hospitalized and outpatient group (p<0.01). In the outpatient group, the ears referred from the 1st NHS showed middle ear effusion in 100% of the well babies and 78.6% of the NICU babies. CONCLUSION: 1000 Hz tympanometry can help estimate the causes and middle ear function of the referred newborns after the hearing screening test. Parents could feel relieved by being explained that the refer result of NHS was due to middle ear or ear canal problem rather than to inner ear or neural problem.

Asian Sand Dust Enhances the Inflammatory Response and Mucin Gene Expression in the Middle Ear

OBJECTIVES: Asia sand dust (ASD) is known to cause various human diseases including respiratory infection. The aim of this study was to examine the effect of ASD on inflammatory response in human middle ear epithelial cells (HMEECs) in vitro and in vivo. METHODS: Cell viability was assessed using the cell counting kit-8 assay. The mRNA levels of various genes including COX-2, TNF-a, MUC 5AC, MUC 5B, TP53, BAX, BCL-2, NOX4, and SOD1 were analyzed using semiquantitative realtime polymerase chain reaction. COX-2 protein levels were determined by western blot analysis. Sprague Dawley rats were used for in vivo investigations of inflammatory reactions in the middle ear epithelium as a result of ASD injection. RESULTS: We observed dose-dependent decrease in HMEEC viability. ASD exposure significantly increased COX-2, TNF-a, MUC5AC, and MUC5B mRNA expression. Also, ASD affected the mRNA levels of apoptosis- and oxidative stress-related genes. Western blot analysis revealed a dose-dependent increase in COX-2 production. Animal studies also demonstrated an ASD-induced inflammatory response in the middle ear epithelium. CONCLUSION: Environmental ASD exposure can result in the development of otitis media.

Clinical Analysis of Positional Vertigo without Nystagmus at Initial Examinations / 대한평형의학회지

OBJECTIVE: Patients with benign paroxysmal positional vertigo (BPPV) visit clinics with typical position evoked vertigo. However, typical nystagmus are concealed according to many factors We evaluated the demographic, clinical and nystagmographic features of patients, who visited clinics with typical BPPV symptoms but did not have positional test evoked nystagmus. METHODS: Among 306 patients with history of positional vertigo, we excluded 252 patients who had positional test evoked nystagmus on video Frenzel glass in clinics, and analyzed 54 patients who did not have positional test evoked nystagmus. We divided 54 patients into two groups; patients without subjective vertigo in positional test and patients with subjective vertigo in positional test. We analyzed the serial nystagmographic findings, causes, duration of disease, previous history of medical or rehabilitation treatments, coexisting vestbular disorders, recovery time and recurrence. RESULTS: Etiology, history of previous treatment, coexisting vestibular disorders and recurrence did not differ statistically in both groups. However, the nystagmographic features were significantly different in both groups. CONCLUSION: When patient has positional test evoked vertigo, repeated positional maneuver seemed to increase the expression of positional nystagmus.

Is Intratympanic Dexamathasone Injection Effective for the Treatment of Idiopathic Sudden Sensorineural Hearing Loss?

BACKGROUND AND OBJECTIVES: The purpose of this study is to identify the effectiveness of intratympanic (IT) steroids when used as an initial therapy in sudden sensorineural hearing loss (SSNHL), and when it is used as a salvage therapy in a refractory SSNHL. SUBJECTS AND METHODS: This retrospective study included 122 patients with SSNHL. First, patients were divided into three groups according to the initial treatment; IT steroid, systemic steroid and combined (systemic and IT steroid) groups. Second, patients were divided into two groups according to the salvage treatment in a refractory SSNHL; IT steroid and the control (non IT group). Fifty eight patients who did not respond to initial therapy were included in the second analysis. Hearing was assessed immediately before the treatment and 2 weeks, 4 weeks and 3 months after the treatments. Hearing recovery was defined as an improvement of >15 dB and the final hearing of 25-45 dB in the audiogram. RESULTS: When we analyzed the hearing recovery in initial treatment, the comparison of audiogram among three groups did not result in significantly different outcomes. There were no differences in the recovery rate in 2 and 4 weeks throughout all the frequencies. Also, the analysis of the salvage treatment demonstrated that neither IT steroid group nor control group was significantly effective in treating the refractory SSNHL. CONCLUSIONS: The results suggest that initial treatment of SSNHL with IT steroid alone is as effective as systemic steroid alone or a combination therapy. Also, salvage IT steroids for refractory SSNHL did not have any additional beneficial effects.

Bilateral Vestibulopathy with Alcohol Abuse and Vitamin Deficiency / 대한평형의학회지

Bilateral vestibulopathy (BV) is a clinical entity with impaired function of bilateral peripheral vestibular system, which is characterized by movement-induced vertigo, oscillopsia and gait unsteadiness. Among various etiologies of BV, alcohol and vitamin B deficiency has rarely been reported. We experienced a case of BV with vitamin B deficiency in a 24-year-old man who was previously exposed to alcohol. He had osillopsia and gait unsteadiness as a primary symptom, and was treated successfully with vestibular rehabilitation and vitamin supplement. Bithermal caloric test, rotatory chair test and head impulse test showed the result compatible with BV.

Analysis of 4 kHz Notch Audiogram as a Sign of Noise Induced Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In this study, we tried to study the criteria and characteristics of patients with noise-induced hearing loss by analyzing the pure tone audiogram such as "C5 dip" or "4 kHz notch". SUBJECTS AND METHOD: Out of 553 patients who complained of tinnitus and hearing loss, medical examination by interview, physical examination, hearing test, brain MRI and survey of tinnitus were performed from January 2010 to December 2012, targeting 81 patients who underwent pure tone hearing test. We analyzed the clinical characteristics of 81 patients with the exception of systemic disease or a history of otologic disease, conductive hearing loss, and vestibular schwannomas. Patients consisted of 70 men and 11 women (34 persons on both sides, 31 persons on right side, and 16 persons on left side), with an average of 48.1+/-12.9 years. 4 kHz notch-type sensorineural hearing loss was compared with contralateral hearing. RESULTS: The audiogram of 4 kHz notch was analyzed, and the results were as follows; 0.5 kHz (11.2+/-9.9 dB HL), 1 kHz (13.2+/-9.9 dB HL), 2 kHz (19.4+/-15.4 dB HL), 3 kHz (38.1+/-18.7 dB HL), 4 kHz (49.3+/-16.2 dB HL), 8 kHz (27.2+/-16.2 dB HL). Among all frequencies of 4 kHz notch audiogram, there was no significant hearing loss in 0.5 kHz and 1 kHz, but significant hearing loss was noted in higher frequencies (paired t-test, p>0.05). The contralateral ear showed a ski-slope hearing loss in about half of the patients. CONCLUSION: Remarkable points of the 4 kHz notch audiogram analysis, known as a typical characteristic of noise-induced hearing loss, were as follows; First, there was hearing loss of about 50 dB HL at 4 kHz. Second, the hearing threshold was improved to about 30 dB HL at 8 kHz. Third, the 4 kHz-notch audiogram showed a significant hearing loss in a high-pitched tone of over 2 kHz, but otherwise there were no significant hearing loss observed in 0.5 kHz and 1 kHz. Fourth, even if there were no symptoms, contralateral ear can still show the ski-slope type of hearing loss.

Current Trends in the Assessment of Patients with Tinnitus and the Proposal of Tinnitus Assessment in Korea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The effective management of tinnitus should start with an accurate diagnosis, but no concensus has been developed in Korea concerning how to measure the features of tinnitus. This study surveyed otologists in the training hospitals and hospitals specialized in otologic care in Korea to identify the current status in the assessment of patients with tinnitus. SUBJECTS AND METHOD: The questionnaire on the assessment of tinnitus was sent by email to otologists in training and to specialized hospitals specializing in otologics in Korea. The questionnaire included inquiry about various types of tests conducted, such as the audiologic test, tinnitus test, blood test, radiologic test, and the methods of history taking and physical examination for somatic tinnitus. RESULTS: Regarding the audiologic assessment of tinnitus, all the otologist were using pure tone audiometry, 97% speech audiometry, and 87% tinnitus test. For the psychophysical measure of tinnitus, both loudness and pitch matching were conducted by all the otologists. The performance rate of blood test were 38.5%, and the most preferred radiologic test in pulsatile tinnitus was temporal bone computed tomography (59%). Finally, the rate of investigation including the history taking and physical examination of somatic tinnitus was between 74-84%. CONCLUSION: Our results showed that although the tests perfermed by otologists varied, the essential tests for assessing tinnitus were commonly practiced. We analyzed the current status of tinnitus assessment and supplemented guidlines to help measure tinnitus. Further concensus on tinnitus diagnosis is needed, particularly about the standadized and unified principles.

A Longitudinal Study of Frequency Specific Electrical Stimulation Levels in Cochlear Implant Users / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of the study was to evaluate the changes in electrical stimulation levels, i.e. threshold (T) levels, comfortable (C) levels, dynamic range (DR), and electrode impedance values (EIVs) during the first year in cochlear implant users. SUBJECTS AND METHOD: The maps of 49 cochlear implant users (at least 1 year mapping), using the Nucleus device, were examined at the time of initial connection, and at 6 and 12 months post-initial stimulation. T levels, C levels, DR and EIVs were analyzed according to three frequency levels. RESULTS: During the first 6 months of implant use, C levels and DR increased significantly whereas T levels were stable. EIVs of current carrying electrodes decreased significantly from the connection to the 12-month visit. The changes of electrical stimulation levels did not differ among three frequency levels during the entire follow-up. CONCLUSION: During the first 6 months of implant use, C levels and DR increased significantly. Thus, an appropriate mapping in the first 6 month is critical to setup hearing capacity in implant users. The mapping should be performed under the best communication environment between the audiologist and the patient, and it makes correct setting of T levels from the initial connection period.

Protective Role of Trimetazidine Against Neomycin-induced Hair Cell Damage in Zebrafish

OBJECTIVES: Trimetazidine (TMZ) is known to reduce the generation of oxygen-derived free radicals. The objective of the present study was to evaluate the effects of TMZ on neomycin-induced ototoxicity in transgenic zebrafish (Brn3C: EGFP). METHODS: Five-day, postfertilization zebrafish larvae were exposed to 125 microM neomycin and one of the following TMZ concentrations for 1 hour: 10 microM, 100 microM, 500 microM, 1,000 microM, 1,500 microM, or 2,000 microM. Hair cells within the neuromasts of the supraorbital (SO1 and SO2), otic (O1), and occipital (OC1) lateral lines were analyzed using fluorescence microscopy and confocal microscopy (n=10). Hair cell survival was calculated as a percentage of hair cells in the control group that were not exposed to neomycin. Ultrastructural changes were evaluated using scanning electron microscopy. RESULTS: TMZ protected against neomycin-induced hair cell loss in the neuromasts (TMZ 1,000 microM, 11.2+/-0.4 cells; 125 microM neomycin only, 4.2+/-0.5 cells; n=10; P<0.05) and decreased the terminal deoxynucleotidyl transferase (TdT)-mediated dUTP-biotin nick end labeling (TUNEL) reaction. In the ultrastructural analysis, structures of mitochondria and hair cells within the neuromasts were preserved in zebrafish exposed to 125 microM neomycin and 1,000 microM TMZ. CONCLUSION: TMZ attenuated neomycin-induced hair cell loss in zebrafish. The results of this study suggest that neomycin induces apoptosis, and that apoptotic cell death can be prevented by treatment with tremetazidine.

Nasopharynx as a Microbiologic Reservoir in Chronic Suppurative Otitis Media: Preliminary Study

OBJECTIVES: The present study was designed to identify the correlations of bacterial strains of the middle ear and the nasopharynx in chronic suppurative otitis media (CSOM) patients who were scheduled for operations. METHODS: Sixty-three patients with CSOM were enrolled in the study. Culture specimens were collected from the middle ear and nasopharynx of patients who were admitted for operation. Samples collections were performed 3 times; from the middle ear and nasophaynx at the admission day, from the middle ear during the operation, and from the external auditory canal post-operatively. Bacteria were identified by gram staining and biochemical tests. The correspondence rate of organisms which simultaneously exist in the middle ear and the nasopharynx was measured. RESULTS: Sixty-eight organisms were isolated from the middle ear and 57 organisms from the nasopharynx among 63 patients. Of 68 bacteria identified in middle ear, 26.52% (18 bacteria) corresponded with those of nasopharynx. MRSA had the high correspondence rate, and of 18 methicillin-resistant Staphylococcus aureus (MRSA) isolated from middle ear, 33.3% (6 bacteria) corresponded with nasophaynx. Meanwhile, 3 organisms of MRSA were detected from the external auditory canal post-operatively, although they were only found in nasopharynx pre-operatively. CONCLUSION: The current trend of middle ear swab alone for bacterial detection would be insufficient to identify the potent MRSA and impede early antibiotic intervention for the effective middle ear surgery. Therefore, it is necessary to perform nasopharynx cultures together with conventional middle ear culture to control potent risk for infection pre-operatively.

Anti-Adhesive Effect of GUARDIX-SL(R) after Intact Canal Wall Mastoidectomy: Preliminary Study

BACKGROUND AND OBJECTIVES: Adhesion of middle ear and mastoid cavity after mastoidectomy represents a potential source of surgical failure. GUARDIX-SL(R), absorbable anti-adhesive material, which is composed of sodium hyaluronate and sodium carboxymethyl cellulose, is an effective agent that widely used as a surgical adjuvant to decrease adhesion in the surgery. Therefore, we evaluated the clinical efficacy of the GUARDIX-SL(R) for the prevention of adhesion after mastoidectomy. SUBJECTS AND METHODS: This study was randomized and double-blinded. Conventional intact canal wall mastoidectomy was conducted in both control (n=14) and study group (n=10). To avoid bias because of different surgeons, we only included patients who were operated on by one surgeon. In the study group, 1.5 g GUARDIX-SL(R) was applied in the mastoid cavity at the end of mastoidectomy. To evaluate anti-adhesive effect of GUARDIX-SL(R), the volume of aerated area in the mastoid cavity was calculated and compared with temporal bone computed tomography performed at preoperatively and postoperatively. Besides, to assess the success of operation, pure tone audiometry was also performed at preoperatively and postoperatively. RESULTS: The volume of aerated area of mastoid cavity after mastoidectomy was more increased in GUARDIX-SL(R) group, but was not statistically significant in the GUARDIX-SL(R) group than the control. And all results of pure tone audiometry satisfied the criteria of successful operation which has been suggested by Otological Society of Korea. CONCLUSION: The results suggest that GUARDIX-SL(R) may be an efficacious and safe material in decreasing the incidence of adhesion after mastoidectomy.