The Relationship Between Tinnitus Frequency and Speech Discrimination in Patients With Hearing Loss / 대한이비인후과학회지

Background and Objectives@#Patients with hearing loss and tinnitus experience difficulty in engaging in daily conversations. However, only few studies have examined how tinnitus affects individual speech discrimination to comprehend speech. This study aimed to analyze the correlation between tinnitus frequency and speech discrimination in patients with hearing loss and tinnitus.Subjects and Method A total of 275 ears with hearing impairment were retrospectively analyzed via audiometry and tinnitogram. The ears were divided into three groups depending on the frequency of their tinnitus. Average pure tone audiometry (PTA), hearing threshold of tinnitus frequency, speech discrimination test (SDT), degree of discrepancy between tinnitus frequency and worst PTA frequency were collected and compared among the three groups. @*Results@#No significant difference was observed in PTA in the three patient groups. Hearing threshold of tinnitus frequency was the highest at 78.27 dB in the high-frequency group and the lowest at 45.14 dB in the low-frequency group. SDT was significantly lower (53.69%) in the low-frequency group. The correlation between tinnitus loudness and SDT was the strongest in the low-frequency group. The degree of discrepancy between tinnitus frequency and worst PTA frequency was also significantly observed in the low-frequency group. @*Conclusion@#Patients who are severely affected by tinnitus are found to have significant discrepancy between tinnitus frequency and worst PTA frequency, indicating decreased SDT.

Difference in Thresholds Between Auditory Brainstem Response Test and Pure Tone Audiometry by Frequency / 대한이비인후과학회지

Background and Objectives@#There is no clear standard for the difference in the thresholds of auditory brainstem response (ABR) and pure tone audiometry (PTA) when using ABR to evaluate the reliability of PTA. Therefore, we assessed the difference in the thresholds of ABR and PTA for each frequency. Consequently, we present here the actual difference values between the two tests that can be used as a reference in the clinic.Subjects and Method We retrospectively assessed the audiometry results of 129 ears. Ears in which the hearing thresholds of each frequency continuously declined were classified as the downward group. We compared the average of differences between the two tests by frequency. The differences were compared for each hearing level from 50 dB or higher. @*Results@#For all ears, the appropriate range of difference value was ±5 dB at 2 kHz. At 1 kHz, the ABR threshold was 10 dB higher than PTA, and it was 10 dB less than PTA at 4 kHz. In the downward group, the difference value increased by 10 dB at 1 kHz and 4 kHz. In the subgroups at each hearing level, the difference value showed similar results (p<0.05). @*Conclusion@#The difference in the threshold, regardless of the severity or tendency of hearing loss, was the smallest at 2 kHz and the range was ±5 dB. ABR was 10 dB higher at 1 kHz and and 10 dB lower at 4 kHz than PTA. In the downward group, the difference at 1 kHz and 4 kHz increased by 10 dB each.

Test-Retest Differences of the Speech Discrimination Score in Patients with Hearing Loss / 대한이비인후과학회지

Background and Objectives@#The diagnosis of hearing impairment is based on repeated audiometry, including pure tone audiometry (PTA), speech reception threshold test (SRT), and speech discrimination test (SDT). SDT results particularly show a wide discrepancy upon repeated testing, while malingering is suspected when having more than 12% difference between 3 individual SDT results. Therefore, in this study, we compared the proportion of malingering found in repeated SDT with that found in other audiometric tests and analyzed the characteristics of malingering group in order to reevaluate the current criteria of defining malingering.Subjects and Method We retrospectively assessed the audiometry results of 113 patients (226 ears) with hearing impairment. Each ear was divided into a malingering group and a true hearing loss group. The proportion of ears corresponding to each malingering criterion was compared using a chi-square test. An independent sample t-test was performed to identify the differences between the characteristics between the two groups. @*Results@#The number of ears that met the malingering criteria were 19 (8.41%) in PTA, 15 (6.64%) in SRT, and 75 (33.19%) in SDT. There was a significant difference in the proportion of malingering between the 3 hearing test modalities (p<0.001). There was no significant difference in auditory brainstem response, mean age and sex distribution between the malingering group and the true hearing loss group. @*Conclusion@#When conducting repeated SDT, there is a risk of misdiagnosing an actual hearing loss patient as a malingering patient under the current malingering criteria. Therefore, the current criteria on SDT requires reevaluation.

A Case of Organized Hematoma after Coblation Assisted Turbinoplasty / 대한이비인후과학회지

Organized hematoma of nasal cavity has been reported previously in several articles. However, few studies reported the cause of organized hematoma. Recently, 22-years-old male who underwent coblation associated turbinoplasty one year ago visited our clinic with symptom of nasal obstruction. He was diagnosed as organized hematoma in left maxillary sinus. We performed endoscopic sinus surgery and successfully removed it. Therefore, we report a case of organized hematoma origin from maxillary sinus after coblation associated turbinoplasty.

Correlation between Body Mass Index and Snoring Time in Obstructive Sleep Apnea Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study was performed to elucidate the relationship between body mass index (BMI) and snoring time (ST) in patients with obstructive sleep apnea (OSA) using a portable sleep monitoring device. SUBJECTS AND METHOD: From May 2011 to December 2015, 492 patients whose apnea-hypopnea index (AHI) was more than 5 were enrolled. Subjects were classified into 3 groups on the basis of the AHI (mild=5≤AHI<15; moderate=15≤AHI<30; severe=30≤AHI). Using the multiple linear regression analysis, the relationship between ST and other variables (BMI, arousal index, O2 desaturation events, age and AHI) were measured in each group. RESULTS: There was significant association between ST and BMI, especially in the severe group (p=0.005). CONCLUSION: In the severe group, reducing BMI is important to improve ST.

A Case of Arachnoid Cyst in the Internal Auditory Canal / 대한이비인후과학회지

Arachnoid cysts are intra-arachnoid collections of cerebrospinal fluid; congenital in origin, they account for about 1% of all atraumatic intracranial mass lesions. Arachnoid cysts confined to the internal auditory canal are extremely rare. In most patients who has arachnoid cysts in the internal auditory canal, no direct intervention is necessary, but if the neurologic symptoms are progressive, the arachnoid cyst could be drained surgically to relieve the symptoms caused by compression of structures adjacent to the cyst. We present one case of a arachnoid cyst in the left internal auditory canal which was diagnosed by a temporal bone magnetic resonance imaging.

Comparison between Group I in Which Non-Supine Apnea-Hypopnea Index> or =5 and Group II in Which Non-Supine Apnea-Hypopnea Index<5 in Patients with Positional Sleep Apnea / 수면정신생리

OBJECTIVES: The aim of this study was to evaluate the differences in patients with positional dependent sleep apnea according to their non-supine apnea-hypopnea index (AHI, > or =5 vs. or =5 ; group II was non-supine AHI having less than 5. Statistical analysis was performed to find the difference between two groups. RESULTS: In 92 patients, the number of group I patients was 11 (12%) and the number of group II patients was 81 (88%). In the severe AHI group, percentage of group I was dominated (70%) and showing a significant difference compared with the mild and moderate AHI groups (p or =5 than non-supine AHI<5.

A Study on the Effectiveness of Treatment of Acoustic Trauma Caused by Gunshot Noise / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The effectiveness of many treatment regimens on acoustic trauma has been debated, but there is no established treatment yet. The purpose of this study was to evaluate the efficacy of steroid treatment in acoustic trauma caused by rifles and to find a critical time limit for the treatment to be effective. SUBJECTS AND METHOD: A retrospective review was conducted for 86 conscripted policemen (97 ears) who suffered acoustic trauma after rifle exercise. Pure tone audiograms were compared before and after treatment at 0.5, 1 and 2 kHz (speech-frequency pure tone average, speech-PTA) and at 4, 6 and 8 kHz (high tone pure tone average, high-PTA). Treatment consisted of drugs (steroid, ascorbic acid, gingko biloba, dextran) and carbogen therapy. The patients who came to the hospital after the first 14 days following injury were grouped as control. Hearing outcomes of patients treated within 3 days and within 7 days were compared to the control. Pre-and post-treatment hearing was compared according to the elapsed time before treatment. RESULTS: Hearing outcomes of patients who received treatment within 3 days of acoustic trauma was better than the control group. Speech-frequency did not show any difference. Treatment within 7 days showed no statistical difference compared to the control. Hearing gain was better when treated within 7 days, especially if it was within 3 days. Speech-frequency showed significant spontaneous recovery within 3 days. CONCLUSION: Our data showed a possible effectiveness of treatment of acoustic trauma on the recovery of high frequency hearing when started within 3 days. Speech-frequency seems to recover spontaneously within 3 days.

Correction of Hump Nose Using Radix Augmentation with Silicone / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Hump resection by osteotome or rasp is a commonly used surgical technique in hump correction. However, during this procedure, the structure of the osseous-cartilaginous framework is altered and may lead to an open roof deformity or dorsal irregularity. So we preserved the hump as much as possible, and then augmented the radix with silicone. We compared this result to that of the hump resection group. SUBJECTS AND METHOD: We retrospectively studied 21 patients who underwent rhinoplasty with hump correction. We classified the patients into two groups by operation technique; hump preservation and hump resection. The result of surgery was evaluated by comparing nasal measurements on pre and postoperative photos. Patient's satisfaction about cosmetic results were investigated using the visual analogue scale (VAS). All results were statistically tested. RESULTS: The hump preservation group (N=13) had 12 cases (92.3%) of isolated hump type and one pseudo hump type (7.7%), whereas the hump resection group (N=8) had 5 cases (62.5%) of generalized hump type and 3 isolated hump type (37.5%). The preoperative nasofrontal angle in hump preservation (129.4degrees+/-10.6) was significantly lower than that in the hump resection group (139.3degrees+/-8.2). The nasion/nasal tip depth ratio in the hump preservation group (0.22+/-0.1) was also lower than that in the hump resection group (0.29+/-0.1) preoperatively; but there was no significant difference between the two groups. VAS was improved significantly in both groups after surgery. CONCLUSION: Hump preservation and radix augmentation can be an effective and less complicated surgery for patients who have an acute nasofrontal angle with an isolated hump.

Clinical Features of Bilateral Paranasal Sinus Fungus Ball

BACKGROUND AND OBJECTIVES: Paranasal sinus fungus balls occur usually in a single sinus, most frequently the maxillary sinus. The goal of this study was to delineate the clinical features of a bilateral paranasal sinus fungus ball. MATERIALS AND METHODS: We retrospectively reviewed seven patients who presented with a bilateral sinus fungus ball and who received endoscopic sinus surgery between July 2004 and January 2009. We analyzed age, gender, chief complaint, associated symptoms, nasal endoscopic findings, ostiomeatal unit (OMU) computed tomography (CT) results, and surgical findings. RESULT: The male to female ratio was 1:6, and the age range was from 40 to 76 years. The chief complaints were nasal obstruction in three patients, foul odour in two, postnasal dripping in one, and cheek pain in one patient. Calcification of the paranasal sinus upon CT was observed in three cases (43%). A fungus ball was found in the maxillary sinus or middle meatus in all cases. CONCLUSION: Bilateral paranasal sinus fungus balls usually involve the bilateral maxillary sinus or middle meatus and often invade the anterior ethmoid sinus or frontal sinus.

Ultrasonography Guided Percutaneous Aspiration and Drainage of Deep Neck Abscesses / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: For abscesses in the head and neck, traditional open surgical incision-and-drainage procedure may incur added morbidity and result in disfiguring scars. Therefore, a noninvasive alternative to open surgical drainage may be quite beneficial. The purpose of this study was to evaluate the efficacy of percutaneous ultrasonography-guided aspiration and drainage in the management of the selected head and neck abscesses. SUBJECTS AND METHOD: Retrospective review was done for 12 patients with unilocular or multilocular abscess sized 2 cm or more in the greatest in different locations and origins. All patients did not present imminent airway compromise and subsequently underwent ultrasonography guided aspiration and drainage. RESULTS: All of the abscesses were resolved in 11 patients within 10 days. Even multilocular abscesses were resolved without open surgical drainage. One abscess in which Mycobacterium tuberculosis was isolated persisted more than 3 weeks in spite of ultrasonography guided aspiration and drainage, and resolved by antituberculosis medication of more than 10 months. CONCLUSION: Percutaneous ultrasonography-guided aspiration and drainage is a safe and effective procedure, for the abscesses in the head and neck without life threatening conditions.

Postoperative Results of Ossiculoplasty over Stapes Head / 대한이비인후과학회지

BACKGROUD AND OBJECTIVES: Incus erosion with intact stapes head was most common ossicular impairment in chronic otitis media. Here, we aimed to investigate hearing and clinical results of the ossiculoplasties when the stapes head was intact. SUBJECTS AND METHOD: We analyzed 281 patients of ossiculoplasties over stapes head performed from 1990 to 2005. Patients were divided into 3 groups: Si group (n=121) included patients with interposition of prosthesis between malleus and stapes; Sc-PORP group (n=99) included patients with columellarization between tympanic membrane and stapes head with PORP; Sc-SC group (n=61) included patients with columellarization with the autologous materials between tympanic membrane and stapes head. Hearing improvement and extrusion rates of three groups were analyzed. RESULTS: At 6 months after the surgery, the postoperative air-bone gap (ABG) level within 20 dB was 45%, 44%, 25% in Si, Sc-PORP, Sc-Sc, respectively. The closure of ABG was statistically better in Si and Sc-PORP compared with Sc-SC. In canal wall-up mastoidectomy, Sc-PORP showed better hearing results than Si, while Si was better than Sc-PORP in canal wall-down mastoidectomy. At 36 months after the surgery, extrusion-free survival according to the type of ossiculoplasty were 100%, 89.6%, 100% in Si, Sc-PORP, Sc-SC, respectively. CONCLUSION: Si and Sc-PORP provide good hearing results. However, Si has lower extrusion rates than Sc-PORP and remains stable over time.

Acetic Acid Induced Laryngitis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Acetic acid is not uncommon suicidal material and it can cause serious laryngitis. The purpose of this study was to investigate the clinical characteristics, proper management, and clinical course of laryngitis induced by acetic acid. SUBJECTS AND METHOD: We analyzed the medical records of 39 patients with acetic acid ingestion from 1996 to 2006, retrospectively. RESULTS: Flexible fiberoptic laryngoscopy showed supraglottic laryngeal edema or mucosal ulcer with narrowed airway in 15 cases (38.5%). More common reason of ingestion was suicidal attempt than accidental exposure. There was no significant correlation between severity and the amount of ingestion, or the reason of ingestion. Eight patients needed orotracheal intubation for airway management, but no emergency tracheotomy was imperative. Most laryngeal lesions were relieved by supportive care within 2 weeks. CONCLUSION: Acetic acid laryngitis could narrow airway, and could be resolved by supportive management. Flexible fiberoptic laryngoscopy was useful in evaluating laryngeal involvement and severity.

Clinical Features and Comparison of the Results according to Surgical Methods in Patients with Intrameatal Vestibular Schwannoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Modern imaging and surgical techniques have made intrameatal vestibular schwannoma (IMVS) surgery safe and have allowed for good outcomes with respect to facial nerve function and hearing outcome. This study aimed to analyze clinical features and to compare the results of the middle fossa approach (MFA) and translabyrinthine approach (TLA) used during IMVS surgery. SUBJECTS AND METHOD: We reviewed retrospectively 10 patients who were operated for IMVS from November 1995 to May 2005. This study analyzed chief complaint, size of tumor, audiological studies, caloric test, imaging study, and treatment modality. RESULTS: The main symptom for IMVS patients is vertigo. But, in our study, patients having only vertigo was rare ; most cases had vertigo with tinnitus or hearing disturbance. Patients with vertigo and tinnitus had mild hearing disturbance in PTA and unilateral weakness in the Caloric test. In terms of mean operation time, it took 7.5 hours in MFA and 4 hours in TLA. Postoperative hearing loss and facial nerve palsy occurred in early MFA operation cases. With respect to facial nerve function, the MF approach group had a higher rate of development of facial neuropathy than did the TL approach group. CONCLUSION: We think patients with vertigo and tinnitus will progress to hearing loss. We should suspect IMVS if patients complain of vertigo and tinnitus. But, further evaluation should be needed. If postoperative hearing preservation is not important, the TLA technique has made IMVS surgery safe and has allowed for good outcomes with respect to facial nerve function preservation. To use the MFA method, otolaryngologic surgeons need more direct and indirect experiences, considering the low incidence of acoustic schwannoma surgery and that the MFA method requires longer mean operation time than TLA.

Clinical Usefulness of Vestibular Evoked Myogenic Potential in Unilateral Meniere's Disease / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Because the saccule, next to the cochlea, is the second most frequent site of hydrops formation, we evaluated whether vestibular evoked myogenic potential (VEMP) responses can reflect the diagnosis and the stage of Meniere's disease. SUBJECTS AND METHOD: Retrospectively, we analyzed the results of VEMP in 40 patients (11 men and 29 women) with unilateral definite Meniere's disease. All subjects underwent VEMP testing using ipsilateral 500 Hz-tone burst sound with 90 dBnHL (rise/fall time=2 msec, plateau time=3 msec). RESULTS: VEMP was present in 92.5% of Meniere's affected ear (37/40). The latency of p13 of affected ears in patients with Meniere's disease was significantly prolonged than that of normal ears in the control group (p=0.05). However, no relationship was found in latencies of p13, n23, and interpeak latency among groups classified by the stage of Meniere's disease. In the patients with Meniere's disease, the mean interaural amplitude difference (IAD) ratio was 23.9+/-16.9%. The IAD ratio of patients with Meniere's disease was larger than that of the control group, but it is statistically insignificant (p=0.133). CONCLUSION: Prolonged p13 latency of VEMP was a pathognomic finding for Meniere's disease in this study.

Cochlear Implantation in the Cochlear Nerve Hypoplasia or Aplasia as Suggested by Temporal Bone Magnetic Resonance Imaging / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Identifying cochlear nerve hypoplasia or aplasia is dependent on temporal bone magnetic resonance imaging (TBMRI) providing information on the cochlea, internal auditory canal, and the cochlear nerve. The purpose of this study was to review the results of cochlear implantation (CI) in ears with cochlear nerve hypoplasia or aplasia as suggested by TBMRI. SUBJECTS AND METHOD: From April 1999 to April 2005, 321 patients were fitted with cochlear implants in our department by two surgeons. The present study focused on four prelingual patients who underwent CI in ears with cochlear nerve hypoplasia or aplasia as suggested by TBMRI. The perceptive and linguistic results were evaluated based on speech perception and production at preimplantation and at 1, 3, 6, 9, 12, and 24 months postimplantation. RESULTS: Pre-operative auditory brainstem responses were absent at 90 dB nHL in all patients. At least 10 months after implantation all patients were able to detect consonants and vowels in 100% and their categories of auditory performance scores were 4 or above. CONCLUSION: We confirmed cochlear nerve presence in cases of cochlear nerve hypoplasia or aplasia as suggested by TBMRI and made their auditory habilitation possible with cochlear implantation. However, even in cases of cochlear nerve hypoplasia or aplasia suggested by TBMRI, physicians need to confirm cochlear nerve presence before implantation and to predict the outcome of cochlear implantation.

Clinical Values of Fine Needle Aspiration Biopsy in Salivary Gland Diseases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Fine-needle aspiration biopsy (FNAB) has been used as a diagnostic instrument in patients with salivary gland lesions. This article is aimed at defining the exact role of FNAB in the diagnostic workup of patients. MATERIALS AND METHOD: A retrospective study design was used to evaluate the accuracy of FNAB for salivary gland diseases. From January 1997 to June 2004, FNABs, confirmed histologically after surgery, were carried out on 419 patients with salivary gland diseases. Cytopathologic and histologic findings were categorized as malignant, suspicious, benign neoplastic, or nonneoplastic. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of FNAB were calculated using histologic diagnosis of the surgical specimen as the criterion standard. RESULTS: FNAB was performed in all of 419 salivary gland lesions undergoing surgical procedures. A total of 321 lesions were in the parotid gland and 98 in the submandibular gland. There were 417 FNAB specimens (99%) that were satisfactory for evaluation. The FNAB diagnosis of malignant or suspicious lesions had positive and negative predictive values of 77% and 91%, respectively. Fine-needle aspiration biopsy diagnosis of a benign neoplasm had positive and negative predictive values of 93% and 77%, respectively. A cytopathologic diagnosis of a nonneoplastic lesion was predictive in only 59% of the cases. CONCLUSION: Although an FNAB diagnosis of malignant or neoplastic major salivary gland disease is generally predictive of the final histologic diagnosis, the predictive value of a negative FNAB finding is low. A negative FNAB finding should not supersede clinical judgment in the management of a clinically suspected malignant or neoplastic lesion of the major salivary glands.

Clinical Analysis of Castleman's Disease of the Neck: Report of 6 Cases / 대한이비인후과학회지

Castleman's disease is a rare, benign disease of unknown cause that induces reactive lymph node hyperplasia. Head and neck region is the second most affected area after the mediastinum. It has 2 histologic subtypes: hyaline vascular and plasma cellular. It is difficult to differentiate Castleman's disease from other diseases such as lymphoma, tuberculosis, metastatic papillary thyroid carcinoma, Kaposi's sarcoma and Kimura's disease in the neck with CT. The study comprised of 6 patients with lymph node biopsy-proved Castleman disease and solitary involvement. One case favoring neurogenic tumor in MRI and another case with skin adhesion are confirmed histologically as Castleman's disease after surgery. A definitive diagnosis necessitates tissue biopsy. Surgery is the treatment of choice for the solitary form, whereas chemotherapy, radiotherapy, and steroids are proposed for the multicentric type. No recurrences have been reported after complete resection of the hyaline vascular type.

Three Cases of Extramedullary Plasmacytoma of the Head and Neck / 대한이비인후과학회지

The diagnosis and management of extramedullary plasmacytoma require the same range of clinical and laboratory expertise as for multiple myeloma. The primary treatment is radiotherapy, but surgery may also be required. We report three cases of extramedullary plasmacytoma located in the nasopharynx, neck, and nasal cavity respectively. The case of nasopharyngeal plasmacytoma, developed in a 55-year-old man, was associated with multiple bilateral cervical lymphadenopathy. Diagnosis was made with MRI, endoscopic nasopharyngeal biopsy, and bone marrow aspiration biopsy. Radiotherapy of 45 Gy resulted in the partial remission of primary and cervical lesions. The second case presented with cervical and retropharyngeal masses. Radiotherapy had not been successful, so the tumors were surgically excised. The third case was developed in the nose of a 43-year-old man complaining of nasal obstruction and epistaxis. Nasal cavity mass was identified as an extramedullary plasmacytoma. The patient underwent radiotherapy with 50 Gy with complete remission.

Postoperative Change of Ionized Calcium Level after Total Thyroidectomy and Risk Factors of Postoperative Permanent Hypoparathyroidism / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aims of this study were to evaluate postoperative change of ionized calcium level in relation to clinical symptoms of hypoparathyroidism after total thyroidectomy and to find risk factors of postoperative permanent hypoparathyroidism. SUBJECTS AND METHOD: A retrospective study of 118 patients who had underwent total thyroidectomy between January 2000 and July 2003 was performed at the Department of Otolaryngology. Postoperative serum ionized calcium concentration was obtained daily. RESULTS: The incidence of postoperative permanent hypoparathyroidism was 11% (13/118). In the permanent hypocalcemic group, compared with normocalcemic and transient hypocalcemic group, following characteristics were related: increased incidence of hypocalemia from postoperative second day, advanced T stage, anaplastic cancer. CONCLUSION: Careful attention was needed for the case with advanced stage to prevent postoperative permanent hypoparathyroidism. It was found that when the second postoperative day's ionized calcium level is below the normal range, daily blood sampling has to be done to detect continuous hypocalcemia.