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

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

Measurement of Loudness Discomfort Levels as a Test for Hyperacusis: Test-Retest Reliability and Its Clinical Value

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.

Advantages of Cold-knife Dissection with Adjunctive Suction Cauterization Adenotonsillectomy: A Useful and Safe Surgical Technique for Pediatric Patients / 대한이비인후과학회지

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.

A Case of Benign Fibrous Histiocytoma of External Auditory Canal / 대한이비인후과학회지

Benign fibrous histiocytoma (BFH) is a benign tumor composed of fibroblasts and histiocytes that most frequently occur in upper and lower extremities. BFH is rarely found in the area of head and neck; especially so in the external auditory canal. The authors have encountered a 52-year old male patient with a chief complaint of otorrhea from the right ear. A round, wellcircumscribed mass filled 80% of the right external auditory canal. Non-enhanced temporal bone CT and enhanced temporal bone MRI showed a 0.9×1.0 cm sized dermal or subdermal polypoid mass arising at the right anterosuperior external auditory canal. Under local anesthesia, the patient underwent a complete resection of the mass, and the pathological result of the mass showed BFH. We thus report a rare case of BFH of the external auditory canal.

A Case of Simultaneous Active Transcutaneous Bone Conduction Implantation (BonebridgeTM) Performed with Subtotal Petrosectomy / 대한이비인후과학회지

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.

Association of the Prognosis and the Facial Nerve Enhancement in Gadolinium Enhanced MRI in Patients with Bell's Palsy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study aimed to investigate the association of prognosis and facial nerve signal intensity in enhanced magnetic resonance imaging (MRI) in patients with Bell's palsy. SUBJECTS AND METHOD: Patients who visited hospital for Bell's palsy from January of 2015 to June of 2016 were included in this study. A total of 30 patients were gathered and their facial palsy grades were evaluated with the House-Brackmann grade system on the initial visit and at six months after the first visit. In T1-weighted MRI, we measured the signal intensity of the region of interest (ROI), or the most-highly-enhanced portion of the affected facial nerve and the corresponding portion of the contralateral side. We calculated the ratio of ROI of the affected side to the contralateral side, and investigated the correlation between the ratio and the degree of improvement in facial palsy. RESULTS: The most frequent ROI of the affected facial nerve was labyrinthine segment. There was no significant correlation between the ROI ratio and initial H-B grade, or the degree of improvement in facial palsy. CONCLUSION: This study corresponds with the previous studies that indicated that the degree of the gadolinium enhancement of facial nerve in T1-weighted MRI is not related to the prognosis or the severity of the Bell's palsy.

Functional Significance of Medial Olivocochlear System Morphology in the Mouse Cochlea

OBJECTIVES: Baso-apical gradients exist in various cochlear structures including medial olivocochlear (MOC) efferent system. This study investigated the cochlear regional differentials in the function and morphology of the MOC system, and addressed the functional implications of regional MOC efferent terminals (ETs) in the mouse cochlea. METHODS: In CBA/J mice, MOC reflex (MOCR) was assessed based on the distortion product otoacoustic emission in the absence and presence of contralateral acoustic stimulation. High, middle, and low frequencies were grouped according to a mouse place-frequency map. Cochlear whole mounts were immunostained for ETs with anti-α-synuclein and examined using confocal laser scanning microscopy. The diameters of ETs and the number of ETs per outer hair cell were measured from the z-stack images of the basal, middle and apical regions, respectively. RESULTS: The middle cochlear region expressed large, clustered MOC ETs with strong MOCR, the base expressed small, less clustered ETs with strong MOCR, and the apex expressed large, but less clustered ETs with weak MOCR. CONCLUSION: The mouse cochlea demonstrated regional differentials in the function and morphology of the MOC system. Strong MOCR along with superior MOC morphology in the middle region may contribute to ‘signal detection in noise,’ the primary efferent function, in the best hearing frequencies. Strong MOCR in spite of inferior MOC morphology in the base may reflect the importance of ‘protection from noise trauma’ in the high frequencies.

Association between Vestibular Function and Hearing Outcome in Idiopathic Sudden Sensorineural Hearing Loss

BACKGROUND AND OBJECTIVES: To investigate whether different vestibular function tests such as cervical vestibular evoked myogenic potential (cVEMP) and caloric test were correlated with severity, pattern and prognosis in idiopathic sudden sensorineural hearing loss (ISSNHL). SUBJECTS AND METHODS: Ninety-two patients with unilateral ISSNHL were subjected to complete audiovestibular evaluation. cVEMP and caloric test results were compared with patients' initial and final audiogram. We classified patients in 4 groups as cochlear nerve (C) type, cochlear and superior vestibular nerve (C+S) type, cochlear and inferior vestibular nerve (C+I) type and cochlear, superior vestibular nerve, inferior vestibular nerve (C+S+I) type, for evaluation of the results. cVEMP and caloric tests were compared among the groups. RESULTS: Abnormal caloric test results and abnormal cVEMP results were found in 50% and 31.6% patients, respectively. Multivariate analysis showed that abnormal caloric result (canal paresis) is a significant negative prognostic factor. CONCLUSIONS: Initial vestibular function test can be valuable in predicting the final outcome in patients with ISSNHL.

A Case of Cartilaginous Choristoma of External Auditory Canal / 대한이비인후과학회지

Cartilaginous choristoma of bony external auditory canal is very rare. Appearing as a horny sha-ped hard mass, cartilaginous choristoma can be found in the medial portion of anterior wall of external auditory canal. Histologically, it consists of adult-type hyaline cartilage without neoplastic features. If cartilaginous choristoma shows growing tendency or ear symptoms, surgical excision would be the treatment of choice. Here, we report a case of cartilaginous choristoma that occurred in the external auditory canal in an 8-year-old boy.

A Clinical Analysis of Revision Endoscopic Sinus Surgery: Single-Center 10-Year Experience

BACKGROUND AND OBJECTIVES: Endoscopic sinus surgery (ESS) has become a popular procedure for treating chronic sinusitis. Despite recent developments in medical and surgical techniques, primary ESS can still fail. Although revision ESS is one solution to the problem of recurrent sinusitis, revision surgery is stressful for patients and otolaryngologists. Therefore, we examined the causes of ESS failure and sought to find ways to prevent the failure of primary ESS. MATERIALS AND METHODS: All patients who underwent revision ESS in our department between April 2003 and March 2012 were studied retrospectively. RESULTS: During this period, revision ESS was performed 40 times to treat chronic sinusitis. We analyzed the preoperative computed tomographic (CT) findings of primary and revision ESS cases using the Lund-Mackay and Kennedy CT staging scores to compare disease severity. In our cases, the failure of ESS was not affected by the extent of disease, asthma, or allergy. Polyposis was the only useful predictor of revision ESS. CONCLUSION: Polyposis is an important predictor of revision ESS. We recommend that patients be followed frequently and carefully, especially those with polyps.

Clinical Characteristics of Auricular Keloids Treated with Surgical Excision

BACKGROUND AND OBJECTIVES: Differences in morphology of auricular keloids possibly contribute to distinct results of treatment. The aim of this study was to evaluate clinical characteristics of the auricular keloids according to the modified Chang-Park classification and to compare the results of treatment including recurrence rate between the subgroups. SUBJECTS AND METHODS: Clinical data of 15 patients of auricular keloids were retrospectively reviewed. The keloids were classified according to modified Chang-Park classification. Clinical characteristics, the presence of recurrence, and the duration required for the recurrence were compared. RESULTS: Eight out of 15 patients (53.3%) were single sessile type (type II), followed by 4 patients of pedunculated type, 1 patient of multiple sessile type, 1 patient of buried type, and 1 patient of mixed type, respectively. Recurrent keloids after previous surgeries were noted in 7 out of 15 patients and most of them (6 of 7, 85.7%) were sessile type. Three patients who underwent surgery at our department showed recurrence. CONCLUSIONS: The classification of auricular keloids according to morphologic patterns can assist surgeons in choosing the appropriate management.

Clinical Characteristics of Auricular Keloids Treated with Surgical Excision

BACKGROUND AND OBJECTIVES: Differences in morphology of auricular keloids possibly contribute to distinct results of treatment. The aim of this study was to evaluate clinical characteristics of the auricular keloids according to the modified Chang-Park classification and to compare the results of treatment including recurrence rate between the subgroups. SUBJECTS AND METHODS: Clinical data of 15 patients of auricular keloids were retrospectively reviewed. The keloids were classified according to modified Chang-Park classification. Clinical characteristics, the presence of recurrence, and the duration required for the recurrence were compared. RESULTS: Eight out of 15 patients (53.3%) were single sessile type (type II), followed by 4 patients of pedunculated type, 1 patient of multiple sessile type, 1 patient of buried type, and 1 patient of mixed type, respectively. Recurrent keloids after previous surgeries were noted in 7 out of 15 patients and most of them (6 of 7, 85.7%) were sessile type. Three patients who underwent surgery at our department showed recurrence. CONCLUSIONS: The classification of auricular keloids according to morphologic patterns can assist surgeons in choosing the appropriate management.

Prognostic Factors in Liposarcomas: A Retrospective Study of 52 Patients / 대한골관절종양학회지

PURPOSE: To investigate prognostic factors influencing on local recurrence, distant metastasis and event-free survival of liposarcomas. MATERIALS AND METHODS: Fifty-two patients managed for liposarcomas since 1993 were analyzed respectively in the view of prognostic influence of patient age, tumor size, location, histologic type, histologic grade, resection type, surgical margin, chemotherapy and radiation therapy on local recurrence, distant metastasis and event-free survival. The mean follow up period was 39 months. The univariate and multivariate regression analysis were performed for statistical evaluation. RESULTS: The local recurrences occurred in 11 patients (21.2%) and distant metastasis in 4 patients (8%), Event-free survival rate at 4 year follow up was 67%. In univariate analysis, histologic grade, surgical margin, chemotherapy and radiation therapy were significant prognostic factors on local recurrence (p<0.05). However, histologic grade lost its significance in muitivariate analysis. Trunk location revealed higher rate of distant metastasis than extremity location. In univariate analysis on event-free survival. histologic grade and chemotherapy were significant factors (p<0.05). No factor remained significant in multivariate analysis. CONCLUSION: Considering selection bias, positive surgical margin was negative prognostic factor on local recurrence. Liposarcomas arisen in trunk revealed higher rate of distant metastasis. There was no independent prognostic factor on event-free survival of patients with liposarcomas.