A Case of Incus Extrusion into the External Auditory Canal after Head Trauma

Various types of ossicular chain interruption may occur in temporal bone fractures. The most common type is incudostapedial joint disruption. Incus is the most vulnerable to traumatic injury as compared with malleus or stapes, because it is suspended only by ligamentous structures and connected to the incudomalleolar and incudostapedial joints. Incus may rarely be pushed through tympanic membrane or pass through a fracture of posterosuperior external auditory canal. However, a case of complete extrusion of incus into the external auditory canal has not been reported. The author presents a rare case of incus extrusion into the external auditory canal with temporal bone fracture after head trauma.

Clinical Features of Patients with Labyrinthine Concussion after Head Trauma

OBJECTIVE: Blunt head injury can lead to isolated damage of the inner ear (cochlear labyrinthine concussion) or damage of the otolith organ (vestibular labyrinthine concussion) due to a bone conduction pressure. We evaluated the clinical characteristics of hearing impairment in patients who suffered from a blunt head trauma without any organic problems, including temporal bone fracture or intracranial hemorrhage. METHODS: This retrospective study examined 9 patients presenting with hearing impairment after blunt head trauma within recent 5 years. This study included only patients without temporal bone fracture or intracranial hemorrhage. RESULTS: Most patients complained of associated auditory symptoms including tinnitus, dizziness, earfullness, and otalgia. Twelve ears of 9 patients showed sensorineural hearing loss; mild (1 ear), moderate (3 ears), moderate-severe (4 ears), severe (2 ears), and profound (2 ears). After high-dose steroid therapy, 2 ears had a significant hearing gain, but 10 ears showed no improvement of hearing. CONCLUSION: Blunt head injury is one of the most common causes of the neurologic disorders. It is important to perform thorough assessment of auditory symptoms as soon as possible. Otologic consultation should be sought in all cases for appropriate management.

Volumetric Changes in the Bony External Auditory Canal in Unilateral Chronic Otitis Media

BACKGROUND AND OBJECTIVES: Pneumatization of air cells in the mastoid bone is decreased in chronic otitis media (COM). A decrease in the size of the external auditory canal (EAC) is also found frequently in patients with COM, but this has been little studied. We compared the size of affected bony EACs and the contralateral side in patients with single-side COM using high-resolution computed tomography. SUBJECTS AND METHODS: In total, 99 patients with single-side COM were included. Four indicators related to the size of the bony EAC and IAC were measured using high-resolution computed tomography: the axial and coronal lengths of the tympanic membrane, the length of the isthmus, and the area of the bony ear canal. We also compared both internal auditory canals as negative controls. These assessments were made by radiologists who were blinded to the objective of this study. RESULTS: In patients with single-side COM, the axial length of the tympanic membrane was significantly shorter than normal, and the volume of the EAC was also significantly smaller. The length of the isthmus of the EAC was shorter on the affected side, but the difference was not significant. The IAC volume showed no difference between the two sides. CONCLUSIONS: COM affects general temporal bony development, including the bony EAC and mastoid bone. Therefore, whether to correct this should be considered when preparing for COM surgery.

Compound Nevus Occurring Near External Auditory Canal: Successful Treatment by CO2 Laser Abrasion

Melanocytic nevus is common pigmented skin tumor, but it has rare occurrence near the external auditory canal. A skin graft is required if a wide surgical excision is performed for the nevi occurring near the external auditory canal. A CO2 laser was considered to be a good alternative for the removal of melanocytic nevus in this area. We herein report a case of compound nevus occurring near the external auditory canal that was successfully treated by CO2 laser abrasion.

Mupirocin Ointment Prevents Early Post-Tympanostomy Tube Otorrhea: A Preliminary Study

BACKGROUND AND OBJECTIVES: The most common complication of tympanostomy tube (T-tube) insertion is the development of postoperative otorrhea. Post-tympanostomy tube otorrhea (PTTO) is defined as active drainage through an existing T-tube. Many surgeons routinely use topical antibiotics as prophylaxis against early PTTO. Mupirocin calcium ointment is a topical antimicrobial agent with broad-spectrum antimicrobial activity against many Gram-positive organisms. This study evaluated the clinical effectiveness of topical mupirocin ointment in reducing early PTTO. SUBJECTS AND METHODS: The study included 98 ears (67 patients, mean age 32.9 years) that had a T-tube inserted because of chronic middle ear effusion or atelectatic otitis media. A Paparella type-I polyethylene-tube coated with mupirocin was inserted through the tympanostomy. Patients were instructed not to use otic drops or any other medications. All patients were seen by day 14 postoperatively. RESULTS: Early PTTO occurred in one case (1.5%). No early PTTO was seen with a middle ear effusion. Nineteen children were treated under general anesthesia; none developed early PTTO. CONCLUSIONS: Insertion of a T-tube coated with mupirocin ointment could be effective at preventing early PTTO.

Mupirocin Ointment Prevents Early Post-Tympanostomy Tube Otorrhea: A Preliminary Study

BACKGROUND AND OBJECTIVES: The most common complication of tympanostomy tube (T-tube) insertion is the development of postoperative otorrhea. Post-tympanostomy tube otorrhea (PTTO) is defined as active drainage through an existing T-tube. Many surgeons routinely use topical antibiotics as prophylaxis against early PTTO. Mupirocin calcium ointment is a topical antimicrobial agent with broad-spectrum antimicrobial activity against many Gram-positive organisms. This study evaluated the clinical effectiveness of topical mupirocin ointment in reducing early PTTO. SUBJECTS AND METHODS: The study included 98 ears (67 patients, mean age 32.9 years) that had a T-tube inserted because of chronic middle ear effusion or atelectatic otitis media. A Paparella type-I polyethylene-tube coated with mupirocin was inserted through the tympanostomy. Patients were instructed not to use otic drops or any other medications. All patients were seen by day 14 postoperatively. RESULTS: Early PTTO occurred in one case (1.5%). No early PTTO was seen with a middle ear effusion. Nineteen children were treated under general anesthesia; none developed early PTTO. CONCLUSIONS: Insertion of a T-tube coated with mupirocin ointment could be effective at preventing early PTTO.

Combination Therapy with Systemic Steroids, an Antiviral Agent, Anticoagulants, and Stellate Ganglion Block for Treatment of Sudden Sensorineural Hearing Loss

BACKGROUND AND OBJECTIVES: Sudden sensorineural hearing loss (SSNHL) is commonly defined as a loss of at least 30 dB in three contiguous frequencies occurring within 3 days. Systemic steroid administration has become the most widely accepted treatment option for SSNHL. Since viral infection and vascular compromise are considered specific causes of SSNHL, antiviral agents, anticoagulants, and stellate ganglion block have been used for its treatment, although the evidence of their effectiveness is weak. The present study evaluated the hearing recovery rate in the combination therapy group (systemic steroids, antiviral agent, anticoagulants, and stellate ganglion block) in comparison with patients treated with systemic steroids alone. SUBJECTS AND METHODS: A total of 85 patients diagnosed with SSNHL were treated with combination therapy (group A, 46 patients) or systemic steroids only (group B, 39 patients). Hearing improvement was defined as a hearing gain of more than slight improvement using Siegel's criteria. All patients were treated with a 10-day course of systemic steroids (10-mg dexamethasone for 5 days, followed by tapering for 5 days). Acyclovir, heparin, and stellate ganglion block were included in the group A treatment regimen. RESULTS: The overall rate of hearing improvement was 60.9% (28/46 patients) in group A, which was significantly higher than that (38.5%, 15/39 patients) in group B. The distribution of prognostic factors was not significantly different between the two groups with the exception of the degree of initial hearing loss, which was more severe in group A. Upon analysis according to prognostic factors, group A showed a better hearing improvement recovery rate than group B in patients with hearing loss >70 dB, age >41 years, dizziness, and early treatment (<1 week). CONCLUSIONS: Thus SSNHL patients treated with combination therapy have a higher likelihood of hearing improvement than those treated with systemic steroids alone.

Evaluation of the Interaural Attenuation for Pure Tone Audiometry in Korean

BACKGROUND AND OBJECTIVES: The masking should be used in pure tone audiometry when the difference between the air-conduction threshold of the tested ear and the bone-conduction threshold of the non-tested ear is more than interaural attenuation (IA). But the standardized average value of IA in Korean has not been evaluated until now. The purpose of this study is to evaluate the interaural attenuation in Korean population. SUBJECTS AND METHODS: Of the patients who visited our department from March, 2007 to August, 2009, 44 patients were selected who had unilateral severe sensorineural hearing loss or deafness and contralateral normal hearing. When the difference between air-conduction threshold with and without masking was more than 10 dB, the interaural attenuation at each frequency was obtained by subtracting the contralateral bone conduction from the air-conduction threshold without masking. RESULTS: The interaural attenuations at each frequency were 45-75 dB (250 Hz), 50-75 dB (500 Hz), 40-75 dB (1 kHz), 45-85 dB (2 kHz), 50-90 dB (4 kHz). 77.2% of the subjects showed interaural attenuation of 55-65 dB at 250 Hz, and 80.9% in 50-60 dB at 500 Hz, 79.5% in 55-65 dB at 1 kHz, 83.4% in 45-60 dB at 2 kHz, and 76.4% in 50-65 dB at 4 kHz. Most of the patients were distributed 15-25 dB higher than the minimal interaural attenuation at 1 kHz. At 2 kHz and 4 kHz, most of the patients were distributed around 15 dB of the minimal interaural attenuation. CONCLUSIONS: These results can be used as reference values for masking of pure tone audiometry. But, further studies with large population should be done to get more precise results and contributing factors to IA values.

Intratympanic Steroids in Severe to Profound Sudden Sensorineural Hearing Loss as Salvage Treatment

OBJECTIVES: Intratympanic steroids are being increasingly used in the treatment of sudden sensorineural hearing loss (SSNHL) after the failure of systemic therapy. This study evaluated the efficacy of administering intratympanic dexamethasone (ITD) as a salvage treatment for severe to profound SSNHL. METHODS: We reviewed the medical records of patients who presented with severe to profound SSNHL between January 2007 and December 2009. ITD was given about 14 days after the initial systemic treatment. Successful recovery was defined as complete or partial recovery using Sigel's criteria. We compared the results of treatment between the severe SSNHL (S-SSNHL) and profound SSNHL (P-SSNHL) groups. RESULTS: All the patients in the S-SSNHL group showed significant improvement, as compared to the P-SSNHL group (P=0.017). The recovery rate after the initial systemic treatment was 36% (9/25) in the S-SSNHL group and 18.1% (4/22) in the P-SSNHL group (P=0.207). In comparison, the recovery rate of ITD as a salvage treatment was 37.5% (6/16) in the S-SSNHL group and 5.5% (1/18) in the P-SSNHL group (P=0.03). CONCLUSION: Our comparative study dose not support the efficacy of ITD as salvage treatment for patients with P-SSNHL as compared with that for S-SSNHL. We recommend that patients with P-SSNHL be informed about the low efficacy of ITD as a salvage treatment.

A Case of Unilateral Conductive Hearing Loss Treated with Stapedial Tenotomy / 대한이비인후과학회지

The ossification of stapedial tendon is a rare disorder of middle ear that results in conductive hearing loss. It might be easily misdiagnosed as otosclerosis, and only exploratory tympanotomy can indicate cases where the mobility of stapes is not fixed or has increased. Cutting of the tendon results in nearly normal ossicular mobility and hearing improvement. A 41-year-old patient visited our clinic with slowly progressive hearing loss. Hearing evaluation revealed that he had a conductive hearing loss with intact tympanic membrane. The mobility of stapes was enhanced by cutting of the tendon through exploratory tympanotomy ; hearing was improved thereafter.

Actinomycosis-Superinfected Peripheral T Cell Lymphoma Presenting as a Perforating Palatal Ulcer / 대한이비인후과학회지

Peripheral T cell neoplasms (PTCNs) comprise a group of uncommon and heterogenous lymphoid malignancies. They are more difficult to diagnose and treat and have a worse prognosis than B cell lymphomas. NK/T cell lymphoma is the most common histologic subtype in the head and neck. Unspecified type is the most common subtype of PTCNs but is not reportedin oral cavity or nasal cavity. We report a case of a perforating palatal ulceras a rare presentation of peripheral T cell lymphoma with a review of literature.

A Case of Acoustic Neuroma Presenting as an External Auditory Canal Tumor / 대한이비인후과학회지

Acoustic neuromas arise frequently within the internal auditory canal and cerebellopontine angle. Rarely, a schwannoma may occur primarily within the labyrinth or may extend secondarily into the labyrinth from the internal auditory canal. The authors experienced a very rare case of acoustic neuroma presenting as a tumor of the external auditory canal in a 43 year-old woman. Tumor was removed by a transotic approach and found to be present in the external auditory canal, middle ear, labyrinth, internal auditory canal and cerebellopotine angle. Subtotal resection of the tumor was performed due to severe adhesions to the facial nerve in the proximal internal auditory canal. Serial magnetic resonance imaging is planned to follow up the residual tumor.

A Case of Nevus Sebaceous in the External Ear / 대한이비인후과학회지

Nevus sebaceous is a rare tumor in the external ear. It is clinically important because this tumor has chance to progress to benign or malignant neoplasm. This change generally occurs after adolescent age. The most common malignant neoplasm arising in this lesion is basal cell carcinoma. Therefore, many authorities recommend complete excision before puberty. A 9-year-old boy visited our clinic with multiple nevi sebaceous involving the pinna and external auditory canal. The tumors were removed completely and the defect was covered with skin graft. There has been no evidence of recurrence as of 10 months following the surgery. We report this case with a review of literature.

Surgical Outcomes of Jugular Foramen Tumors; Postoperative Facial Nerve Palsy and Lower Cranial Nerve Palsy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Surgical treatment of jugular foramen tumors can have significant complications such as facial nerve palsy due to complicated regional anatomy. In this study, we investigated the outcomes and complications of surgical approach to the jugular foramen tumors. SUBJECTS AND METHOD: Thirteen patients had operations for their tumors around jugular foramen with a mean follow-up period of 52 months. We reviewed their medical records with emphasis on postoperative facial nerve palsy and other low cranial nerve palsies. RESULTS: There were jugular foramen schwannoma (n=9), glomus jugulare (n=2), meningioma (n=1) and chondrosarcoma (n=1). Gross total removal was achieved in 12 patients. Facial nerves were rerouted at genigulate ganglion (long rerouting) or at the second genu (short rerouting). Mastoidectomies were performed with canal wall-up (CWU) fashion or with canal wall-down (CWD) fashion. The mean size of tumor with long rerouting was significantly larger than that with short rerouting (p=0.037). Facial nerve palsy (FNP) greater than House-Brackmann grade (HB grade) III remained for more than 6 months in a patient. Low cranial nerve palsies were developed in 3 patients. CONCLUSION: Surgical treatment of jugular foramen tumors had a good local control rate with a low rate of complications. Depending on the size and location of tumors, detailed surgical methods can be determined to avoid unnecessary manipulation of facial nerve and loss of hearing.

Whirling Vertigo as a Prognostic Factor in Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Presence of whirling vertigo accompanied by sudden sensorineural hearing loss has been known to give negative effects on the hearing recovery. But the effect of whirling vertigo on the recovery of hearing cannot be simply evaluated because prognosis is related with other several variables, such as severity of hearing loss, onset of treatment and age. This study sets out to investigate the impact of whirling vertigo on the severity and recovery of hearing loss by multivariant analysis to exclude the effects of other variables. MATERIALS AND METHOD: A total of 176 patients who were admitted to Samsung Medical Center from March 1997 to March 2001 were entered into our study. All patients were divided into three groups according to the presence of dizziness: with whirling vertigo (39 ears), with non-whirling dizziness (36 ears), without dizziness (101 ears). To investigate the impact of whirling vertigo on the severity of hearing loss, each group was divided into four groups according to the severity of hearing loss. Each group was analyzed respectively by the presence of whirling vertigo. Secondly, the effect of whirling vertigo on hearing recovery was investigated by multivariant analytic technique to exclude the effect of the other probable prognostic factors. Thirdly, the effect of other variables (severity of hearing loss, onset of treatment, age) on the prognosis was investigated. RESULTS: The presence of whirling vertigo was not statistically related with the severity of hearing loss (p=0.063). The results of the multivariant analysis showed that the recovery of hearing loss was related with the presence of whirling vertigo (p=0.02), severity of hearing loss (p=0.001), onset of treatment (p=0.034) and age (p=0.034). CONCLUSION: Hearing loss in the group with whirling vertigo was not more severe than that in the other two groups. According to the multivariant analytic technique, whirling vertigo in sudden sensorineural hearing loss has a negative effect on the prognosis of hearing recovery.

Improvement of Speech Intelligibility in Patients with Sensorineural Hearing Loss Using Noise Reduction Algorithms / 대한이비인후과학회지

BACKGROUND & OBJECTIVES: Speech intelligibility is significantly decreased in noisy environments in patients with sensorineural hearing loss (SNHL) compared to those without hearing loss. It is caused by increased hearing threshold, recruitment, and decreased frequency selectivity. The hearing threshold and recruitment could be grossly controlled by the hearing aid with a compression circuit. It has been well established that various techniques can be used to trigger the signal to increase the noise ratio (SNR), such as noise reduction algorithms, in order to compensate for decreased speech intelligibility in noisy environments. These algorithms are incorporated into some of the commercially available digital hearing aids. This study was designed to measure the effect of noise in speech intelligibility of patients with sensorineural hearing loss and the effect of reducing the background noise with a noise reduction algorithm. MATERIALS AND METHODS: Twenty-one ears with sensorineural hearing loss were selected for this study. Speech reception thresholds (SRTs) and speech discrimination scores (SDSs) were checked with or without noise, and after removal of noise using a noise reduction algorithm. RESULTS: SRTs were increased in noise compared with a quiet environment. By reducing noise using the algorithm we prepared, SRTs were decreased by 4.6 dB, 4.2 dB, and 4.9 dB at +6, 0, -6 dB SNRs, respectively, in comparison with those who didn't use the algorithm in noise. It was observed that SDSs were decreased by 24-50% in noise and patients partially recovered hearing loss when noise was reduced. CONCLUSION: Speech intelligibility deteriorated in noise but partially improved with a noise reduction algorithm. A further study on the development of the noise reduction algorithm is needed to improve SNRs.

Soft Palate Reconstruction with a Superior-Constrictor Advancement-Rotation Flap(SCARF) / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Reconstruction of the soft palate after tumor resection is a difficult surgical procedure because of the requirements of the dynamic functional velopharynx. The ideal technique should be simple, reliable, sensate, dynamic and fast, and should be performed transorally or transcervically. Many methods such as obturators, loco-regional flaps, and free flaps have been devised to reconstruct the soft palate but none meets all this criteria. Superior-constrictor advancement-rotation flap (SCARF) is a dynamic local myomucosal flap to achieve circumferential closure of the velopharynx and reestablish its valvular sphincteric function and this satisfies all the criteria mentioned above. We evaluated the validity of SCARF for reconstruction of the soft palate after tumor resection. MATERIALS AND METHODS: From 1998 to 1999, three patients underwent a SCARF reconstruction of the velopharynx after 30% to 70% of the soft palate had been resected. All patients were evaluated after wound healing with regard to subjective satisfaction and objective parameters such as speech-language evaluation and videofluoroscopic study. RESULTS: All patients reestablished velopharyngeal competence without significant phonatory or deglutitive disability. There was no donor site complication. CONCLUSION: We could functionally reconstruct the defect of soft palate (maximum 70%) after tumor resection with SCARF. The SCARF reconstruction of the soft palate was simple, fast, reliable and performed transorally without any significant donor site morbidity.