The Effect of Different Counselors on Treatment Outcome of Tinnitus Retraining Therapy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tinnitus retraining therapy (TRT) is one of the most effective treatment modalities of tinnitus based on the neurophysiological model proposed by Jastreboff and Hazell. This study was performed to evaluate the effect of counselor factor on treatment outcomes of TRT. SUBJECTS AND METHOD: The total of 78 patients who had TRT from three different counselors in a tinnitus clinic of tertiary referral center from Jan 2015 to Dec 2015 were included in this study. Their medical records were retrospectively reviewed to evaluate the therapeutic response to TRT. RESULTS: Among 78 patients who were followed-up for more than 6 months, 47, 20, and 11 patients were treated by counselors A, B, C (all ENT specialists), respectively. Counselor A had 15-year-experience of TRT counseling, whereas counselor B and C were well trained but beginners of TRT counseling. Initial clinical characteristics including Tinnitus Handicap Inventory (THI) and tinnitus Visual Analogue Scale (VAS) scores of the patients among three groups were not significantly different. Treatment responses evaluated via THI and most of the tinnitus VAS scores after at least 6 months after TRT were significantly improved in all three groups (p<0.05) with no significant difference between the senior (A) and junior (B, C) group. CONCLUSION: TRT seems to be an effective treatment modality of tinnitus even in this short term follow-up study. Treatment outcomes of TRT may not depend on the counselors once they are well trained and follow the same protocol.

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.

Cochlear Implantation after Subtotal Petrosectomy in Patients with Chronic Otitis Media / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study investigated the surgical and rehabilitative results of cochlear implantation combined with subtotal petrosectomy in patients with chronic otitis media. SUBJECTS AND METHOD: We retrospectively reviewed the medical records of nine adult patients (7 men and 2 woman; mean age 58.9 years), who were operated between 2004 and 2014. Out of the nine, seven patients received simultaneous cochlear implantation and subtotal petrosectomy and two patients were operated by stage depending on the condition of the middle ear. All cases underwent closure of the external auditory canal and Eustachian tube, and the obliteration of mastoid cavity using abdominal fat. Surgical outcomes and performance of the patients after cochlear implantation were analyzed. RESULTS: Middle ear inflammation was completely managed with this surgical technique. No patients showed postoperative symptoms related to otitis media after the surgery. Cochlear implant was successfully replaced and active electrodes were fully inserted in all of the cases. There were no immediate complications including abscess, infection, meningitis, cerebrospinal fluid leakage and ear canal problem. One patient was observed with delayed extrusion of the ball electrode, which was replaced with cartilage reinforcement under local anesthesia. Patient performance, measured in terms of speech evaluation and quality of life during the medical interview, were successful and satisfactory. CONCLUSION: Cochlear implantation with subtotal petrosectomy seems to be very safe and effective for patients deafened by chronic otitis media. Long term follow-ups for possible extrusion of the electrode or other complications are still necessary.

Single-Center 10-Year Experience in Treating Patients With Vascular Tinnitus: Diagnostic Approaches and Treatment Outcomes

OBJECTIVES: Vascular tinnitus is the most common form of pulsatile tinnitus, particularly when the tinnitus corresponds with the pulse of patients. In this study, we reviewed the 10-year clinical data on vascular tinnitus of our tinnitus clinic to investigate the frequency of the underlying etiologies, to introduce a diagnostic protocol, and to evaluate the treatment outcomes. METHODS: We retrospectively collected the data of 57 patients who were diagnosed as vascular tinnitus between April 2001 and December 2011. Careful history taking, otoscopy, thorough physical examinations, audiometry, laboratory tests, as well as radiologic examinations were performed according to our diagnostic protocol to find the origin of pulsatile tinnitus. Treatment options were individualized based on the specific etiology, and the outcomes were assessed using patient's subjective reports at the follow-up interviews. RESULTS: High jugular bulb was the most common cause (47.4%) of vascular tinnitus, and venous hum was the next (17.5%). Dural arteriovenous fistula, intracranial aneurysm, atherosclerotic carotid artery disease, and hypertension were less common causes. Vascular tinnitus was alleviated in most patients after the appropriate treatment: surgical intervention, tinnitus retraining therapy, reassurance, and medications. CONCLUSION: Vascular tinnitus can be successfully diagnosed by the regular use of the suggested protocol. Many patients with vascular tinnitus have treatable underlying etiologies. Treatment of those etiologies or at least counseling about the tinnitus itself can benefit the patients with troublesome vascular tinnitus.

Radial Maze Test in a Mouse Model of Noise-Induced Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Hearing loss has been hypothesized to contribute to cognitive decline in the elderly. However, earlier studies yielded conflicting results, and the causal relationship has not been elucidated to date. In the present study, the authors set up a radial maze apparatus for assessment of cognition in mice, and investigated the relationship between cognition and hearing loss that occur immediately after noise exposure. MATERIALS AND METHOD: Spatial learning and memory were assessed in male C57BL/6 mice with or without hearing loss using an unconfined, partially-baited, 8-arm radial maze with different arm length (25 or 50 cm). The performance indicators included total trial time, latency, reference memory error, working memory error, and correct entry ratio. Mice in the hearing loss group were exposed to 60 min of 110 dB white noise for 14 days, and then auditory brainstem response thresholds were measured. RESULTS: Mice showed better performances in a 25 cm-arm radial maze than in a 50 cm-arm maze. The control and the hearing loss groups exhibited similar performance curves, except for the working memory curve in 25 cm-arm radial maze. Hearing-impaired mice were better at working memory tasks than the control mice, probably due to an early cognitive compensatory mechanism. CONCLUSION: A radial maze with 25 cm arm is appropriate for the test of learning and memory in mice. Acute hearing loss after noise exposure was not associated with decreased cognition. Further follow-up research has been planned to find the effect of long-term hearing loss on cognition and the mechanism by which these two domains are connected.

Objective Tinnitus due to Spontaneous Temporomandibular Joint Herniation Treated by Reconstruction with Titanium Mesh / 대한이비인후과학회지

Herniation of the temporomandibular joint (TMJ) into the external auditory canal (EAC) is known to be associated with a defect of the anterior wall of the EAC. Spontaneous herniation of TMJ into EAC is very rare and can induce clicking tinnitus, conductive hearing loss, otalgia, otorrhea and even no symptom. Here we report a very interesting case of spontaneous TMJ herniation, which resulted in severe and annoying clicky tinnitus and otalgia. There was no response to the initial conservative management, so surgical correction of TMJ herniation using titanium mesh was performed. After the surgery, the annoying clicky tinnitus completely disappeared. This study suggests that tinnitus caused by TMJ herniation be considered as another type of surgically curable objective tinnitus.

Meteorological Conditions Related to the Onset of Idiopathic Sudden Sensorineural Hearing Loss

PURPOSE: The objective of this study was to evaluate the effect of meteorological factors on the onset of idiopathic sudden sensorineural hearing loss (ISSHL). MATERIALS AND METHODS: Meteorological data from 2005 to 2011 were obtained from the web-based "Monthly Weather Reports of the Meteorological Administration" database. Patients with ISSHL who visited our hospital during this same period and presented the precise day on which hearing loss developed were included in this retrospective study. Twelve meteorological factors were analyzed between the days when ISSHL onset was observed as well as the days when ISSHL did not occur. The weather conditions occurring 1-7 days before ISSHL onset were also analyzed to assess any possible delayed effects of meteorological factors on the onset of ISSHL. RESULTS: During the study period, 607 patients were included for the study. Although mean and maximal wind velocities were higher for the days when ISSHL occurred than the days without ISSHL onset, after adjusting the value for multiple comparisons, we cannot find any significant relationship between any of meteorological factors and the onset of ISSHL. However, in analysis of time lag effect of the weather conditions, we found that there was still a significant difference in maximum wind speed on 5 days before ISSHL onset even after applying Bonferroni correction. CONCLUSION: The result of this study suggests that stronger wind speed may be related to the occurrence of ISSHL.

Small-Group Counseling in a Modified Tinnitus Retraining Therapy for Chronic Tinnitus

OBJECTIVES: The authors have treated chronic tinnitus patients using a combination of a simplified tinnitus retraining therapy (TRT) and medications, which we called modified TRT. In this clinical setting, we have attempted small-group counseling to find a time-effective equivalent of individual counseling. The aim of the present study was to evaluate the effectiveness of small-group counseling by comparing the treatment outcomes between individual and small-group counseling. METHODS: The patients who had distressing chronic tinnitus with normal hearing or mild hearing loss were included. The subjects were placed into the small-group (group 1:4) or the individual (group 1:1) counseling group, and underwent a modified TRT composed of a single session of directive counseling and ambient sound stimulation. In addition, alprazolam (0.25 mg) and ginkgo biloba extract (80 mg) were administered orally to the subjects for 3 months. The 3- and 6- month outcomes were assessed using the follow-up rates and tinnitus severity scores: awareness, tinnitus handicap inventory (THI), loudness, annoyance, and effect on life. The treatment responses were classified as improvement, no changes, and worsening. RESULTS: Of the total 149 patients (77 in group 1:1; 72 in group 1:4), 104 patients completed the protocol at 3 months, and 55 patients at 6 months. The follow-up rates were similar in both groups. Over the period of 6 months, all scores declined significantly except the loudness score at 3 months in both groups. Treatment responses showed no between-group differences. The success rate based on THI was 70% in group 1:1, and 64% in group 1:4 at 6 months. CONCLUSION: The small-group counseling of our modified TRT was comparable to the individual counseling for tinnitus relief. We suggest that this protocol can be implemented effectively in any crowded otolaryngology clinics.

Palatal Myoclonus Associated with Orofacial Buccal Dystonia

Palatal myoclonus is a rare condition in which there are rhythmic jerky movements of the soft palate and sometimes of the other muscles innervated by the brainstem A particularly annoying symptom is a rhythmic clicking sound in the ear due to the opening and closing of the Eustachian tube. Orofacial buccal dystonia is a focal dystonia with sustained spasms of the masticatory, facial or lingual muscles. The frequent symptoms of this disease have mainly been reported to be involuntary and possibly painful jaw opening, closing, deflecting and retruding, or a combination of the above. However, the subtle and unnoticeable involuntary movement of multiple facial muscles, which might be an infrequent symptom of orofacial buccal dystonia, makes this disease hard to diagnose. Understanding the functional orofacial anatomy that is responsible for the clinical signs and symptoms is necessary for making a proper diagnosis. Here we report on a rare case of palatal myoclonus that was associated with orofacial buccal dystonia, and such a case has not been previously reported. We describe the diagnostic approach and excellent treatment results after Botulinum toxin A (Dysport) injection and proper counseling.

A Case of Chronic Suppurative Otitis Media with Facial Nerve Palsy due to Aspergillus Infection / 대한이비인후과학회지

Chronic otitis media of fungal origin and its complications like facial palsy are highly unusual. Although human exposure to Aspergillus is common, infections are infrequent. Aspergillus infections of the ear are usually limited to superficial growth on cerumen or moist debris. The main risk factor for fungal infection of middle ear is being in an immunocompromised state, which may be caused by malignant neoplasms, immunosuppressive therapy, poorly controlled diabetes mellitus, blood dyscrasia, or protein-energy malnutrition. Aggressive surgical debridement is required in fungal infections with facial palsy, and the prognosis is better with early treatment. Facial palsy caused by fungal infection showed poor improvement in most of the reported cases. Early diagnosis, surgical resection and antifungal therapy with control of underlying immunologic conditions and maintenance of antifungal therapy are required for best results. Fungal otitis media with facial nerve palsy has not yet been reported in Korea. We report a case of fungal otitis media with facial palsy in an immune-compromised woman who improved with mastoid process resection and facial nerve decompression.

Role of Interleukin-10 on Mouse Otitis Media Model Using Lipopolysaccharide / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Interleukin (IL)-10 is a major regulator of innate immunity. It interferes with the production of inflammatory mediators by reacting with polymorphonuclear neutrophils, monocytes and macrophages. In addition, it also up-regulates the ex-pression of molecules that amplify the anti-inflammatory effect of IL-10. This study tested the hypothesis that injection of various concentrations of exogenous IL-10 in the middle ear cleft can inhibit the acute stage of otitis media induced by lipopolysaccharide (LPS). And if so, the level of concentration for inhibition can be determined. MATERIALS AND METHOD: IL-10 and/or LPS were injected transtympanically into the middle ear cavity of normal mice. Histopathological measurement of submucosal thickness and num-ber of inflammatory cell infiltration was performed at 24 hours after inoculation of IL-10 and/or LPS. RESULTS: At 24 hours after inoculation, every group of IL-10 inoculation reduced both thickening of the mucous and submucosal infiltration of inflammatory cells in a dose-dependent manner. As the concentrations of IL-10 inoculated increased, mucosal thickness and submucosal infiltration of inflammatory cells were more reduced. CONCLUSION: This study demonstrated that exogenous IL-10 injection into the middle ear can directly reduce LPS-induced otitis media in acute stage in a dose-dependent manner. These findings also indicate that IL-10 may be a candidate for local modulator of acute otitis media.

Incidence and Clinical Characteristics of Patients with Tinnitus According to Diagnostic Classification / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Knowledge about the incidence and clinical characteristics of tinnitus can be useful for diagnostic approach and treatment plan. We analyzed the incidence and clinical characteristics of each case of tinnitus according to the classification of tinnitus. SUBJECTS AND METHOD: The study recruited 211 tinnitus patients who visited tinnitus clinic from March 2009 to August 2009. First, patients were diagnosed and classified as sensorineural tinnitus and somatosounds. Somatosounds were subdivided to vascular tinnitus, muscle origin tinnitus and patulous Eustachian tube. Patients were evaluated by history taking by means of having them fill out tinnitus questionnaires and psychoacoustic questionnaires. Audiologic findings of each type of tinnitus have also been analyzed. RESULTS: Incidences of sensorineural tinnitus and somatosounds were 82.9% and 17.1% respectively. Among somatosounds, vascular tinnitus occupied 7.6%, muscle origin tinnitus, 4.3% and patulous Eustachian tube, 5.2%. The mean age of the patients with sensorineural tinnitus was older than somatosounds. Patients with muscle origin tinnitus had higher scores of tinnitus loudness, effect on life, tinnitus handicap inventory, stress and depression than those with other types of tinnitus. Overall compliance of the treatment was 66.7% and their tinnitus had been significantly improved after treatment. CONCLUSION: With the knowledge of incidence, clinical characteristics and treatment approach for each tinnitus, clinicians can be more confident in providing proper diagnosis and management of patients with tinnitus. Somatosounds, which showed relatively high incidence in this study, should not be neglected but properly treated with early diagnosis.

Frequency-Specific Hearing Results After Surgery for Chronic Ear Diseases

OBJECTIVES: To analyze frequency-specific hearing results after surgery for chronic ear diseases while considering pathological findings and various surgical factors. METHODS: Patients who underwent surgical management of chronic otitis media were reviewed retrospectively (n=559). Using pure tone audiometry, air conduction (AC), bone conduction (BC), and air bone gap (ABG) change between pre- and post-operative tests were calculated for the frequencies of 250, 500, 1,000, 2,000, 3,000, 4,000 (AC and BC), and 6,000 Hz (AC). Frequency-specific results were investigated, considering various surgical factors, such as type of surgery, type of ossiculoplasty and pathological findings. RESULTS: AC results in the intact canal wall mastoidectomy showed improvement at each frequency except 4,000, 6,000 Hz. AC results in the tympanoplasty showed improvement at each frequency except 6,000 Hz. AC and ABG results in the open cavity mastoidectomy showed improvement only at the frequencies of 250, 500, 2,000 Hz. AC and ABG improved at low and mid frequencies but not in high frequencies above 3,000 Hz when ossicular reconstruction was conducted. AC and ABG results also improved at low and mid frequencies in the cholesteatoma, and ABG results improved at all frequencies except 3,000 Hz in the non-cholesteatoma. CONCLUSION: After chronic ear surgery, AC and ABG changes improved, primarily in the low and mid frequencies. Further evaluation and studies for post-operative hearing loss at high frequencies are recommended for rehabilitation of hearing ability after surgery.

Clinical and Audiologic Characteristics of Acute Low-Tone Sensorineural Hearing Loss: Therapeutic Response and Prognosis

OBJECTIVES: This study was designed to observe the clinical and audiologic characteristics of patients diagnosed as low tone hearing loss (LHL) and to evaluate the treatment response and prognosis. SUBJECTS AND METHODS: A retrospective chart review of 61 patients who were diagnosed with LHL was performed. Result of various audiologic studies and therapeutic responses of medication have been evaluated. Data were statistically analyzed with variables such as age, sex, interval between onset and treatment, initial hearing levels, findings of electrocochleargraphy, and initial concomitant symptoms according to their treatment response. RESULTS: Frequent chief complaints of LHL were tinnitus and earfullness. Tinnitus was usually matched at lower frequencies. Treatment with low-dose steroids, diuretics, and betahistine produced a high response rate of 79.4%. Complete response occurred in 49 of the 68 ears (72.1%) and partial response occurred in five of the 68 ears (7.4%). Fourteen of the 68 ears (20.6%) were in the non-responder group. Patients treated within 7 days after the onset of symptoms all showed complete response. Statistically significant prognostic factors affecting treatment response were age and intervals between onset and treatment (p<0.05). CONCLUSION: Patients with acutely onset tinnitus or ear fullness should be carefully evaluated and promptly treated under the diagnosis of LHL.

A Case of Cognitive Behavioral Therapy for Superior Semicircular Canal Dehiscence

Semicircular canal dehiscence is a rare but well-described condition to be induced noise or straining. Patients with Superior semicircular canal dehiscence (SSCD) present with a wide variety of symptoms. Reported case is a 51-year-old woman who presented with intermittent vertigo and left-side aural fullness for one month after traffic accident. To establish the diagnosis, high resolution temporal bone CT scanning has been performed to demonstrate bone defect overlying superior semicircular canal, and vestibular auditory symptoms and signs are evaluated through vestibular function test and auditory examination. Cognitive behavior therapy, vestibular rehabilitation and vestibular suppressants are prescribed. Auditory symptoms and vertigo have been subsided. At the same time, Presented depression and anxiety have been improved after 3 month treatment and the quality of life of patient has been improved.

Tinnitus in the Patients with Cochlear Implantation: Preliminary Report / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: With the wide use of cochlear implants, there have been many published studies which report that cochlear implants have a suppressive effect on tinnitus in profoundly deaf patients. The aim of this study was to understand the clinical and audiologic characteristics of the tinnitus in patients with cochlear implantation and to observe changes of their tinnitus after cochlear implantation. SUBJECTS AND METHOD: A total 23 patients who had undergone cochlear implants in our hospital from August 2003 to December 2006, were included in this study. The patients were divided into tinnitus (n=11) and non-tinnitus groups (n=12) according to the presence of tinnitus at the time of surgery. We compared clinical and audiologic features between the two groups. We also studied changes in tinnitus after surgery in the tinnitus group using validated self-report measures [tinnitus handicap inventory (THI), tinnitus handicap score (THS), and visual analogue scale]. RESULTS: There were significant differences between the two groups with respect to the age of cochlear implant recipients, whether or not the subjects had impaired hearing or were wearing hearing aids. Tinnitus was rarely observed in patients under 20 years of age with cochlear implantation (11.1%) in contrast to the higher rates in the patients of 20 years old and over (71.4%). Marked reduction of THI, THS and visual analogue scale of tinnitus were observed in all patients. CONCLUSION: For the adult patients who had undergone cochlear implant surgery and had tinnitus preoperatively, cochlear implants had shown suppressive effect on their tinnitus. Considering the significant prevalence of tinnitus in profoundly deaf patients, tinnitus of these patients should not be overlooked and further studies should be made to define relationship between cochlear implant and tinnitus.

Expression of HSP70 and Its Relation with Other Cytokines in Human Middle Ear Effusion

OBJECTIVES: While other cytokines are known to be associated with otitis media with effusion (OME), the involvement of heat shock protein 70 (HSP70) in middle ear effusion (MEE) is unknown. This study was undertaken to investigate the possibility of there being a HSP70 expression in human MEE and to determine its potential role as a cytokine in OME. METHODS: The levels of HSP70, tumor necrosis factor-alpha and interleukin-1beta were measured by enzyme-linked immunosorbent assay in the effusion of different groups of OME patient following collection of the MEE using our new collection system. The clinical characteristics of the OME patients and the MEE status were analyzed. RESULTS: HSP70 was expressed in all the types of MEE. The mucous and seromucous effusions showed higher HSP70 levels than that of the serous effusion. The HSP70 level was correlated with the levels of tumor necrosis factor (TNF)-alpha and interleukin (IL)-1beta in the effusions. The positive correlations between HSP70, TNF-alpha and IL-1beta were statistically significant (P<0.05). CONCLUSION: The highly elevated level of HSP70 in the seromucous and mucous effusions implicates this protein in the chronicity of OME.

Comparison of Cochlear Morphology and Apoptosis in Mouse Models of Presbycusis

OBJECTIVES: Morphological studies on presbycusis, or age-related hearing loss, have been performed in several different strains of mice that demonstrate hearing loss with auditory pathology. The C57BL/6 (C57) mouse is a known model of early onset presbycusis, while the CBA mouse is characterized by relatively late onset hearing loss. We performed this study to further understand how early onset hearing loss is related with the aging process of the cochlea. METHODS: We compared C57 cochlear pathology and its accompanying apoptotic processes to those in CBA mice. Hearing thresholds and outer hair cell functions have been evaluated by auditory brainstem response (ABR) recordings and distortion product otoacoustic emission (DPOAE). RESULTS: ABR recordings and DPOAE studies demonstrated high frequency hearing loss in C57 mice at P3mo of age. Cochlear morphologic studies of P1mo C57 and CBA mice did not show differences in the organ of Corti, spiral ganglion, or stria vascularis. However, from P3mo and onwards, a predominant early outer hair cell degeneration at the basal turn of the cochlea in C57 mice without definitive degeneration of spiral ganglion cells and stria vascularis/spiral ligament, compared with CBA mice, was observed. Additionally, apoptotic processes in the C57 mice also demonstrated an earlier progression. CONCLUSION: These data suggest that the C57 mouse could be an excellent animal model for early onset 'sensory' presbycusis in their young age until P6mo. Further studies to investigate the intrinsic or extrinsic etiologic factors that lead to the early degeneration of organ of Corti, especially in the high frequency region, in C57 mice may provide a possible pathological mechanism of early onset hearing loss.

The Relationship between Korean Version of Berg Balance Scale with Ambulation Activities in Subjects with Stroke in Brain Stem and Cerebellum

OBJECTIVE: To evaluate the correlation between Korean version of Berg balance scale (K-BBS) with activities related to ambulation in subjects with stroke in brain stem and cerebellum by obtaining the cutoff value for each step of K-BBS. METHOD: We divided the step of activities related to ambulation into 4 stages; independent sitting, independent sit to stand, independent ambulation with Q (quadripod) cane and independent ambulation without any assistance. Accordingly, we measured the K-BBS and checked the activity step in 31 subjects with stroke every other week. Data were analyzed by ROC (receiver operating characteristic) curve technique to obtain each cutoff value of the K-BBS representing individual step of activities. RESULTS: The ROC analysis showed that each step of activity matched the following cutoff values: independent sitting, 5; independent sit to stand, 16; independent gait with Q cane, 25; and independent gait without any assistance, 35. CONCLUSION: K-BBS is a useful instrument in representing each step of activities related to ambulation and the cutoff values. Also, it is helpful for judging the assistance level for ambulation in subjects with stroke in brain stem and cerebellum.

The Value of Electrodiagnostic Studies Performed before and after Microvascular Decompression

OBJECTIVE: To evaluate the usefulness of electrodiagnostic studies in hemifacial spasm patients by comparing abnormal muscle response (AMR) and irregular bursting discharge (IBD) before and after the surgery of hemifacial spasm. METHOD: Fifty nine patients who had been diagnosed with hemifacial spasm and underwent microvascular decompression (MVD) were chosen. The AMR was carried out in three different ways; 1) abnormal response of orbicularis oris when stimulating the supraorbital branch of trigeminal nerve (AMR1), 2) abnormal response of mentalis when stimulating the zygomatic branch of facial nerve (AMR2) and 3) abnormal response of orbicularis oculi when stimulating the marginal mandibular branch of facial nerve (AMR3). We identified the correlation between the loss of IBD and the AMR results per each method, the results of the electrodiagnostic studies according to the onset duration, and the point of follow up time. RESULTS: The AMR and IBD decreased or disappeared after the surgery. AMR which had a significant statistical correlation with the changes of IBD, were AMR2 and AMR3. No definite changes were seen regarding the onset duration. According to the studies done during the follow up period, there was a significant reduction in lateral spread and IBD as the length of the follow up period lengthened. CONCLUSION: Investigation of pre- and postoperative electrodiagnostic study, especially abnormal muscle response (facio- facial reflex) is very helpful in predicting the outcome of operation and the overall prognosis.