Expression of Toll-Like Receptor Messenger Ribonucleic Acid in the Distal Facial Nerve After Facial Nerve Injury / 대한이비인후과학회지

Background and Objectives@#This study aimed to evaluate whether Toll-like receptors (TLRs) messenger ribonucleic acid (mRNA) were expressed in the facial nerve after incurring a crush or an injury of the facial nerve.Materials and Method An adult Sprague-Dawley underwent a crush or injury of the unilateral facial nerve. The crush or injury was incurred by a cutting at the midpoint between the facial nerve trunk and its branch. The whisker movement of vibrissae muscle was examined 4 and 14 days after injury. Real-time polymerase chain reaction was performed for the normal facial nerve taken from the left side and the damaged nerve taken from the right side. @*Results@#On the 4th day of injury, the expression of TLR 9, 13 mRNA was significantly lower in the crush and injured groups than in the control group (p<0.05). On the 14th day of injury, the expression of TLR 2 mRNA was significantly higher in the injured group than in the control group (p<0.05). @*Conclusion@#The expressions of TLR 9, 13 mRNA in the distal facial nerve after injury in the crush and injured groups were significantly lower than that in the control group, but the expression of TLR 2 mRNA in the injured group was significantly higher. Therefore, TLRs may be involved in facial nerve damage and regeneration.

A Study of Otologic Symptoms and Prognosis in Patients With Ramsay Hunt Syndrome and Bell’s Palsy / 대한이비인후과학회지

Background and Objectives@#Although several studies have compared the characteristics of Ramsay Hunt syndrome (RHS) with Bell’s palsy (BP), the differences in comorbid symptoms and prognosis according to symptoms have not been determined. This study therefore evaluated the differences in otologic symptoms and prognosis between patients with these two conditions.Subjects and Method The medical records of 118 patients with RHS and 215 patients with BP were retrospectively reviewed. Factors compared in these two groups included otologic symptoms, general health condition, electroneurography (ENoG) and House-Brackmann grades. @*Results@#Age, sex, body mass index, lipid profiles, ENoG, rate of diabetes, and side of palsy did not differ significantly between patients with RHS and BP (p>0.05). The rates of hearing disturbance, tinnitus, vertigo, and postauricular pain were significantly higher in RHS (p0.05). Additionally, in patients with facial paralysis, diabetes was associated with hearing disturbance and vertigo symptoms and dyslipidemia was associated with postauricular pain (p<0.05 each). @*Conclusion@#Otologic symptoms were more common in RHS than in BP. However, the prognosis of RHS and BP were not related to otologic symptoms. In patients with facial palsy hearing disturbance and vertigo were associated with diabetes and hypertension. Also, dyslipidemia was associated with post auricular pain.

Comparison of Autophagy mRNA Expression between Chronic Otitis Media With and Without Cholesteatoma

Background and Objectives@#Autophagy is known to be associated with pathogen infection. However, the expression of autophagy-related proteins has not been studied in chronic otitis media without cholesteatoma (COM) or with cholesteatoma (CholeOM). This study aimed to determine whether there is a difference between COM and CholeOM in autophagy-related gene mRNA expression. @*Subjects and Methods@#For 47 patients with chronic otitis media, the inflammatory tissues were classified into granulation tissue (COM) or cholesteatoma (CholeOM) according to biopsy results. @*Results@#PI3K mRNA expression (COM vs. CholeOM, mean±SD, 0.009±0.010 vs. 0.003±0.004; p=0.004) was lower, whereas Beclin-1 mRNA expression (0.089±0.107 vs. 0.176±0.163; p=0.034) was higher in the CholeOM group. Expression of PI3K mRNA in the CholeOM group was lower than that in the COM subgroups with presence of bacteria (0.022±0.019 vs. 0.001±0.001; p=0.001), otorrhea (0.049±0.068 vs. 0.003±0.004; p=0.004), and hearing loss over 40 dB (0.083±0.130 vs. 0.003±0.004; p=0.005). @*Conclusions@#The data suggested that different autophagy proteins play important roles in chronic otitis media according to the presence or absence of cholesteatoma.

Association Between High Neutrophil to Lymphocyte Ratio and Delayed Recovery From Bell's Palsy

OBJECTIVES: Factors predictive of the severity of and recovery from Bell's palsy remain unclear. This study evaluated the association between neutrophil to lymphocyte ratio (NLR) and the severity of and recovery from Bell's palsy. METHODS: This retrospective study included 51 patients who were hospitalized with Bell's palsy from 2015 to 2017. Degree of paralysis was assessed by House-Brackmann (H-B) grade. Patients with H-B grades 2–4 were classified as having mild to moderate palsy and patients with H-B grade 5 or 6 were classified as having severe palsy. Patients were evaluated for obesity, hypertension and diabetes mellitus, and blood tests were performed to determine NLR and platelet to lymphocyte ratio. Patients were treated with steroids and antiviral agents. H-B grade was assessed 1 week, 1 month, and 3 months after treatment. RESULTS: NLR was significantly higher in patients with severe than with mild to moderate palsy (P=0.048). Recovery time was significantly longer in patients with high NLR than low NLR (P=0.045). CONCLUSION: Higher NLR in patients with Bell's palsy was associated with longer recovery time. NLR may be prognostic of recovery time in patients with Bell's palsy.

Decreased Aquaporin 4 and 6 mRNAs in Patients With Chronic Otitis Media With Otorrhea

OBJECTIVES: Aquaporins (AQPs) are integral membrane proteins engaged in the modulation of water homeostasis, but the roles they play in chronic otitis media (COM) have not been well investigated. Accordingly, we undertook document relations between the mRNA expressions of AQPs and COM, and explored the relation between these expressions and otorrhea, which is one of the most common symptoms of COM. METHODS: Levels of the mRNAs of AQP 1, 2, 3, 4, 5, 6, 8, and 10 were assayed by real-time polymerase chain reaction in inflammatory tissue samples from 81 patients with COM with or without otorrhea. Relationships between AQP mRNA levels and the presence or absence of otorrhea, the presence or absence of bacteria, hearing threshold levels, types of hearing loss, and clinical manifestations were also evaluated. RESULTS: AQP 1, 2, 3, 4, 5, 6, 8, and 10 mRNAs were expressed in inflammatory tissues obtained from all 81 patients with COM with or without otorrhea. AQP 5 mRNA was most expressed in, followed in descending order by AQP 3, 1, 10, 6, 8, 2, and 4. There were no significant intergroup differences in terms of age, sex, duration of illness, levels of hearing loss in both ears, or incidences of conductive or sensorineural hearing loss. However, AQP 4 (P=0.035) and 6 (P=0.085) mRNA levels were significantly lower in the otorrhea group. In addition, bacteria culture positivity (P=0.014) and the incidence of sensorineural hearing loss (P=0.020) were higher in the otorrhea group. CONCLUSION: AQP 1, 2, 3, 4, 5, 6, 8, and 10 are involved in the development of COM. Specifically, it shows reductions in AQP 4 and 6 mRNA levels, as observed in the otorrhea group, have an effect on the clinical manifestations of COM.

Clinical Characteristics and Short-term Outcomes of Acute Low Frequency Sensorineural Hearing Loss With Vertigo

OBJECTIVES: This study analyzed short-term prognosis in patients with acute low frequency hearing loss (ALHL), and also investigate hearing recovery rates in patients with ALHL accompanied vertigo. METHODS: Retrospective medical record review of the patients who received treatment for ALHL between June 2005 and June 2015 were analyzed. Of the 84 patients, 53 were without vertigo, and 31 were with vertigo. Of the 31 patients, eight were treated with steroids, seven with diuretics alone, and 16 with both. Clinical and auditory characteristics before and after treatment were compared in these three groups. RESULTS: Pure tone audiometry after 8 weeks of treatment showed that patients with vertigo had significantly higher than patients without vertigo (P=0.020). Patients with vertigo who recovered from ALHL had a greater tendency to receive early treatment than patients who did not recover. Patients who received the two steroid therapy groups (steroids alone and steroids plus diuretics) had a higher recovery rate than patients who received diuretics alone (P=0.043 and P=0.037, respectively). CONCLUSION: The prognosis of patients with ALHL is worse in those with vertigo compared to without vertigo. The hearing recovery rate in patients with vertigo tends to be higher in those treated with steroids than with diuretics alone.

Microbiological Results From Middle Ear Effusion in Pediatric Patients Receiving Ventilation Tube Insertion: Multicenter Registry Study on the Effectiveness of Ventilation Tube Insertion in Pediatric Patients With Chronic Otitis Media With Effusion: Part

OBJECTIVES: The aim of this multicenter registry study was to investigate the effectiveness of ventilation tube insertion and the microbiology of otitis media with effusion (OME) in children. This part I study was conducted to evaluate the microbiological profile of children with OME who needed ventilation tube insertion. METHODS: Patients < 15 years old who were diagnosed as having OME and received ventilation tube insertion were prospectively enrolled in 16 tertiary hospitals from June 2014 to December 2016. After excluding patients with missing data, the data of 397 patients were analyzed among a total of 433 enrolled patients. The clinical symptoms, findings of the tympanic membrane, hearing level, and microbiological findings were collected. RESULTS: In 103 patients (25.9%), antibiotics were used within 3 weeks before surgery. Ventilation tube insertion was performed in a total of 710 ears (626 in both ears in 313 patients, 55 in the left ear only, and 29 in the right ear only). Culture of middle ear effusion was done in at least one ear in 221 patients (55.7%), and in a total of 346 ears. Only 46 ears (13.3%) showed positive results in middle ear effusion culture. Haemophilus influenzae (17.3%, followed by coagulase-negative Staphylococcus and Staphylococcus auricularis) was the most common bacteria detected. CONCLUSION: H. influenzae was the most commonly found bacteria in middle ear effusion. Relatively low rates of culture positivity were noted in middle ear effusion of patients with OME in Korea.

Clinical Characteristics of the Patients with Dizziness after Car Accidents / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: With increasing frequency of car accidents, patients of dizziness caused by car accidents are also increasing. Various types of dizziness or vertigo can occur from car accidents depending on different injury mechanisms. Since accurate diagnosis is important for providing proper treatments, we evaluated clinical characteristics related to vestibular function of patients with dizziness caused car accidents. SUBJECTS AND METHOD: In this retrospective case review study that runs from January 2011 to March 2013, a total of 82 patients with dizziness following car accident were enrolled consecutively. We analyzed the final diagnosis of dizziness according to different mechanisms of injury during car accident through clinical record review. Patients who developed dizziness within one month of car accident were included, excluding those who had temporal bone fracture and previous history of dizziness. RESULTS: Of the different types observed, 36.6% was head injury, 24.4% whiplash injury, 3.7% complex injury, 2.4% others and the rest was unknown. In the final diagnosis, the different types included 36.6% benign paroxysmal positional vertigo (BPPV), 23.2% unclassifiable dizziness, 18.3% cervical vertigo, 7.3% labyrinthine concussion, 3.7% BPPV with labyrinthine concussion and the rest was others. Of the different types of dizziness symptoms, 58.5% was headache, 45.1% was audiologic symptoms, and others included earfullness, tinnitus and hearing disturbance. Tinitogram and pure tone audiogram results show that 2.9% (27 people) of patients have tinnitus and 7.3% (6 people) have hearing disturbance. CONCLUSION: An accurate diagnosis and timely management would be very important in forming a proper approach for post traumatic vertigo patients.

Effect of Age and Severity of Facial Palsy on Taste Thresholds in Bell's Palsy Patients

BACKGROUND AND OBJECTIVES: To investigate whether taste thresholds, as determined by electrogustometry (EGM) and chemical taste tests, differ by age and the severity of facial palsy in patients with Bell's palsy. SUBJECTS AND METHODS: This study included 29 patients diagnosed with Bell's palsy between January 2014 and May 2015 in our hospital. Patients were assorted into age groups and by severity of facial palsy, as determined by House-Brackmann Scale, and their taste thresholds were assessed by EGM and chemical taste tests. RESULTS: EGM showed that taste thresholds at four locations on the tongue and one location on the central soft palate, 1 cm from the palatine uvula, were significantly higher in Bell's palsy patients than in controls (p0.05). The severity of facial palsy did not affect taste thresholds, as determined by both EGM and chemical taste tests (p>0.05). The overall mean electrical taste thresholds on EGM were higher in younger Bell's palsy patients than in healthy subjects, with the difference at the back-right area of the tongue differing significantly (p0.05). CONCLUSIONS: Electrical taste thresholds were higher in Bell's palsy patients than in controls. These differences were observed in younger, but not in older, individuals.

Factors Prognostic of Season-Associated Sudden Sensorineural Hearing Loss: A Retrospective Observational Study

BACKGROUND AND OBJECTIVES: This study examined whether the prognosis of sudden deafness was dependent on the time of onset and evaluated the factors affecting prognosis during each period. SUBJECTS AND METHODS: Patients who developed sudden hearing loss from January 2005 to December 2015 were evaluated retrospectively. Meteorological data were obtained from the official website of the Korea Meteorological Administration. Factors prognostic of hearing recovery rate were analyzed. RESULTS: The hearing recovery rate of the 318 patients who developed sudden deafness did not differ significantly by month. Mean temperature and daily temperature range at onset of sudden deafness were not associated with recovery rate. CONCLUSIONS: The recovery rate in patients with sudden deafness did not differ markedly by season.

The Author's Response: the Bacterial Etiology of Otitis Media and Specimen Collection

No abstract available.

Bacterial Species and Antibiotic Sensitivity in Korean Patients Diagnosed with Acute Otitis Media and Otitis Media with Effusion

Changes over time in pathogens and their antibiotic sensitivity resulting from the recent overuse and misuse of antibiotics in otitis media (OM) have complicated treatment. This study evaluated changes over 5 years in principal pathogens and their antibiotic sensitivity in patients in Korea diagnosed with acute OM (AOM) and OM with effusion (OME). The study population consisted of 683 patients who visited the outpatient department of otorhinolaryngology in 7 tertiary hospitals in Korea between January 2010 and May 2015 and were diagnosed with acute AOM or OME. Aural discharge or middle ear fluid were collected from patients in the operating room or outpatient department and subjected to tests of bacterial identification and antibiotic sensitivity. The overall bacteria detection rate of AOM was 62.3% and OME was 40.9%. The most frequently isolated Gram-positive bacterial species was coagulase negative Staphylococcus aureus (CNS) followed by methicillin-susceptible S. aureus (MSSA), methicillin-resistant S. aureus (MRSA), and Streptococcus pneumonia (SP), whereas the most frequently isolated Gram-negative bacterium was Pseudomonas aeruginosa (PA). Regardless of OM subtype, ≥ 80% of CNS and MRSA strains were resistant to penicillin (PC) and tetracycline (TC); isolated MRSA strains showed low sensitivity to other antibiotics, with 100% resistant to PC, TC, cefoxitin (CFT), and erythromycin (EM); and isolated PA showed low sensitivity to quinolone antibiotics, including ciprofloxacin (CIP) and levofloxacin (LFX), and to aminoglycosides. Bacterial species and antibiotic sensitivity did not change significantly over 5 years. The rate of detection of MRSA was higher in OME than in previous studies. As bacterial predominance and antibiotic sensitivity could change over time, continuous and periodic surveillance is necessary in guiding appropriate antibacterial therapy.

Refractory Granulomatosis with Polyangiitis Presenting as Facial Paralysis and Bilateral Sudden Deafness

Granulomatosis with polyangiitisis [(GPA) or Wegener granulomatosis] is a multi-system disease characterized by granuloma formation and necrotizing vasculitis. GPA classically shows involvement of the respiratory tracts and the renal system. However, locoregional disease is common and may include otologic manifestations. Although otologic involvement can occur during the course of GPA, no report has described facial palsy with sudden sensorineural total deafness with vertigo as the presenting feature of GPA. This case describes a patient with multiorgan involving resistant form of GPA initially presenting with bilateral profound sudden sensorineural hearing loss and left facial paralysis with vertigo. The condition responded well to treatment with rituximab.

Characteristics of Patients with Hearing Aids according to the Degree and Pattern of Hearing Loss

BACKGROUND AND OBJECTIVES: This study was designed to assess the characteristics of patients according to the degree and audiogram shape of hearing loss and the association of these characteristics with hearing aids (HA) choice, return rate, and cause of return. SUBJECTS AND METHODS: This study included 460 individuals who received HAs from 2011 to 2015. The relationships between type of HA and age, primary and accompanying symptoms, HA choice and return and cause of return were evaluated according to the degree and pattern of hearing loss. RESULTS: HA type did not differ significantly according to the degree and pattern of hearing loss. Intensity of hearing loss was greater in male than in female (p<0.05). Open and completely-in-canal types of HA decreased with age (p<0.05). As degree of hearing loss intensified, behind-the-ear and in-the-ear types increased and Open type decreased (p<0.05). The HA return rate was 9.7%, but was not associated with degree or pattern of hearing loss. The main causes of HA return were costs, psychological fears and adaptive failure. CONCLUSIONS: Choice of HA is affected by age, sex, and degree and pattern of hearing loss. HA for hearing rehabilitation in patients with hearing loss can be personalized according to each patient's characteristics and tendencies.

Relationship Between Otorhinolaryngologic Diseases and Obesity

OBJECTIVES: Obesity rates have been increasing for all population groups worldwide, leading to the increased development of various diseases. This study was designed is to identify the relationships between obesity and several important otorhinolaryngologic diseases, including chronic otitis media (COM), chronic rhinosinusitis, and chronic tonsillitis. METHODS: Mean body mass index (BMI) was compared in patients with COM, rhinosinusitis, and tonsillitis and in a control group. The relationships among the prevalence rates of overweight and obesity, morbidity period, and BMI were assessed in each group. RESULTS: Mean BMIs in the COM, rhinosinusitis, and tonsillitis groups were 24.45+/-2.72 kg/m2, 24.68+/-3.25 kg/m2, and 24.67+/-3.82 kg/m2, respectively, with each significantly higher than in the control group (23.22+/-3.01 kg/m2, P0.05 each). CONCLUSION: Mean BMI and the prevalence of obesity were elevated in the three groups of patients with representative otorhinolaryngologic inflammatory diseases, including COM, chronic rhinosinusitis, and chronic tonsillitis.

Clinical Differences in Types of Otalgia

BACKGROUND AND OBJECTIVES: Although otalgia is usually associated with ear problems, it may also originate outside the ear. We therefore assessed the clinical characteristics of patients with otalgia. SUBJECTS AND METHODS: We analyzed 294 patients who presented with otalgia. We assessed differences in otalgia between adults and children, differences in otogenic vs. referred otalgia between adults and children, differences between men and women. RESULTS: Of the 294 patients, 208 (70.7%) had otogenic otalgia and 86 (29.3%) had referred otalgia. Hearing disturbance and otorrhea were significantly more common in otogenic otalgia, whereas rhinorrhea, sore throat, and postnasal drip were significantly more common in referred otalgia. Children were more likely to have otogenic otalgia than adults. The proportion of patients with referred otalgia was significantly higher in adults than in children (p<0.05). Otogenic otalgia was more common in men, whereas referred otalgia was more common in women. Among patients with referred otalgia, neuralgia was significantly more frequent in women than in men (p<0.05). CONCLUSIONS: Otogenic otalgia was more frequent in men than in women and in children than in adults, whereas referred otalgia was more frequent in women and adults, indicating that types of otalgia were dependent on age and gender.

Presbycusis / 한양의대학술지

Presbycusis is gradual hearing loss in both ears that commonly occurs as people age. Presbycusis is a complex phenomenon characterized by audiometric threshold shift, deterioration in speech-understanding and speech-perception difficulties in a noisy environment. Factors contributing to presbycusis include mitochondria DNA mutation, genetic disorders, hypertension, diabetes, metabolic disease and other systemic diseases in the intrinsic aspects. Extrinsic factors include noise, ototoxic medication and diet. However, presbycusis may not be related to the intrinsic and extrinsic factors separately. Presbycusis can greatly affect one's quality of life; impaired hearing restricts communication and untreated presbycusis could result in social isolation and even depression. Current amplification methods related to auditory rehabilitation can provide improved communication ability to users. Nevertheless, only a minority of elderly people with impaired hearing use hearing aids. The purpose of this review is to raise the awareness of presbycusis, to update our current understanding of presbycusis with a focus on age-related deficits in auditory and cognitive processing of speech and to explore strategies of prevention, identification, amplification, and aural rehabilitation. The ultimate goal is to improve the quality of hearing health care and the overall quality of life of older adults.

Trichofolliculoma in External Auditory Canal / 대한이비인후과학회지

Trichofolliculoma is an uncommon follicular hamartoma of hair follicle tissue, typically occurring on the face and skin of the head and neck and appearing as papules or nodules. Dents in the central portion and immature white hair may be observed. Asymptomatically, trichofolliculoma occurs at any age but rather frequently in adults in many cases. A 47-year-old man presented a right ear canal mass, which had not been treated for 12 years. The tumor began to increase its size 4 years ago. A little red bump blocked the entrance of the right external auditory canal and there was a little dinge at the center of bump with growing black hair. This case was first reported in our country. Thus, we report this rare case with a review of the literature.

Influence of Head and Neck Muscle Contraction on Tinnitus / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tinnitus can be classified into two types, otogenic and somatic tinnitus. Somatic tinnitus can occur even when the ear is normal, as it is known that tinnitus can occur after there is movement in the muscles of the head and neck. This study aims to characterize tinnitus and clarify the nature of tinnitus when it occurs from the contraction of the head and neck muscle. SUBJECTS AND METHOD: Thirty-five people with normal hearing, who had no history of otitis media or inner ear disease, were taken as subjects. First, we investigated whether the natural tinnitus occurred or not in the silent environment and checked its characteristics for five minutes. We then implemented eight different kinds of muscle contractions maneuver and measured whether the tinnitus occurred and the recorded the onset time, duration and location of the occurrence of the tinnitus. RESULTS: Among the total of 35 subjects inspected, 15 (42.9%) people felt the natural tinnitus. In terms of natural tinnitus, ringing was the most common characteristic and heard most often from both sides. Twenty (57.1%) subjects out of total 35 subjects inspected felt tinnitus after the contraction of the head and neck muscles. Tinnitus after the resistance to a force applied by the people to the occiput was the most common for 14 (40.0%) people, followed by parietal and right temporal area. The most common location was the left side for 6 (17.1%) subjects followed by right side and both sides. For the type of tinnitus after the contraction of muscles, ringing was observed the most by 6 (17.1%) subjects, followed by high frequency and pulsatile sound. The average onset time of the tinnitus was 8.8 seconds and the average duration was 29.6 seconds. CONCLUSION: The study showed that the muscle contraction of head and neck affects the occurrence of tinnitus for people who had no tinnitus. By clarifying the occurrence of tinnitus due to the contraction of muscles, the study identified the basic features of hearing and the role of the somatic tinnitus.

Changing Patterns of Bacterial Strains in Adults and Children With Otitis Media in Korean Tertiary Care Centers

OBJECTIVES: Otitis media (OM) is an infectious disease that affects all age brackets. Aural discharge is a typical symptom, occurring in all subtypes of OM. We have compared the identity and antibiotic sensitivity of bacteria isolated from aural discharges of adults and children with various types of OM, including acute OM (AOM), OM with effusion (OME), chronic OM (COM), and cholesteatomatous OM (CSOM). METHODS: The study involved 2,833 patients who visited five tertiary hospitals between January 2001 and December 2010 and were diagnosed with AOM, OME, COM, or CSOM. The patients were divided into a pediatric group and an adult group, and the distribution of cultured bacteria and their antibiotic sensitivity were compared in the two groups. RESULTS: Bacterial detection rates were higher in adults than in children with OME and COM (P=0.000 each). The majority of the bacteria cultured from patients with AOM and OME bacteria were methicillin-susceptible Staphylococcus aureus (MSSA) and Streptococcus pneumoniae. Bacteria cultured from children were more susceptible to antibiotics (P=0.002) and had higher antibiotic sensitivity (P=0.001) than were bacteria cultured from adults. The majority of bacteria culture from patients with COM and CSOM were MSSA and pathogenic Pseudomonas aeruginosa. The frequency of methicillin-resistant Staphylococcus aureus was significantly higher in adults than in children, and more strains of bacteria isolated from adults were sensitive to the antibiotics septrin, vancomycin, and teicoplanin. CONCLUSION: Bacteria cultured from children were more susceptible to antibiotics and had higher antibiotic sensitivity than did bacteria cultured from adults.