Two Cases of Intra-Operative Cardiac Arrhythmia During Balloon Eustachian Tuboplasty: The Mechanism and Treatment / 대한이비인후과학회지

Balloon eustachian tuboplasty (BET), a surgical technique to expand the cartilaginous portion of the eustachian tube by ballooning via opening at the nasopharynx, has been introduced as a useful surgical modality for eustachian tube dysfunction patients. Although BET is known as a relatively safe procedure, we recently have experienced two cases of cardiac complications during balloon inflation. In one case, an asystole occurred for 13 seconds during this procedure; the heart rate was recovered after balloon deflation with an intravenous injection of glycopyrrolate and atropine. In the other case, bradycardia occurred and continued during BET. Heart rate was recovered immediately after deflation of balloon without drug injection. As far as we know, this is the first report of cardiac complications during BET, probably related with trigemino-cardiac reflex. In both cases, no other sequelae remained after the surgery. We report these two cases of cardiac complications that occurred during BET along with a review of literature.

Safety and Efficacy of Mastoidoplasty With Demineralized Bone Matrix in Canal Wall Down Mastoidectomy: A Pilot Study / 대한이비인후과학회지

Background and Objectives@#The canal wall down mastoidectomy brings changes in the anatomy of the external auditory canal (EAC), causing potential problems, such as accumulated crust, vertigo attacks, and difficulties in wearing hearing aids (HAs). The objective of this study is to evaluate the safety and efficacy of mastoidoplasty using the demineralized bone matrix (DBM) to obliterate the mastoidectomized cavity and reconstruct EAC.Subjects and Method Medical records of patients with chronic otitis media with or without cholesteatoma who received mastoidoplasty using DBM by a single surgeon at Seoul St. Mary’s hospital between 2014 and 2021 were reviewed retrospectively. @*Results@#A total of 27 patients were included in this study. None of the patients showed any recurrence of cavity problem, wound infection, or any other complications during their followup period of 13.07±37 months. The average air and bone conduction hearing level of pure tone audiometry showed no significant change after surgery (p=0.50, p=0.54, respectively). Five patients indicated for hearing rehabilitation could adopt canal type HAs after surgery; six patients used completely-in-the canal type HAs, and one patient used in-the-canal type HAs. None of the patients using HAs complained of acoustic feedback or any other problem in wearing HAs. @*Conclusion@#Mastoidoplasty using DBM seems to be a very safe and effective surgical procedure that shows functionally acceptable EAC for hearing rehabilitation with canal type HAs and demonstrates no specific complication.

Surgical Outcomes of Sigmoid Sinus Resurfacing for Pulsatile Tinnitus: The Predictive Value of the Water Occlusion Test and Imaging Studies

Objectives@#. Sigmoid sinus resurfacing (SS-R) is one of the most effective surgical treatments for patients with pulsatile tinnitus (PT) originating from anatomical variants of the vascular walls in the temporal bone. This study aimed to provide updated information on the clinical outcomes of SS-R and evaluate the efficacy of the water occlusion test (WOT) as an additional diagnostic modality. @*Methods@#. We retrospectively reviewed medical records including tinnitus questionnaires, temporal bone computed tomography (TBCT) scans, audiologic tests, and preoperative WOT results from patients who underwent SS-R. @*Results@#. In total, 26 patients were included in the study. The mean age was 44 years, and the mean symptom duration was 3 months. Fourteen patients (53.8%) were completely cured, seven (26.9%) significantly improved, and five (19.2%) remained stable. The mean visual analog scale loudness score decreased from 5.26 to 1.34 (P<0.001) and the mean Tinnitus Handicap Inventory score also improved from 50.23 to 5.5 (P<0.001) after SS-R surgery. In 10 patients with discrepancies between the preoperative TBCT and intraoperative findings, WOT showed a significant additive effect in predicting surgical outcomes. No patients experienced severe intraoperative or postoperative complications during the entire follow-up period. @*Conclusion@#. SS-R provides significant symptom improvement in patients with sigmoid sinus dehiscence who had a positive WOT without other sigmoid sinus variants. A combined diagnostic approach with TBCT, WOT, and intraoperative findings is crucial for achieving better surgical outcomes in patients with PT caused by sigmoid sinus variants.

Treatment Efficacy of Various Maneuvers for Lateral Canal Benign Paroxysmal Positional Vertigo With Apogeotropic Nystagmus: A Randomized Controlled Trial

Objectives@#The aim of this study was to determine the most effective treatment approach by comparing the impacts of various otolith reduction techniques in patients with apogeotropic lateral semicircular canal benign paroxysmal positional vertigo (LC-BPPV). @*Methods@#We performed a multicenter randomized prospective study from January to December 2015, involving 72 consecutive patients with apogeotropic LC-BPPV. The patients were divided into three treatment groups: therapeutic head-shaking (group A), the Gufoni-Appiani maneuver (group B), and the cupulolith repositioning maneuver (CuRM; group C). Each group underwent evaluation and treatment up to the fourth week. Treatment success was defined as the disappearance of positional vertigo and nystagmus. @*Results@#This study included 72 patients (49 male and 23 female), with a mean (±standard deviation) age of 55.4±13.5 years. The mean duration of vertigo experienced prior to treatment was 3.9±4.4 days. The mean latency and duration of nystagmus were 2.7±3.0 seconds and 47.9±15.8 seconds, respectively. The overall treatment frequency was 2.0±0.9. The number of treatments differed significantly among the three groups (P0.05). However, CuRM was the only method with a 100% treatment success rate. @*Conclusion@#While no clear difference was observed among the three treatments for LC-BPPV, CuRM was found to be superior to the other approaches in the long term.

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.

Results of Active Middle Ear Implantation in Patients With Mixed Hearing Loss After Middle Ear Surgery: A Prospective Multicenter Study (the ROMEO Study)

Objectives@#. This study was conducted to evaluate the user satisfaction, efficacy, and safety of round window (RW) vibroplasty using the Vibrant Soundbridge (VSB) in patients with persistent mixed hearing loss after mastoidectomy. @*Methods@#. The study included 27 patients (mean age, 58.7 years; age range, 28–76 years; 11 men and 16 women) with mixed hearing loss after mastoidectomy from 15 tertiary referral centers in Korea. The VSB was implanted at the RW. The Korean translation of the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire and the Korean version of the International Outcome Inventory for Hearing Aids (K-IOI-HA) questionnaire were used to evaluate user satisfaction as the primary outcome. The secondary outcome measures were audiological test results and complication rates. @*Results@#. The mean scores for ease of communication (61.3% to 29.7% to 30.2%), reverberation (62.1% to 43.1% to 37.4%), and background noise (63.3% to 37.7% to 34.3%) subscales of the APHAB questionnaire significantly decreased after VSB surgery. The mean K-IOI-HA scores at 3 and 6 months after surgery were significantly higher than the mean preoperative score (18.6 to 27.2 to 28.1). The postoperative VSB-aided thresholds were significantly lower than the preoperative unaided and hearing aid (HA)-aided thresholds. There was no significant difference between preoperative unaided, preoperative HA-aided, and postoperative VSB-aided maximum phonetically balanced word-recognition scores. None of the 27 patients experienced a change in postoperative bone conduction pure tone average. One patient developed temporary facial palsy and two developed surgical wound infections. @*Conclusion@#. RW vibroplasty resulted in improved satisfaction and audiological test results in patients with mixed hearing loss after mastoidectomy, and the complication rate was tolerable.

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.

Otoplastic Surgery for Calcified Auricular Deformity / 대한이비인후과학회지

Auricular hematoma is one of the most common problems among people who have got repetitive blunt trauma to the external ear. Prompt managements are drainage of hematoma and following prevention of re-accumulation (e.g. compression dressing). If the treatment is not successful, many complications can occur, including perichondritis, infection and necrosis. Especially long-lasting loss of blood supply to the ear cartilage and formation of neocartilage from disrupted perichondrium can result in cauliflower ear deformity. There were some studies trying to classify and to treat the cauliflower ear by the degree of deformities. And excision of deformed cartilage with reshaping of the auricle has been reported several times. In this article, we would like to introduce a successful drilling technique of otoplasty as a useful treatment option.

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 Intralabyrinthine Schwannoma Removal and Sequential BonebridgeTM Implantation / 대한이비인후과학회지

Intralabyrinthine schwannoma (ILS) is a rare benign tumor that arises within the membranous labyrinthine. Since hearing loss is inevitable after tumor removal in most cases, an appropriate rehabilitation method should be considered. A 41-year-old male, who was diagnosed with ILS underwent tumor removal via translabyrinthine approach, has subsequently experienced right-side deafness as a result. Seventeen months after the tumor removal, a surgery for hearing rehabilitation was performed. Since cochlear implantation was not doable due to cochlear ossification, an active transcutaneous bone conduction implant (BonebridgeTM , MEDEL) was placed at the sinodural angle. To the best of our knowledge, this is the first report describing hearing rehabilitation with BonebridgeTM implantation after ILS removal.

The Mediating Effect of Psychological Distress on the Association between BDNF, 5-HTTLPR, and Tinnitus Severity

Objective@#To investigate the association between genetic polymorphisms of brain-derived neurotrophic factor (BDNF) or serotonin transporter gene-linked polymorphic region (5-HTTLPR) and tinnitus, and the mediating effects of psychological distress on this association. @*Methods@#Eighty-six patients experiencing tinnitus and 252 controls were recruited. The Tinnitus Handicap Inventory was used to assess the severity of tinnitus and the Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory-II (BAI-II), and the Korean version of the Brief Encounter Psychosocial Instrument (BEPSI-K) were used to assess psychological distress. We compared the association of BDNF rs6265 (Val66Met) and 5-HTTLPR variants in the two groups. The mediating effects of BDI-II, BAI-II, and BEPSI-K were examined using multiple regression analysis and validated by the Sobel test and bootstrapping. @*Results@#No significant differences were found between the groups regarding BDNF Val66Met and 5-HTTLPR, but the 5-HTTLPR variants trended toward association. Depressive symptoms appeared to act as a mediator on the relationship within the 5-HTTLPR s/s genotype and the severity of tinnitus. @*Conclusion@#Our findings provide a speculative idea on the association between the serotonergic system and tinnitus and suggest that depressive symptoms act as a mediator in tinnitus. Therefore, screening for depressive symptoms in patients with tinnitus is essential and intervention for depressive symptoms may help alleviate the severity of tinnitus.

The Mediating Effect of Psychological Distress on the Association between BDNF, 5-HTTLPR, and Tinnitus Severity

Objective@#To investigate the association between genetic polymorphisms of brain-derived neurotrophic factor (BDNF) or serotonin transporter gene-linked polymorphic region (5-HTTLPR) and tinnitus, and the mediating effects of psychological distress on this association. @*Methods@#Eighty-six patients experiencing tinnitus and 252 controls were recruited. The Tinnitus Handicap Inventory was used to assess the severity of tinnitus and the Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory-II (BAI-II), and the Korean version of the Brief Encounter Psychosocial Instrument (BEPSI-K) were used to assess psychological distress. We compared the association of BDNF rs6265 (Val66Met) and 5-HTTLPR variants in the two groups. The mediating effects of BDI-II, BAI-II, and BEPSI-K were examined using multiple regression analysis and validated by the Sobel test and bootstrapping. @*Results@#No significant differences were found between the groups regarding BDNF Val66Met and 5-HTTLPR, but the 5-HTTLPR variants trended toward association. Depressive symptoms appeared to act as a mediator on the relationship within the 5-HTTLPR s/s genotype and the severity of tinnitus. @*Conclusion@#Our findings provide a speculative idea on the association between the serotonergic system and tinnitus and suggest that depressive symptoms act as a mediator in tinnitus. Therefore, screening for depressive symptoms in patients with tinnitus is essential and intervention for depressive symptoms may help alleviate the severity of tinnitus.

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.

Gender Differences Affecting Psychiatric Distress and Tinnitus Severity

OBJECTIVE: This study evaluated gender differences in the relationship between psychiatric distress and subjective tinnitus severity. METHODS: This cross-sectional study included 134 female and 114 male patients who visited the otology outpatient clinic at Seoul St. Mary’s Hospital for tinnitus from February to July 2015. Patients completed a series of instruments, including the Tinnitus Handicap Inventory, Beck Depression Inventory, Korean version of Brief Encounter Psychosocial Instrument (BEPSI-K), and visual analogue scales assessing various tinnitus characteristics (loudness, awareness, annoyance, and effect on life). RESULTS: Tinnitus severity did not significantly differ between the gender groups (p=0.632), and it correlated significantly with tinnitus characteristics and psychiatric distress. Partial correlations between tinnitus severity and depressive symptoms were stronger in males (r=0.411, p<0.01) than in females (r=0.304, p<0.01) while controlling for duration of tinnitus and tinnitus characteristics. However, stress (BEPSI-K) was positively correlated with tinnitus severity in only males (r=0.463, p<0.01). A multiple regression analysis revealed that effect of tinnitus on life, depressive symptoms, and stress were significantly associated with tinnitus severity in males, whereas only tinnitus annoyance and depressive symptoms were associated with tinnitus severity in females. CONCLUSION: Tinnitus severity was significantly correlated with depressive symptoms and stress, and there were gender differences in the relationship between tinnitus severity and psychiatric components. It is necessary to be vigilant of psychiatric symptoms among patients with tinnitus who visit the otology outpatient clinic, especially for male patients.

Development of a Korean-Type Qualitative Case History Tinnitus Questionnaire / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Qualitative and quantitative data of tinnitus are both important to obtain necessary information for assessing tinnitus evaluation. But contrary to quantitative questionnaire, qualitative data is not standardized in Korea. This study aimed to standardize the qualitative data of tinnitus by developing a Korean-type integrated qualitative tinnitus questionnaires. SUBJECTS AND METHOD: A cross-sectional survey of Korean otolaryngologists was performed. The questionnaires were administered to otologists who were registered as participants in the tinnitus study group of otology research interest group (ORIG). RESULTS: Most of the otologists (100% of responders) have used the quantitative tinnitus questionnaire measurement (90.5%), but only 76% have used qualitative tinnitus questionnaire. From the responses of otologists who regularly use qualitative questionnaire, 25 items were adopted from the 35 item list. Questionnaire items were selected according to the frequency of listed items in the individual lists. CONCLUSION: We made a qualitative questionnaire consisting of 25 items that were essential and widely accepted. We expect this work will integrate and standardize qualitative tinnitus questionnaires in Korea.

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.

Swing-Door Overlay Tympanoplasty: Surgical Technique and Outcomes

OBJECTIVES: The classical overlay tympanoplasty is technically difficult with some disadvantages and thus less popular. However, it is particularly useful for large, anterior perforations. In this study, we describe the technique of a modified overlay graft in the tympanoplasty coined as the swing-door overlay tympanoplasty and report its outcomes. METHODS: Retrospective review of patients undergoing the swing-door overlay tympanoplasty at a tertiary referral center between 2003 and 2016 was performed. Patient who had ossicular abnormality, previous tympanoplasty, and profound hearing loss were excluded. The surgical technique is described in detail. The outcomes were evaluated by the graft success rate, complication rate, and hearing results. The hearing level was determined by four pure-tone average at 0.5, 1, 2, and 4 kHz. Air-bone gap closure was mainly assessed. RESULTS: A total of 306 patients (110 males and 196 females) were included. The mean age was 49.1±16.6 years. Follow-up periods ranged from 6 to 108 months with an average of 18.4 months. The overall graft success rate reached 98.4%. Five graft failures occurred with reperforation in three cases and lateralization in two cases. Postoperative complications occurred in 12 cases (3.9%). Air-bone gap changes (closures) were 7.8±12.8, 5.2±12.2, 5.7±10.2, and 6.0± 12.8 dB at 0.5, 1, 2, and 4 kHz, respectively (all P < 0.001) with an average improvement of 6.2 dB. Postoperative airbone gap was closed to ≤20 dB in 86.9%. CONCLUSION: The swing-door overlay tympanoplasty is a highly successful surgical technique suitable for all types of tympanic membrane perforations. This approach is technically easier than classical overlay tympanoplasty and affords an excellent graft success rate with satisfying hearing results.

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.