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Objectives@#. Endoscopic tympanoplasty (ET) provides minimally invasive transcanal access to the middle ear and improves middle ear visibility for the treatment of tympanic membrane (TM) perforations. However, the literature on surgical outcomes for large TM perforations is lacking and limited to small series. This study aimed to evaluate the clinical benefits of ET for large TM perforations. @*Methods@#. This retrospective cohort study was conducted at nine tertiary referral hospitals in South Korea, where 252 patients who underwent ET as primary surgery from September 2019 to August 2021 were included. The outcome measures included the graft success rate and pre- and postoperative audiometric data. @*Results@#. In 239 patients, the graft success rate of ET for large or subtotal perforations was 86.2% (206 patients), while the graft failure rate was 13.8% (33 patients). The graft failure rate was directly correlated with surgical techniques, including overlay and medial or lateral underlay tympanoplasty (P=0.027). Lateral underlay tympanoplasty showed the most favorable results. Sex, laterality, etiology, site and size of perforation, operation time, and graft materials did not vary significantly between the graft success and failure groups (P>0.05). The mean air-bone gap (ABG) improved significantly in both groups (graft success group: 10.0±0.6 dB and graft failure group: 7.7±0.3 dB; P<0.001). However, the ABG improvement did not significantly differ between the groups. Analysis of covariance revealed that the postoperative 500-Hz bone conduction threshold improved after successful ET (adjusted coefficient, –11.351; 95% confidence interval, –21.491 to –1.212; P=0.028). @*Conclusion@#. This study involved the largest population to date of large TM perforations treated by ET. The study findings suggest that ET is feasible and effective in treating large TM perforations.
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Objectives@#. Particulate matter (PM) is a risk factor for various diseases. Recent studies have established an association between otitis media (OM) and PM exposure. To confirm this relationship, we developed a novel exposure model designed to control the concentration of PM, and we observed the effects of PM exposure on the Eustachian tube (ET) and middle ear mucosa of rats. @*Methods@#. Forty healthy, 10-week-old, male Sprague-Dawley rats were divided into 3-day, 7-day, 14-day exposure, and control groups (each, n=10). The rats were exposed to incense smoke as the PM source for 3 hours per day. After exposure, bilateral ETs and mastoid bullae were harvested, and histopathological findings were compared using microscopy and transmission electron microscopy (TEM). The expression levels of interleukin (IL)-1β, IL-6, tumor necrosis factor-α, and vascular endothelial growth factor (VEGF) in the middle ear mucosa of each group were compared using real-time reverse transcription polymerase chain reaction (RT-PCR). @*Results@#. In the ET mucosa of the exposure group, the goblet cell count significantly increased after PM exposure (P=0.032). In the middle ear mucosa, subepithelial space thickening, increased angio-capillary tissue, and inflammatory cell infiltration were observed. Moreover, the thickness of the middle ear mucosa in the exposure groups increased compared to the control group (P<0.01). The TEM findings showed PM particles on the surface of the ET and middle ear mucosa, and RT-PCR revealed that messenger RNA (mRNA) expression of IL-1β significantly increased in the 3-day and 7-day exposure groups compared to the control group (P=0.035). VEGF expression significantly increased in the 7-day exposure group compared to the control and 3-day exposure groups (P<0.01). @*Conclusion@#. The ET and middle ear mucosa of rats showed histopathologic changes after acute exposure to PM that directly reached the ET and middle ear mucosa. Therefore, acute exposure to PM may play a role in the development of OM.
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Bilateral internal auditory canal (IAC) tumors are usually pathognomonic for vestibular schwannomas in the setting of neurofibromatosis type 2 (NF2). Descriptions of bilateral nonschwannomatous IAC tumors, such as metastasis that may mimic NF2, are limited to case reports. Here, we report a case of unusual metastatic bilateral IAC tumor originating from the ovary with a rapidly progressive pattern, which we initially suspected to be NF2.
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Objectives@#. Balloon Eustachian tuboplasty (BET) is a novel treatment method for Eustachian tube dilatory dysfunction (ETD). However, surgeons cannot identify the insertion depth of the catheter during BET, resulting in potential risks such as internal carotid artery (ICA) injury. Therefore, we developed an image-guided navigation balloon catheter to identify the insertion depth of the catheter and to establish awareness of the proximity of the ICA. This study aimed to evaluate the technical feasibility of this image-guided navigation balloon catheter system in patients with ETD. @*Methods@#. Twenty-nine patients (38 ears; nine bilateral; 21 right ears, and 17 left ears) diagnosed with ETD were assessed. All patients who showed no improvement despite medical therapy with topical steroids, anti-reflux medication, and the Valsalva maneuver for a minimum of 6 weeks received image-guided navigation-assisted BET. The 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) score and Valsalva maneuver were used to evaluate patients’ symptoms preoperatively and at the postoperative follow-up. @*Results@#. Image-guided navigation-assisted BET was safely performed in all patients. The mean total ETDQ-7 score was 25.4±7.1 preoperatively, 17.5±6.2 at 1 month, and 15.2±7.0 at 6 months (P<0.001). In total, a Valsalva maneuver was possible for 28 of 38 ears (73.7%) at the time of the patient’s final visit at 6 months post-procedure. @*Conclusion@#. Image-guided navigation balloon catheters are a potentially valuable tool in patients with ETD. Their use is also technically feasible and safe when performing BET to treat ETD.
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Objectives@#. This study aimed to investigate whether optical coherence tomography (OCT) provides useful information about the microstructures of the middle and inner ear via extratympanic approach and thereby could be utilized as an alternative diagnostic technology in ear imaging. @*Methods@#. Five rats and mice were included, and the swept-source OCT system was applied to confirm the extent of visibility of the middle and inner ear and measure the length or thickness of the microstructures in the ear. The cochlea was subsequently dissected following OCT and histologically evaluated to compare with the OCT images. @*Results@#. The middle ear microstructures such as ossicles, stapedial artery and oval window through the tympanic membrane with the OCT could be confirmed in both rats and mice. It was also possible to obtain the inner ear images such as each compartment of the cochlea in the mice, but the bone covering bulla needed to be removed to visualize the inner ear structures in the rats which had thicker bulla. The bony thickness covering the cochlea could be measured, which showed no significant differences between OCT and histologic image at all turns of cochlea. @*Conclusion@#. OCT has been shown a promising technology to assess real-time middle and inner ear microstructures noninvasively with a high-resolution in the animal model. Therefore, OCT could be utilized to provide additional diagnostic information about the diseases of the middle and inner ear.
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Background and Objectives@#The combined intratympanic and oral steroid treatment has been accepted as effective treatment strategy for idiopathic sudden sensorineural hearing loss (ISSNHL). However, the treatment protocol of combined treatment for ISSNHL has not been established. In this study, we investigated whether hearing outcome differed according to different starting timing of intratympanic steroid injection (ITSI) in combined treatment for ISSNHL.Subjects and Method Tertiary academic referral center-based retrospective medical records of idiopathic 144 ISSNHL patients who received combined treatment from January 2015 to April 2018 were reviewed. All patients underwent a 2-week oral systemic steroid treatment and multiple ITSI. The hearing results of 3 months after treatment were compared according to the timing of ITSI. @*Results@#The mean pure tone audiogram gain was 24.3±23.6 dB. When Siegel’s criteria was applied, the overall rate of hearing improvement was 63.9% (92/144). The rate of hearing improvement was significantly higher in women (p=0.043) statistically, and there was a statistically significant lower rate of recovery in the former history of hearing loss (p＜0.01) or otitis media (p＜0.01). Moreover, the shorter the delay between symptom onset and initial ITSI, greater the statistical significance of hearing recovery rate became (p＜0.01). @*Conclusion@#The result of this study suggests that early ITSI during combined intratympanic and oral steroid treatment increases the chance of hearing recovery.
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OBJECTIVES: To investigate the effect of surgical treatment with eustachian tube (ET) catheter insertion in patients with acquired cholesteatoma associated with patulous eustachian tube (PET) and habitual sniffing. METHODS: Nine ears of nine patients (two men and seven women; age, 20 to 65 years; average, 37.9±12.0 years) of acquired cholesteatoma associated with PET and habitual sniffing who underwent cholesteatoma surgery with simultaneous additional ET catheter insertion were examined in this study. Successful treatment was defined as stoppage of sniffing, a relief of a PET handicap inventory-10 (PHI-10), an improvement of autophony grade and no cholesteatoma recurrence. RESULTS: ET catheter insertion was performed in all ears. Follow-up duration ranged from 16 to 37 months (average, 25.4 months). Cases consisted of nine pars flaccida type (100%). All patients obtained relief from aural symptoms and stopped sniffing. Postoperative PHI-10 scores were significantly lower than preoperative scores (P<0.001). During an average follow-up of 25.4 months, no cholesteatoma recurrence has occurred to date. One patient developed otitis media with effusion (OME) post-catheterization; OME resolved spontaneously without treatment. Four patients had a consecutive ET catheter insertion on the other side to resolve PET-related aural symptoms. CONCLUSION: In case of acquired cholesteatoma with PET and habitual sniffing, ET catheter insertion performed simultaneously with cholesteatoma surgery could help reduce aural symptoms and stop sniffing. Moreover, the procedure might help in preventing cholesteatoma recurrence.
Subject(s)
Female , Humans , Male , Catheters , Cholesteatoma , Ear , Eustachian Tube , Follow-Up Studies , Otitis Media with Effusion , RecurrenceABSTRACT
Angioleiomyoma is a benign tumor which arises from vascular smooth muscle. It originates primarily in the upper and lower extremities, but several isolated cases have been described. Although angioleiomyoma has a benign nature, there is a potential risk of malignant change and recurrence in case of incomplete resection. We acknowledge that venous type angioleiomyoma on the posterior surface of auricle has not been reported in the Korean literature. We report a rare case of 49-year-old male who had angioleiomyoma originating from the auricle along with a literature review.
Subject(s)
Humans , Male , Middle Aged , Angiomyoma , Lower Extremity , Muscle, Smooth, Vascular , RecurrenceABSTRACT
Posterior semicircular canal dehiscence represents a third-window lesion manifesting as hearing loss with vestibular dysfunction. Computed tomography findings of a dehiscent posterior canal can be verified with increased vestibular evoked myogenic potential responses as in other third-window lesions. The jugular bulb is the bulbiform connection between the sigmoid sinus and the internal jugular vein at the skull base. High jugular bulb can erode into inner ear structures. According to the literature review, there has been no case report about posterior semicircular canal dehiscence caused by high jugular bulb in Asia. Therefore, the authors report a case with a review of literature.
Subject(s)
Asia , Colon, Sigmoid , Cytochrome P-450 CYP1A1 , Ear, Inner , Hearing Loss , Jugular Veins , Semicircular Canals , Skull BaseABSTRACT
BACKGROUND AND OBJECTIVES: The cause of idiopathic sudden sensorineural hearing loss (ISSNHL) is still unclear, but recently, chronic inflammation and thrombosis have received attention. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are some of the markers that show the state of inflammation and ischemia, which are measured routinely in the complete blood cell count (CBC) test. The aim of this study were to investigate the relevance of NLR and PLR with ISSNHL. SUBJECTS AND METHOD: Enrolled in our retrospective analysis were 103 patients diagnosed with ISSNHL. Blood samples were taken from the patients and hearing assessments were performed. NLR and PLR were calculated using the CBC results. Then the patients were divided into 4 groups using Sigel's criteria according to their response to the treatment, which were again classified two groups, the “recovered” and “unrecovered” group. RESULTS: NLR, PLR, and neutrophil values of the unrecovered group were significantly higher than the recovered group (p=0.002, p=0.009, and p=0.038, respectively). On the other hand, lymphocyte values were significantly higher in the recovered group (p=0.007). After adjustment in a multivariate logistic regression analysis, NLR was associated with the recovery of ISSNHL (Odds ratio=1.290, p=0.042). In addition, NLR and PLR values were also significantly different between the groups classified by the Sigel's criteria (p=0.009 and p=0.029, respectively). CONCLUSION: PLR values may be useful in predicting hearing recovery after treatment in patients with ISSNH. It is also expected to be a potential marker for predicting the prognosis and determining further treatment options.
Subject(s)
Humans , Biomarkers , Blood Cell Count , Hand , Hearing , Hearing Loss, Sensorineural , Inflammation , Ischemia , Logistic Models , Lymphocytes , Methods , Neutrophils , Prognosis , Retrospective Studies , ThrombosisABSTRACT
Angioleiomyoma is a benign tumor which arises from vascular smooth muscle. It originates primarily in the upper and lower extremities, but several isolated cases have been described. Although angioleiomyoma has a benign nature, there is a potential risk of malignant change and recurrence in case of incomplete resection. We acknowledge that venous type angioleiomyoma on the posterior surface of auricle has not been reported in the Korean literature. We report a rare case of 49-year-old male who had angioleiomyoma originating from the auricle along with a literature review.
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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.
Subject(s)
Cross-Sectional Studies , Korea , Methods , Otolaryngology , Public Opinion , Qualitative Research , TinnitusABSTRACT
Complete removal is most important in treating the malignant tumor from the auricle, but the cosmetic and reconstructive plan after removal should also be considered because auricular appearance contributes enormously to the facial aesthetics. Mohs micrographic surgery (MMS), which is commonly used in dermatology, is considered as minimal marginal surgery that offers superior cure rates in the treatment of facial skin cancer. Therefore, MMS could provide a minimally invasive way to manage the malignant tumor of the auricle. This article reports that basosquamous cell carcinoma arising in the auricle was treated with wide resection combined with MMS. Conclusively, we could accomplish the surgical purpose of both completely removing the tumor and maintaining the auricular aesthetic shape by additionally introducing MMS in the treatment.
Subject(s)
Dermatology , Esthetics , Mohs Surgery , Skin NeoplasmsABSTRACT
BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate the advantages and limitations of using fibrin glue for securing bioresorbable panels to reconstruct the fractured orbital floor by transantral approach. SUBJECTS AND METHOD: A retrospective study was conducted from July 2009 to July 2015 in 35 patients with pure orbital floor fractures. Nineteen patients underwent reduction surgery for inserting the bioresorbable panel and 16 patients underwent reduction surgery using fibrin glue for securing the bioresorbable panel via a transantral approach. In both groups, a chart review of preoperative and postoperative ocular symptoms, operation records, and complications was conducted. RESULTS: There was no significant difference between two groups in the demographic data of patients. Comparing the surgical outcomes between two groups, diplopia and mean discrepancy between fractured bone chip and intact orbital floor based on computed tomography scans showed much better results in the group that used bioresorbable panel secured by fibrin glue than in the bioresorbable only group. Furthermore, we carried out revision operations in six cases in the bioresorbable panel only group, where we found that the main cause of fracture to be the dislocation of bioresorbable panel. On the other hand, in the bioresorbable panel secured by the fibrin glue group, there were no reoperation and postsurgical complications. CONCLUSION: During the course of the study, we sensed orbital floor fracture repair using bioresorbable panel secured by fibrin glue via a transantral approach as an easy and effective technique with good postoperative results, and minimal implant related complications. This novel procedure is recommended as a surgical option for the reduction of orbital floor fractures, especially in large and posterior fractures.
Subject(s)
Humans , Diplopia , Joint Dislocations , Fibrin Tissue Adhesive , Fibrin , Hand , Methods , Orbit , Orbital Fractures , Reoperation , Retrospective StudiesABSTRACT
Dural arteriovenous fistula (DAVF) have been treated by transarterial or transvenous embolization, surgery, and radiosurgery. Besides these treatment options, the external compression technique is a non-invasive, low-cost form of treatment. This article reports that a 60-year-old man with DAVF between multiple arterial branches and transverse/sigmoid sinus was treated by repeated external manual compression method.
Subject(s)
Humans , Middle Aged , Arteriovenous Fistula , Central Nervous System Vascular Malformations , Methods , Radiosurgery , TinnitusABSTRACT
Dural arteriovenous fistula (DAVF) have been treated by transarterial or transvenous embolization, surgery, and radiosurgery. Besides these treatment options, the external compression technique is a non-invasive, low-cost form of treatment. This article reports that a 60-year-old man with DAVF between multiple arterial branches and transverse/sigmoid sinus was treated by repeated external manual compression method.
Subject(s)
Humans , Middle Aged , Arteriovenous Fistula , Central Nervous System Vascular Malformations , Methods , Radiosurgery , TinnitusABSTRACT
BACKGROUND AND OBJECTIVES: It is important to figure out the location between the internal carotid artery (ICA) and the Eustachian tube (ET) for conducting safe ET surgery. Using computed tomography (CT), this study was aimed to evaluate the anatomical relationship between ET and ICA according to age and gender. SUBJECTS AND METHOD: Contrast enhanced CT scans of the paranasal sinus taken between January 2005 and December 2010 were reviewed retrospectively. A total of 216 patients (432 ears) were enrolled. In each patient, we measuresed the distance from the anterior cushion of torus tubarius to ICA (AC-ICA), the distance from the posterior cushion of torus tubarius to ICA (PC-ICA), the distance from the Rosenmuller fossa to ICA, the shortest distance from ET lumen to ICA (ET-ICA), and the angle between the imaginary lines from the orifice of ET to the posterior end point of nasal septum to point ICA (ET-NS-ICA). Patients were divided into 10 groups based on age difference of 15-years. RESULTS: For the female patients aged 65 to 80 years old, AC-ICA, PC-ICA were closest from the nasopharynx. For this group, at p<0.05, the distances of AC-ICA, PC-ICA and ET-ICA showed a negative correlation with increasing age, whereasET-NS-ICA (p<0.05) showed a positive correlation, indicating a tendency of medicalization with increased age. CONCLUSION: The distance between ET and ICA represents a variety of distribution according to gender and age. When performing a surgery for the nasopharyngeal portion of ET, the surgeon should be aware of the location of ICA in the preoperative CT findings.
Subject(s)
Female , Humans , Carotid Artery, Internal , Eustachian Tube , Medicalization , Nasal Septum , Nasopharynx , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
Meningoenceophalic herniation into the external auditory canal is a rare and potentially life threatening condition that needs a surgical treatment. It can lead to potential infectious sequelae including meningitis, encephalitis, otologic brain abscess and dysfunctional herniated brain tissue can trigger epilepsy. It is caused by chronic otitis media, cholesteatoma, middle ear surgery, trauma, congenital skull base defect and irradiation. We present a case of meningoencephalic herniation into the external auditory canal that had occurred 8 years after open cavity tympanomastoidectomy, which was treated with subtemporal middle cranial fossa approach.
Subject(s)
Brain , Brain Abscess , Cholesteatoma, Middle Ear , Cranial Fossa, Middle , Ear Canal , Encephalitis , Epilepsy , Meningitis , Otitis Media , Skull Base , Temporal BoneABSTRACT
Myoepithelioma, a generally benign tumor comprised of myoepithlial cells, is an uncommon salivary gland tumor. Myoepithelioma originates primarily in the parotid gland, but several isolated cases have been described. Although myoepithelioma has a benign nature, but there is a potential risk of malignant change and recurrence in case of incomplete resection. We acknowledge that benign myoepithelioma originating from the auricle has not been reported in the English literature. We present a rare case of 27-year-old female who had recurrent benign myoepithelioma originating from the auricle and already had been given twice operations at the other clinic.
Subject(s)
Adult , Female , Humans , Ear Auricle , Myoepithelioma , Parotid Gland , Recurrence , Salivary GlandsABSTRACT
The preoperative hearing status is one of the important factors to determine the method of surgical approach to the vestibular schwannoma. It has been widely recognized that the hearing preservation surgery is not valuable if the patient has no serviceable hearing. The worldwide reported cases of hearing improvement after surgical removal of vestibular schwannoma with profound hearing disturbance are extremely rare, and so far, there have been no domestic cases reported. The authors have experienced a case of significant hearing improvement after surgical removal of vestibular schwannoma with preoperative unilateral total deafness but with normal otoacoustic emission response. We report this case with literature review.