Neuroglial Choristoma of the Middle Ear with Massive Tympanosclerosis: A Case Report and Literature Review

Neuroglialchoristoma is a rare cerebral heterotopia typically involving extracranial midline structures of the head and neck, including the nose, nasopharynx and oral cavity. It rarely involves non-midline structures, such as the middle ear, mastoid and orbit. We report the case of a 63-year-old woman with right-sided hearing loss and aural fullness who was diagnosed with neuroglialchoristoma of the middle ear and mastoid. To our knowledge, this is the first report on neuroglialchoristomawith massive tympanosclerosis. The presence of combination supported the inhalation theory of neuroglialchoristoma, given that tympanosclerosis is typically caused by Eustachian tube dysfunction.

Significance of 125 Hz Pure-Tone Thresholds for Acute Low Frequency Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To analyze the 125 Hz pure-tone thresholds in patients with acute low frequency sensorineural hearing loss (LFHL) and to investigate the value of 125 Hz thresholds for the assessment of LFHL. SUBJECTS AND METHOD: Hearing tests including 125 Hz pure-tone were performed in 91 patients with acute LFHL ≤500 Hz and in 46 subjects with normal hearing. Patients with sudden sensorineural hearing loss or Meniere's disease were excluded. Inter-group and intra-group comparison of 125 Hz was made between LFHL and the control groups. RESULTS: There was a significant difference of mean pure-tone thresholds at 125 Hz between the acute LFHL and the normal groups (39.8±8.9 vs. 14.3±6.7 dB). Eight (8.8%) patients in the LFHL group showed normal thresholds at 125 Hz, but all other subjects were normal at 125 Hz in the control group. None with the average hearing thresholds at 250 and 500 Hz ≥40 dB had normal threshold at 125 Hz. There was a significant correlation between 125 Hz and other low frequencies in the LFHL group (250 Hz; r=0.81, 500 Hz; r=0.63). CONCLUSION: Not all patients with acute LFHL show abnormal hearing threshold at 125 Hz although every subject with normal hearing is within the normal limits at 125 Hz. Threshold assessment should be made at 125 Hz when a mild LFHL exists in the conventional pure tone audiometry.

Intratympanic Steroid and Oral Diuretics Combination Therapy for Acute Low Frequency Sensorineural Hearing Loss without Vertigo / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The effectiveness of intratympanic dexamethasone injections (ITD) alone is compared against the combination therapy of ITD and oral diuretics as treatments for acute low frequency sensorineural hearing loss (LFHL) without vertigo. SUBJECTS AND METHOD: A total of 36 patients, with LFHL 0.05). For subjective symptoms, there were no statistically significant differences in the improvement rate in either group (combination 58.8% vs. ITD only 63.2%, p>0.05). In pure tone audiometry, the improvement rate of the combination group was not significantly different from that of the ITD only group (76.5% vs. 73.7%, p>0.05). There was a significant correlation between the complete recovery rate and duration of symptoms. CONCLUSION: ITD alone is an effective treatment modality for LFHL within 1 month after onset. Diuretics have no additive effect for the recovery of hearing in patients with acute LFHL without vertigo.

The Relationship of the Medial Maxillary Sinus Roof to the Sphenoid and Posterior Ethmoid Sinuses in Korean: A Radiologic Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to perform radiologic study assessing the utility of the medial maxillary sinus roof (MMSR) as a reference point for providing a safe route of entry into the sphenoid and the posterior ethmoid sinuses in Korean patients. SUBJECTS AND METHOD: We retrospectively reviewed 82 consecutive ostiomeatal computed tomographic scans of Korean adult patients performed from January 2014 to December 2014. Using the nasal floor as a reference point, the vertical distances to the highest MMSR, natural sphenoid ostium, anterior sphenoid roof and floor and posterior ethmoid skull base were measured. Then the vertical distances from the highest MMSR to the sphenoid ostium, anterior sphenoid roof and floor and posterior ethmoid skull base were calculated. The maxillary sinus to posterior ethmoid height ratio was calculated. RESULTS: The average height of the highest MMSR relative to the nasal floor was measured to be 33.95+/-3.36 mm. The vertical distance from the highest MMSR to the natural sphenoid ostium, anterior sphenoid roof and floor and posterior ethmoid skull base was 1.87+/-3.52 mm, 11.77+/-3.30 mm, 6.09+/-3.16 mm, and 15.46+/-3.07 mm respectively. The mean ratio of the maxillary sinus to the posterior ethmoid height was 2.3+/-0.56. CONCLUSION: The MMSR can be used as a reliable landmark to localize the natural sphenoid ostium and to enable a safe entry into the posterior ethmoid. Moreover, it provides a reasonable margin of safety from the skull base.

Fatal Case of Klebsiella Meningitis Combined with Bilateral Sudden Sensorineural Hearing Loss: A Case Report and Literature Review / 대한이비인후과학회지

Bilateral sudden sensorineural hearing loss (SSNHL) is very uncommon. Unlike unilateral SSNHL, bilateral SSNHL is more closely associated with serious systemic diseases and shows a more severe degree of hearing loss, poorer hearing prognosis and more significant impairment in morbidity. Although meningitis is one of possible causes of bilateral SSNHL, only a few cases were reported. We present a case of fatal Klebsiella meningitis accompanied by bilateral SSNHL with a literature review.

The Effect of High Frequency Sensorineural Hearing Loss on Auditory Temporal Resolution: Gaps-In-Noise Test Performance in Older and Young Adults with Normal Hearing / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Auditory temporal resolution, which refers to the time-related aspects of acoustic processing, can be evaluated by the Gaps-In-Noise (GIN) test. We investigated whether the presence of high frequency sensorineural hearing loss (HF-SNHL) affects the temporal resolution of GIN performance in older adults with normal hearing. SUBJECTS AND METHOD: Hearing tests including the GIN test were performed in 87 subjects with normal pure tone average. The GIN threshold and percentage of correct answers were compared among 4 groups of participants; older adults with normal hearing (n=18), older adults with HF-SNHL (n=24), young adults with normal hearing (n=24) and young adults with HF-SNHL (n=21). RESULTS: There was no significant difference in the mean GIN thresholds between the HF-SNHL group (5.8+/-0.8 msec) and the normal hearing group (6.0+/-0.8 msec) in older adults, whereas the mean GIN thresholds of HF-SNHL group was higher than that of the normal group in young adults (4.6+/-0.3 msec vs. 4.2+/-0.5 msec, p<0.05). The mean percentage of correct answers of HF-SNHL group (62.5+/-5.5%) was not significantly different from that of the normal hearing group (60.6+/-3.9%) in the old, unlike in the young (71.3+/-4.0% with HF-SNHL vs. 76.9+/-4.3% with normal hearing, p<0.05). Age only showed a significant correlation with the GIN performance. Neither the GIN threshold nor the GIN perception level had any relation with the presence of HF-SNHL in older adults. CONCLUSION: We found no evidence that supported the influence of HF-SNHL on auditory temporal resolution in older adults. These results imply that HF-SNHL may be of little importance in gap detection after age-related changes in central auditory system.

Prevalence of Onodi Cells in Korean Based on Computed Tomography / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The Onodi cell is the posterior-most ethmoid air cell that lies superior to the sphenoid sinus, and has intimate relationship with the optic nerve. The aim of this study was to evaluate Onodi cell prevalence, protrusion and bony dehiscence of the optic nerve in Korean population using computed tomography (CT). SUBJECTS AND METHOD: A retrospective analysis was performed on 129 Korean patients who consecutively underwent CT between January 2014 and December 2014. The presence of Onodi cells and protrusion and bony dehiscence of the optic nerve were analyzed using 3-dimensional CT images. RESULTS: A total of 70 males and 59 females were studied. Onodi cells were present in 61 (47.3%) patients but in 88 CT slides (34.1%); this consisted of 27 Onodi cells found bilaterally (44.3%), 18 on the right side only (29.5%), and 16 on the left only (26.2%). Of the total 61 patients with Onodi cells, the optic nerve protrusion and dehiscence were present in 34.4% and 23.8% of the studied CT slides. There was no statistically significant relationship between the presence of Onodi cells and protrusion and bony dehiscence of the optic nerve. CONCLUSION: In our study, Onodi cells were found in almost half of the patients. This prevalence is higher than previously reported in the literature. In patients with Onodi cells, the optic nerve protrusion and dehiscence were present in about 1/3 and 1/5 of the total slides, respectively. Therefore, the identification of these cells is essential prior to endoscopic sinus and skull base surgery to prevent potential complications.

Caudal Septal Extension Graft Using Nasal Septal Osteocartilaginous Graft / 대한이비인후과학회지

The septal extension graft from the septum has become a common method of correcting a small or drooping nose in Korea. It can provide superior tip projection and definition if there is a sufficient amount of cartilage and nasal septal stability. In our case, the caudal type septal extension graft was applied unilaterally using septal osteocartilaginous graft harvested in one piece during septoplasty. It was useful in patients who needed septal extension graft in spite of the insufficient amount of available septal cartilage. For those patients, it could be used to achieve the cephalic rotation of drooping tip and the strengthening of septal support effectively. The nasal septal osteocartilaginous graft may serve as an alternative material for conchal cartilage or costal cartilage for caudal septal extension graft if the stable nasal support is maintained and the harvested graft is applied appropriately.