Correlation between Auditory Brainstem Response Characteristics and Hearing Recovery in Sudden Deafness / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#Auditory brainstem response (ABR) can be utilized to verify the hearing threshold and determine the existence of retrocochlear pathology in sudden deafness. However, little is known about the significance of ABR characteristics as a prognostic factor in sudden deafness. The purpose of this study is to evaluate which characteristics of ABR is associated with the prognosis of sudden deafness.SUBJECTS AND METHOD: We studied patients who were diagnosed with unilateral sudden deafness from January 2017 to May 2018. ABR results of click stimuli at 90 dB nHL were analyzed by the latency of wave I, III, and V.@*RESULTS@#A total of 113 patients (55 men and 58 women) participated in the study. Hearing recovery was observed in 94 cases (83.2%). The absolute latency of wave I, III, and V was prolonged in the affected ears when compared with the unaffected ears. Hearing improvement was only correlated to the interaural latency delay of wave I (Pearson's r=−0.278, p<0.05). Prolonged interaural latency delay was noted from complete toward slight hearing recovery group. When the hearing outcome was evaluated by the interaural latency delay of wave I at 0.2 ms, the result of under 0.2 ms was significantly better than that over 0.2 ms and no visible wave I.@*CONCLUSION@#Prolonged interaural delay of wave I over 0.2 ms and no visible wave I in ABR showed worse hearing outcome in sudden deafness. This finding may provide ABR as a potential prognostic indicator in sudden deafness.

Correlation between Auditory Brainstem Response Characteristics and Hearing Recovery in Sudden Deafness / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Auditory brainstem response (ABR) can be utilized to verify the hearing threshold and determine the existence of retrocochlear pathology in sudden deafness. However, little is known about the significance of ABR characteristics as a prognostic factor in sudden deafness. The purpose of this study is to evaluate which characteristics of ABR is associated with the prognosis of sudden deafness. SUBJECTS AND METHOD: We studied patients who were diagnosed with unilateral sudden deafness from January 2017 to May 2018. ABR results of click stimuli at 90 dB nHL were analyzed by the latency of wave I, III, and V. RESULTS: A total of 113 patients (55 men and 58 women) participated in the study. Hearing recovery was observed in 94 cases (83.2%). The absolute latency of wave I, III, and V was prolonged in the affected ears when compared with the unaffected ears. Hearing improvement was only correlated to the interaural latency delay of wave I (Pearson's r=−0.278, p<0.05). Prolonged interaural latency delay was noted from complete toward slight hearing recovery group. When the hearing outcome was evaluated by the interaural latency delay of wave I at 0.2 ms, the result of under 0.2 ms was significantly better than that over 0.2 ms and no visible wave I. CONCLUSION: Prolonged interaural delay of wave I over 0.2 ms and no visible wave I in ABR showed worse hearing outcome in sudden deafness. This finding may provide ABR as a potential prognostic indicator in sudden deafness.

Caloric Test as a Possible Prognostic Indicator in Sudden Deafness / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Dizziness has been known as a prognostic factor in sudden sensorineural hearing loss (SSHL), but it is difficult to describe and quantify its subjective symptoms. Also, dizziness itself cannot imply vestibular dysfunction in SSHL. Comprehensive evaluation of vestibular function may help us understand the extent of lesions in sudden deafness. The purpose of this study is to determine whether an impaired caloric response is associated with disease severity and hearing outcome. SUBJECTS AND METHOD: A retrospective chart review was conducted of 488 patients diagnosed as unilateral SSHL. The patients were divided into two, an abnormal caloric group (canal paresis >20%) and normal caloric group (canal paresis ≤20%). Initial demographic and audiologic findings and final hearing outcomes were compared between the two groups. RESULTS: The initial pure tone averages of SSHL patients of abnormal caloric group and normal caloric group were 75.4±28.4 dB HL and 68.2±25.4 dB HL (p=0.004), respectively. Patients of abnormal caloric test group showed worse hearing outcome across all frequencies compared to those of the normal caloric group. Also, a significant correlation was noted between the magnitude of hearing recovery and canal paresis (r=-0.223, p < 0.001). CONCLUSION: SSHL patients of abnormal caloric test showed worse initial hearing level and poorer hearing outcome. Evaluation of vestibular function in SSHL patients is important because subjective symptoms alone cannot account for vestibular hypofunction patients, and the caloric test can help in the counseling of patients and prediction of hearing outcome in SSHL patients.

Comparison of Wave V Latencies of Auditory Brainstem Responses by Bone Conduction and Air Conduction in Normal Hearing Infants and Toddlers / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Bone conduction (BC) auditory brainstem response (ABR) is an important factor in determining the type of hearing loss especially in infants and other difficult-to-test populations. However, multiple constraints including technical difficulties make evaluating BC ABR less feasible in the clinic, and there is also lack of information that guides clinicians how to evaluate it. The purpose of this study is to compare the latency of wave V in BC and air conduction (AC) ABR in normal hearing infants and gather reference values for wave V latency of BC ABR. SUBJECTS AND METHOD: A total of 210 ears of normal hearing, of those not belong to the hearing loss risk group, were included. All the infants underwent ABR evoked by clicks via AC (3A insert phone) and BC (Radioear B-71, vibrator positioned on the mastoid) under sedation. The latency of wave V at 30 dB nHL by BC and AC was compared and analyzed according to age. RESULTS: The results revealed that in every age group in the study, wave V latency at 30 dB nHL of BC ABR was shorter than that of AC ABR. There was a significant decrease in BC and AC latencies with age, but among each consecutive age group, significant latency change was not identified after 6 months old. CONCLUSION: The latency of BC ABR in young children was shorter than that of AC ABR, and it decreased significantly as age increased. However, the reference data should be considered by taking each laboratory's test parameter into consideration.

A Case of Sudden Deafness with Spontaneous Nystagmus in the Absence of Canal Paresis / 대한이비인후과학회지

Spontaneous nystagmus is a reflection of tonic left-right vestibular asymmetry. It is typically seen after a recent unilateral peripheral vestibular lesion and has fast phases away from the side of the lesion. Sometimes spontaneous nystagmus is seen in the absence of a recent unilateral peripheral lesion, in which case it provides evidence of a vestibular lesion but does not localize it. We experienced a case of 35-year-old man who had sudden sensorineural hearing loss on the left side with acute onset of vertigo and transient spontaneous nystagmus, which had fast phases away from the side of the sudden deafness, without canal paresis on the bithermal caloric test.

Clinical Nurses' HPV-related Knowledge and Perception of Cancer Causes: HPV Vaccinated vs. Not Vaccinated / 여성건강간호학회지

PURPOSE: The purpose of this study was to compare knowledge level of those clinical nurses who received HPV vaccine and those who did not and their perception of the relatedness of HPV vaccine to causes of cervical cancer. METHODS: A total of 249 clinical nurses were surveyed from June to July, 2009. The questionnaire originally developed by Kim & Ahn (2007) examined HPV-related knowledge originally and the tool for perception of the causes of cervical cancer was originally developed by Kim (1993). The total number of subjects equaled to: vaccination group of 52 (20.9%) and non-vaccination group of 197 (79.1%). RESULTS: Vaccination group showed significantly higher score of both knowledge of HPV vaccination and the perception of the cause of cervical cancer in comparison to the nonvaccination group at (p<.05). Among 4 subscales of the perception of causes of cervical cancer, destiny and constitution subscale scores were significantly different between the two groups at (p<.05). CONCLUSION: Clinical nurses need to constantly update with current knowledge of HPV and be prepared with currently changing cancer prevention strategies, especially in cervical cancer.

Effects of Aroma Inhalation Therapy on Pain in Patients Following a Tonsillectomy / 기본간호학회지

PURPOSE: This study was done to examine the effects of aroma inhalation therapy on pain post tonsillectomy. METHOD: A non-equivalent control group pre- and post-test design was used. The research instruments used in this study were a pain perception measurement and vital signs (systolic & diastolic blood pressure and pulse rate levels). Twenty-five patients in the experimental group went through aroma inhalation therapy for ten minutes after the tonsillectomy. The aroma inhalation therapy used was a blended oil, a mixture of Lavender and Loman chamomile in the ratio of 2:1. The 25 patients in the control group did not receive the therapy. Before and after the experiment, both groups were tested for pain (pain perception and vital signs). Collected data were processed with the SPSS WIN. Ver. 14.0 program and analyzed using frequencies, percentages, chi2-test, Fisher's exact test, t-test and ANCOVA. RESULTS: Pain perception of patients was not significantly reduced. However systolic and diastolic blood pressure and pulse rate were significantly reduced. CONCLUSION: The results of the study indicate that aroma inhalation is a partially effective nursing intervention to reduce the post-operative tonsillectomy pain.

Reversible Sensorineural Hearing Loss due to Pachymeningitis Associated with Elevated Serum MPO-ANCA

Hypertrophic pachymeningitis is a progressive disease resulting in a diffuse thickening of dura mater due to inflammation, tumor or autoimmune diseases, but most cases are idiopathic. It is seldom reported to be related to sensorineural hearing loss, but it can cause sensorineural hearing loss which can be potentially reversed through treatment. Here, we report the case of a 54-year-old woman who had progressive, bilateral, worse in the left, sensorineural hearing loss and visual disturbance with an accompanying headache over several months. Brain MRI showed diffusely thickened dura mater, highly enhanced after gadolinium administration, which was consistent with pachymeningitis. It was assumed to be related to autoimmune pathogenesis on the basis of elevated serum myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) titers. After empirical steroid and cyclophosphamide therapy, auditory impairment improved, especially in the high frequency region of the pure tone audiogram, and significant improvement in the word recognition test. Moreover, a follow-up MRI revealed much decreased enhancement of the dura mater, and the MPO-ANCA titer decreased to within the normal range. In the case of rapidly progressive sensorineural hearing loss or hearing impairment accompanying other cranial neuropathy, pachymeningitis should be taken into consideration, and brain MRI with gadolinium enhancement is the best method of detecting it. Also, to ensure proper treatment, a cautious evaluation including an ANCA work-up should be performed.

Toll-like receptor 9-mediated inhibition of apoptosis occurs through suppression of FoxO3a activity and induction of FLIP expression

Synthetic oligodeoxynucleotides (ODN) with a CpG-motif are recognized by Toll-like receptor 9 (TLR9) and pleiotropic immune responses are elicited. Stimulation of macrophages with TLR9 agonist prevented apoptosis induced by serum deprivation through increased expression of FLICE-like inhibitory protein (FLIP). CpG ODN-mediated anti-apoptosis depended on the TLR9-Akt-FoxO3a signaling pathway. Inhibition of TLR9 by small interfering (si) RNA or an inhibitor suppressed CpG ODN-mediated anti-apoptosis. Analysis of signaling pathways revealed that the anti-apoptotic effect of CpG ODN required phosphorylation of FoxO3a and its translocation from the nucleus to the cytosol. Overexpression of FoxO3a increased apoptosis induced by serum deprivation and CpG ODN blocked these effects through FLIP expression. In contrast, siRNA knock-down of FoxO3a decreased apoptosis by serum deprivation. In addition, Akt activation was involved in CpG ODN-induced phosphorylation of FoxO3a, expression of FLIP, and anti-apoptosis. Taken together, these results demonstrate the involvement of Akt-FoxO3a in TLR9-mediated anti-apoptosis and indicate that FoxO3a is a distinct regulator for FLIP expression.

Sex Differences in a Cross Sectional Study of Age-related Hearing Loss in Korean

OBJECTIVES: The purpose of this study was to obtain sex- and age-specific reference level for hearing threshold of normal aging in Korean and to determine if the rate of change in pure-tone hearing thresholds differed by sex. METHODS: Subjects were clients who visited the Health Promotion Center, Daegu Fatima Hospital, Daegu, Korea, from January 2004 to September 2005. Pure-tone audiometric measures were obtained from 3,470 subjects who also completed a hearing questionnaire. The slope of a linear regression was used to estimate the rate of change in pure-tone thresholds at 0.25 to 8 kHz for each ear in 214 men and 902 women without past history of otorrhea, usage of ototoxic drugs, head injury, job in noisy environment, and military service. RESULTS: Hearing thresholds were elevated with age in all test frequencies. Significant sex differences were found in pure-tone thresholds at 4 and 8 kHz after adjusting for age using analysis of covariance. In those high frequencies, hearing was worse in men than in women. The average rate of change in threshold was 0.28 and 0.24 dB per year at 0.25 kHz, increasing gradually to 1.27 and 1.05 dB per year at 8 kHz for men and women, respectively. Men had significantly faster rates of threshold increase at 4 and 8 kHz than women. CONCLUSION: These cross-sectional measures of hearing levels and rate of threshold increases at 4 and 8 kHz showed significant sex differences in Korean men and women with little evidence of noise-induced hearing loss.

Cochlear Implant in Patients with Incomplete Partition Type III / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Among inner ear anomaly, incomplete partition type III is a quite rare finding which has pathognomonic computerized tomographic finding with bilateral, dilatation of lateral end of internal auditory canal, and deficient or absent bone between internal auditory canal and the basal turn of cochlea. Patients with incomplete partition type III have various range of hearing impairment and in case of severe hearing loss which cannot get benefit from hearing aids, cochlear implantation is indicated. In cochlear implantation for incomplete partition type III, perilymph gusher and abnormal electrode position is highly cautioned. We analyzed cochlear implantation patients with incomplete partition type III to find common intra-operative finding and complication. SUBJECTS AND METHOD: Temporal bone computerized tomographies of 120 patients who received cochlear implantation between September, 2002 and March, 2008 in our hospital were reviewed : the imaging of 4 patients were consistent with typical incomplete partition type III. We reviewed intra-operative finding and postoperative complications along with hearing outcome. RESULTS: During the operation, perilymph gusher was encountered in all cases, and it was tightly sealed with subcutaneous tissue and fat with fibrin glue. In patient 1, electrodes were abnormally positioned in IAC causing facial nerve stimulation. However, the result of postoperative speech perception was good in the patient, and in the rest of patients, the results were various. CONCLUSION: The surgeon should be aware of perilymph gusher when cochlear implantation is performed on patients with characteristic temporal bone computerized tomographic findings and who are suspicious of incomplete partition type III

Effect of Bimodal Hearing in Speech Perception Under Noisy Environment According to Residual Hearing / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In this study, we evaluated the effect of bimodal hearing in the speech perception test and the increasing level of bimodal hearing over cochlear implantation in speech perception score regarding residual hearing. SUBJECTS AND METHOD: Nineteen prelingually deaf patients, who had used bimodal hearing over a period of 8 months, were divided in two groups in accordance to their low frequency residual hearing. The children were tested in open-set speech perception under +10 SNR and +20 SNR. The scores of bimodal hearing and unilateral cochlear implantation were compared by the Wilcoxon signed-rank test. Also, the increased level of speech perception scores of bimodal hearing over cochlear implantation alone were calculated using the formula, [bimodal score (%)-unilateral cochlear implantation (%)], and was compared between groups. RESULTS: In pure tone audiometry under silent condition, the result of bimodal hearing was similar to unilateral cochlear implantation in magnitude in both groups. Under the noisy condition, both groups had better result in bimodal hearing in terms of speech perception. Also, the increased level was higher in bimodal hearing over unilateral cochlear implantation in the better residual hearing group. However, since the sample size was small enough, it is considered that there was no statistical significance. CONCLUSION: Cochlear implanted patients with residual hearing are expected to get better speech perception in noisy environment with bimodal hearing regardless of the level of residual hearing.

Correlation Analysis between Self-reported Measures in Patients with OSA / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Our study evaluated the necessity of measuring the quality of life (QOL) with physiologic parameters by assessing inter-relationship between self reported measures, which are known as a tool for evaluation of generic and disease specific QOL. SUBJECTS AND METHOD: From Oct. 2004 to Apr. 2006, polysomnograpy (PSG) results of 127 patients were retrospectively reviewed. QOL was assessed using the Medical Outcome Study 36-Item Short-Form Health Survey (SF-36), Self-reported measures including Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Stanford Sleepiness Scale (SSS), Insomnia Severity Index (ISI), and Beck Depression Inventory (K-BDI). The association between each domain on the SF-36 and self-reported measures were examined by Spearman correlation measures. RESULTS: ESS, SSS, PSQI and ISI correlated well with SF-36, except for ESS, which didn't with Physical Functioning of SF-36. PSG indexes of patients with OSAS did not show correlation with self-reported measures. CONCLUSION: All self reported measures including generic and disease specific QOL have their own significance in reflecting psychosomatic status in patients with OSAS. Self-reported measures could be more informative in the reflecting severity and pre/post treatment results in the aspect of psychosomatic effects in OSAS patients.

Correlation Analysis between SF36 and Polysomnographic Measures in Patients with OSAS / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Despite the trend in the medical field to understand the effect of diseases on the quality of life, such a study regarding sleep apnea has not been prevailing in Korea. This study analyzed the result of a Medical Outcome Study Short Form-36 (SF-36), which is widely used to evaluate the effect of sleep apnea on patient's medical condition. SUBJECTS AND METHOD: This study included 131 patients of over 18 years of age and who participated in the SF-36 survey and finished the polysomnography study. The relationship between parameters was conducted with Spearman, and the comparison with the independent variables was done by running a paired t-test. RESULTS: AHI was on average 30.9+/-23.5 and BMI was on average 26+/-3.9 kg/m. Except body pain, all values which derived from the statistics of eight categories of SF-36 from the patients was significantly lower than those of the healthy control. In the comparable analysis of polysomnography and SF-36, AHI, the total sleep time, and the sleep efficacy (%) had significant correlation, but correlation coefficient was low (r<3.0). CONCLUSION: It is recommended that the quality of life of OSAS patients should be evaluated beside PSG in order to find out the degree of seriousness of OSAS and result of treatment.

Toll-like receptor 9 dependent activation of MAPK and NF-kB is required for the CpG ODN-induced matrix metalloproteinase-9 expression

Unmethylated CpG oligodeoxynucleotides (CpG ODNs) activate immune cells to produce immune mediators. This study demonstrates that in murine macrophage RAW 264.7 cells, CpG ODN-mediated matrix metalloproteinase-9 (MMP-9) expression is regulated at transcriptional level and requires de novo protein synthesis. Inhibition of ERK and p38 MAPK, but not JNK, results in significant decrease of CpG ODN-induced MMP-9 expression. We found that endosomal maturation inhibitors, chloroquine and bafilomycin A, block CpG ODN-induced ERK and p38 MAPK activation and the subsequent MMP-9 expression. We also observed that CpG ODN induces NF-kappa B activation and NF-kappa B is a downstream target of p38 MAPK. Taken together, our data demonstrate that CpG ODN triggers MMP-9 expression via TLR-9 dependent ERK and p38 MAPK activation followed by NF-kappa B activation.

Comparison of Nasal Packing and Septal Suturing Following Septoplasty / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Nasal packing at the completion of septoplasty is considered routine by most surgeons. However, nasal packing can cause nasal injury, hypoxia, cardiovascular change and most importantly patients' discomfort. The purpose of this study was to compare nasal packing and septal suture (through-and-through suture) with respect to immediate postoperative patients' discomfort and final outcome. SUBJECTS AND METHOD: Fifty patients undergoing routine septoplasty were randomized on the basis of sex and age to receive either nasal packing or septal suture. Fourty-two patients completed their symptom and discomfort scores according to the visual analogue scale (VAS) for 4 days after septoplasty and completed another questionnaire before and 8 weeks after septoplasty. RESULTS: The nasal packing group gave significantly higher scores in headache compared with the septal suturing group. The final outcome of the procedure was the same between both groups. CONCLUSION: Septal suture is a good alternative for nasal packing. It does cause less pain for patients and no statistically significant differences in outcome were found between both groups.