Evaluation of Effectiveness of Stellate Ganglion Block Treatment of Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

Background and Objectives@#Sudden sensorineural hearing loss (SSNHL) is characterized by sudden onset of impaired hearing, and systemic steroid is the most widely accepted treatment option for it. The aim of this study is to evaluate the effectiveness of stellate ganglion block (SGB) as a treatment option for SSNHL.Subjects and Method A total of 318 patients diagnosed with SSNHL were treated with systemic steroid and SGB (SGB group, 127 patients) or systemic steroid only (non-SGB group, 191 patients). Hearing improvement was defined as a hearing gain of more than slight improvement using Siegel’s criteria. @*Results@#The SGB group did not show any significant effects on hearing improvement compared with the non-SGB group (60% vs. 65%). However, some patients with profound hearing loss of more than 90 dB have recovered above average after the SGB treatment. Also, we used multiple regression analysis to ascertain which factors influenced hearing recovery, and found that the initial pure-tone audiometry thresholds at 2000 Hz and 4000 Hz were statistically associated with hearing recovery. @*Conclusion@#In conclusion, SGB did not show a clear therapeutic effect, but suggested the possibility of treatment for improving the inner ear circulation of patients with profound hearing loss.

Effectiveness of Intratympanic Dexamethasone Injection for Tinnitus Treatment: A Systematic Review and Meta-Analysis

Objectives@#. Intratympanic dexamethasone injection (ITDI) has been introduced as a treatment option for subjective tinnitus. However, the effects of ITDI on patients with tinnitus remain unclear. In the present systematic review and metaanalysis, we evaluated the effectiveness of ITDI for tinnitus treatment. @*Methods@#. We searched Medline, the Cochrane Central Register of Controlled Trials, and Embase. Four double-blind randomized controlled trials that tested the efficacy of ITDI compared with a placebo were deemed eligible for a quantitative meta-analysis, while four prospective studies and seven retrospective studies reporting the effectiveness of ITDI on tinnitus treatment were included in a qualitative synthesis. @*Results@#. In the four studies included in the quantitative meta-analysis, ITDI did not show evidence of tinnitus improvement compared with placebo (odds ratio [OR], 1.38; 95% confidence interval, 0.53–3.61). In the 11 studies included in the qualitative synthesis, seven retrospective studies without controls reported rates of tinnitus improvement after ITDI ranging from 35.9% to 91.3%. In the four prospective studies with controls, ITDI seemed to be effective when combined with other drugs for tinnitus treatment. @*Conclusion@#. ITDI alone did not show a significant effect for treating tinnitus compared with placebo. However, the potential of combination treatment of ITDI with other drugs for tinnitus therapy should be further studied in more systematic research.

Influence of Cochlear Implantation on Cognitive Function in Elderly Patients / 대한이비인후과학회지

Hearing loss is the third most common chronic health condition faced by older adults. Recently, a number of studies have demonstrated a significant association between hearing impairment and cognitive decline. However, the underlying explanatory mechanism of this relation has yet to be established. Given the relation between hearing loss and cognitive decline, researchers have been interested in the effect of restoring hearing ability on cognitive functions in older adults. One intervention option for management of the most severe to profound hearing loss in older adults is cochlear implantation (CI). We performed a review to assess the cur- rent status of the literature on the potential influence of CI on cognition in the older adults. Hearing rehabilitation through CI in elderly patients results in improvements in speech perception and cognitive function and lowers the progression to dementia. Further well-designed studies with long follow-up are needed to verify whether CI influences cognition in older adults.

Therapeutics for acute otitis media

Acute otitis media (AOM) is diagnosed in patients with acute onset of signs and symptoms of inflammation in the middle ear, accompanied by middle ear effusion. AOM is a common infectious disease in children, and its diagnosis and treatment can have significant impacts on the health of children.Current Concepts: The evidence-based clinical practice guidelines in Korea and other countries provide recommendations to primary care clinicians regarding the management of children with AOM. The treatment strategy for AOM depends on the patient’s age, severity of symptoms, the presence of otorrhea, and the laterality.Discussion and Conclusion: For children aged from 6-months to 2-years with unilateral non-severe AOM and children aged 2 years or older with unilateral or bilateral non-severe AOM, the published guidelines provide the option of observation rather than immediate treatment with antibiotics. High-dose amoxicillin (80 to 90 mg a day) is the firstline antibiotic for treating AOM in patients without penicillin allergies. Children in whom symptoms persist after 48 to 72 hours of antibiotic treatment should be re-examined and amoxicillin/clavulanate should be used as second-line antibiotics. Careful follow-up is required to identify the complications and sequelae of AOM, and to determine the optimum treatment.

Therapeutics for acute otitis media

Acute otitis media (AOM) is diagnosed in patients with acute onset of signs and symptoms of inflammation in the middle ear, accompanied by middle ear effusion. AOM is a common infectious disease in children, and its diagnosis and treatment can have significant impacts on the health of children.Current Concepts: The evidence-based clinical practice guidelines in Korea and other countries provide recommendations to primary care clinicians regarding the management of children with AOM. The treatment strategy for AOM depends on the patient’s age, severity of symptoms, the presence of otorrhea, and the laterality.Discussion and Conclusion: For children aged from 6-months to 2-years with unilateral non-severe AOM and children aged 2 years or older with unilateral or bilateral non-severe AOM, the published guidelines provide the option of observation rather than immediate treatment with antibiotics. High-dose amoxicillin (80 to 90 mg a day) is the firstline antibiotic for treating AOM in patients without penicillin allergies. Children in whom symptoms persist after 48 to 72 hours of antibiotic treatment should be re-examined and amoxicillin/clavulanate should be used as second-line antibiotics. Careful follow-up is required to identify the complications and sequelae of AOM, and to determine the optimum treatment.

Association of Age-Related Hearing Losswith Cognitive Decline / 대한이비인후과학회지

A number of studies have demonstrated a significant association between age-related hearing loss (ARHL) and cognitive decline. However their relationship is not clear. In this review, we focused on the etiological mechanisms between ARHL and cognitive decline to explain the nature of this relationship: 1) causal mechanisms (e.g., cognitive load hypothesis, cascade hypothesis); 2) common cause mechanisms (e.g., microvascular disease); 3) overdiagnosis or harbinger hypothesis. We conclude that no single mechanism is sufficient and hearing and cognition related to each other in several different ways. In addition, we reviewed the effectiveness of hearing intervention (e.g., hearing aids and cochlear implants) on cognition function, and the role of hearing aid use and cochlear implant depends on the relevant mechanism.

A Case of Binder Syndrome: Rhinoplasty Surgeon's Perspective / 대한이비인후과학회지

Binder syndrome, also called the congenital flat nose syndrome, is a rare congenital malformation with a flat facial profile, intermaxillary hypoplasia and malocclusion. Rhinoplasty plays an important part in the multidisciplinary surgical protocol for this syndrome, for which weak nasal framework and soft tissue underdevelopment have been considered a great challenge. We present a case of Binder syndrome of a 27-year-old male. The nose was reconstructed with a caudal septum replacement graft and bilateral extended spreader grafts using costal cartilage.

A Case of Binder Syndrome: Rhinoplasty Surgeon's Perspective / 대한이비인후과학회지

Binder syndrome, also called the congenital flat nose syndrome, is a rare congenital malformation with a flat facial profile, intermaxillary hypoplasia and malocclusion. Rhinoplasty plays an important part in the multidisciplinary surgical protocol for this syndrome, for which weak nasal framework and soft tissue underdevelopment have been considered a great challenge. We present a case of Binder syndrome of a 27-year-old male. The nose was reconstructed with a caudal septum replacement graft and bilateral extended spreader grafts using costal cartilage.

Ceruminous Pleomorphic Adenoma of the External Auditory Canal: Two Case Reports and Review of the Literature / 대한이비인후과학회지

Ceruminous glands are specialized apocrine glands located in the external auditory canal (EAC). Pleomorphic adenoma (PA) of the EAC is derived from these ceruminous glands. Tumors arising from these ceruminous glands are rare. Furthermore, ceruminous PA of the EAC is extremely rare. About 35 cases have been reported to date in the English literature, and only 4 cases have been reported in Korea. There are several controversial issues about these rare tumors such as nomenclature, histogenesis and classification. We report here on two cases of ceruminous PA and review the cases in the Korean literature.

A Case of Immunoglobulin G4-Related Sclerosing Disease of the Paranasal Sinus Mimicking Nasal Malignancy

Immunoglobulin G4 (IgG4)-related sclerosing disease (RSD) is a chronic inflammatory disorder characterized by elevated serum IgG4 levels as well as an abundant infiltration of IgG4-positive plasmacytes. Involvement of the paranasal sinus is very rare, so it is difficult to make an accurate diagnosis. Hence, various differential diagnoses, which typically include elevated serum IgG4 levels and the infiltration of IgG4-postive cells into tissues, need to be excluded, especially for malignant diseases and mimicking disorders. Systemic corticosteroids are generally effective at inducing IgG4-RSD remission. Recently, a 43-year-old woman presented with a mass originating from the ethmoid sinus, suggesting malignancy. The patient underwent biopsy of the lesion. The pathologic specimen revealed the magnitude of IgG4-positive plasma cell infiltration, which was consistent with IgG4-RSD. In addition, serum IgG4 levels were markedly increased. After glucocorticoid treatment, the serum IgG4 levels decreased and the symptoms improved. We present a rare case of IgG4-RSD with isolated involvement of the paranasal sinuses.

Left Side Otalgia Caused by Acute Myocardial Infarction / 대한이비인후과학회지

Otalgia consists of primary otalgia associated with disorders of the ear itself and referred otalgia due to disorders of organs that share the same innervation with the ear. Disorders of the oral cavity and laryngopharynx served by the glossopharyngeal and vagus nerves are common causes of referred otalgia. Chest pain from myocardial infarction spreads through the afferent pain pathway, especially through the sympathetic nerves in the cardiac plexus and the phrenic nerve, resulting in a typical chest pain or referred pain in the left upper extremity. However, pain spreading through the vagus nerve can theoretically cause referred otalgia. This association between the heart and ear has not been widely acknowledged, even though a referred otalgia can occasionally be the only symptom of the tragic disease, myocardial infarction, and should be taken seriously. We report a patient who complained of left otalgia as the only symptom of myocardial infarction.

In Reply: Dominance of Ossicular Route in Sound Transmission

No abstract available.

A Case of Primary Septated Mucocele of Maxillary Sinus / 대한이비인후과학회지

Paranasal sinus mucoceles are benign non-neoplastic condition characterized by cystic expansion. They are classified into primary and secondary mucoceles by known causes. Most mucoceles are located in the frontal and anterior ethmoid sinuses and they involve the frontoethmoial region, expanding to the region of the orbit, leading to the ocular symptoms. The primary maxillary sinus mucoceles are not common, whereas secondary ones such as postoperative maxillary sinus mucoceles (POMMs) developing after Caldwell-Luc operation are pretty common. POMMs have often multiple septated mucoceles. However, most of the primary maxillary sinus mucoceles are an expansile and cystic mass of maxillary sinus with medial bulging. We present a case of primary septated mucocele in the maxillary sinus of a 36-year-old male who underwent revision surgery.

Determinants of Conductive Hearing Loss in Tympanic Membrane Perforation

OBJECTIVES: Tympanic membrane perforations are common, but there have been few studies of the factors determining the extent of the resulting conductive hearing loss. The aims of this study were to determine whether the size of tympanic membrane perforation, pneumatization of middle ear & mastoid cavity, and location of perforation were correlated with air-bone gap (ABG) of patients. METHODS: Forty-two patients who underwent tympanoplasty type I or myringoplasty were included and preoperative audiometry were analyzed. Digital image processing was applied in computed tomography for the estimation of middle ear & mastoid pneumatization volume and tympanic membrane photograph for the evaluation of perforation size and location. RESULTS: Preoperative mean ABG increased with perforation size (P=0.018), and correlated inversely with the middle ear & mastoid volume (P=0.005). However, perforations in anterior versus posterior locations showed no significant differences in mean ABG (P=0.924). CONCLUSION: The degree of conductive hearing loss resulting from a tympanic membrane perforation would be expected with the size of perforation and pneumatization of middle ear and mastoid.

Erratum: Determinants of Conductive Hearing Loss in Tympanic Membrane Perforation: Correction of the Sixth Author Name

The sixth author's name should have been given as Myung-Whan Suh.

A Case of Post-Traumatic Meniere's Disease

There are only a few reports of post-traumatic Meniere's disease and there is few literature that contains detailed data associated with the disease. We report a case of post-traumatic Meniere's disease. He suffered from tinnitus, fluctuating sensorineural hearing loss, and recurrent vertigo. Symptomatic medical treatment was not helpful and neither was soft tissue plugging around the oval and round windows during exploratory tympanotomy. Three months after soft tissue plugging, endolymphatic sac decompression surgery was performed. The patient's symptoms improved markedly thereafter. The clinical significance of post-traumatic Meniere's disease is described and we present a brief review of the literature.

Subjective and Audiologic Results of Bone Anchored Hearing Aids (BAHA) / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study aims to evaluate audiologic results and subjective satisfaction of bone anchored hearing aids (BAHA) patients. SUBJECTS AND METHOD: Preoperative air-conduction and bone-conduction thresholds, postoperative aided thresholds were measured for 14 patients. To evaluate patient satisfaction, two questionnaires derived from single sided deafness (SSD) questionnaire and Bern Benefit in SSD questionnaire were used. RESULTS: The mean age of patients, consisting of 8 males and 6 females, was 40.0+/-5.9 year. Ten patients (71%) received implantations for conductive or mixed hearing loss and 4 (29%) for SSD. The mean follow-up period was 27.8+/-5.6 months. The mean preoperative bone-conduction threshold of conductive or mixed hearing loss group was 21.4 dB and the mean air-conduction threshold was 65.4 dB. The mean bone-conduction threshold of SSD group was 60.0 dB and the mean air-conduction threshold was 105.9 dB. The postoperative aided threshold was significantly improved in conductive or mixed hearing loss group (p=0.005). The patients in the conductive or mixed hearing loss group showed more satisfaction with BAHA than those in the SSD group did, but the degree of satisfaction was not statistically significant (p=0.08 for questionnaire 1, p=0.12 for questionnaire 2). Patients with better preoperative bone-conduction threshold and patients with better preoperative speech discrimination score showed more satisfaction with BAHA in the questionnaire 1 (p=0.045, p=0.036). CONCLUSION: BAHA can be considered effective and beneficial for patients with conductive or mixed hearing loss and SSD. Further studies will be needed to choose the appropriate indications for BAHA, especially in SSD group in Korea.

Obliteration of the Temporal Dorsal Bullae of Guinea Pigs Using Hydroxyapatite Granules (Bongros(R)): A Radiological and Histological Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The present study reports radiological and histological observations of temporal dorsal bullae obliterated by implantation of hydroxyapatite granules (Bongros(R)). MATERIALS AND METHOD: The guinea pigs underwent obliteration of the left dorsal temporal bullae with hydroxyapatite granules (Bongros(R)). MicroCT images were obtained preoperatively and postoperatively. All animals were killed 3 months later. In 8 animals, light microscopic examination of bullae were conducted, and in 4 animals, morphological changes in the cochlear hair cells were examined by scanning electron microscopy (SEM). RESULTS: The microCT images obtained at 3 months after operation demonstrated high signal intensity areas suggesting new bone formations at implanted sites. Light microscopic examinations showed new bone ingrowth and good osteointegration, but no inflammatory response or foreign-body reaction. SEM showed normal-looking hair cells on all examined animals' specimen. CONCLUSION: Our results suggest that Bongros(R) may be safe and reliable alloplastic materials for mastoid obliteration. (Korean

A Case of Multiple Bony Dehiscences of Semicircular Canals and Vestibule Presenting as Dizziness and Hearing Loss / 대한이비인후과학회지

Dehiscence of the bone overlying the semicircular canals has been shown to have effects on vestibular and auditory function. This case report presents a 48-year-old man presenting atypical vestibular manifestations and bilateral hearing loss. His temporal bone CT scans demonstrated bony dehiscence of posterior semicircular canal and vestibule in the right, superior and posterior semicircular canals in the left.

A Case of Angioleiomyoma of Nasal Vestibule

Angioleiomyoma is an uncommon benign tumor composed of smooth muscle cells and vascular endotheliums. It is common in the uterus and the gastrointestinal tract but rare in the head and neck. This neoplasm is extremely rare in the nasal cavity, accounting for less than 1% of all vascular leiomyomas. The tumor has a benign nature and the recurrence of tumor is rare and complete removal is the treatment of choice. We present a case of angioleiomyoma which involves the nasal vestibule and was excised by a sublabial approach.