Outcomes of Severe to Profound Idiopathic Sudden Sensorineural Hearing Loss

OBJECTIVES: While a severe to profound sudden sensorineural hearing loss (SSNHL) may cause serious disability in verbal communication, there have been little studies focusing on this high degree SSNHL. The present study was aimed to investigate the characteristics of hearing recovery in a high degree SSNHL (>70 dB). METHODS: Three hundred and two SSNHL patients were enrolled. For a long-term follow-up, 46 patients were evaluated. Hearing level was examined by pure tone audiometry on day 1, week 3, month 3, month 6, and year 1 or after. According to the degree of the initial hearing loss, the patients were divided into 4 groups from 70 to > or =100 dB. RESULTS: After 3 weeks, the recovery rate and mean hearing gain was 61%, 23.85 dB in the 70 dB group, whereas 10%, 6.61 dB in the > or =100 dB group. There was a significant correlation between 3-week recovery and final hearing outcome. However, there was almost no recovery after 3 months. CONCLUSION: An early recovery can be a prognostic factor for the final recovery in severe to profound SSNHL. Since recovery after 3 months is rare, an early hearing intervention like hearing aid or cochlear implantation should be considered in the high degree SSNHL to restore the patient's verbal communication.

Donor-Site Morbidity Following Minimally Invasive Costal Cartilage Harvest Technique

OBJECTIVES: Autologous costal cartilage is a promising alternative for mastoid obliteration. However, donor-site morbidities of the chest wall limit the use of this graft. To address this issue, we have developed a minimally-invasive technique of harvesting costal cartilage and report donor site morbidity associated with the procedure. METHODS: Donor site morbidities were evaluated for 151 patients who underwent costal cartilage harvest, canal wall down mastoidectomy, and mastoid obliteration. Pain and cosmetic concern were evaluated via visual analogue scale (VAS). Scars were evaluated via the modified Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS). Postoperative complications were assessed during the follow-up period. RESULTS: The mean duration of noticeable pain was 5.3 days post operation. The mean VAS score for pain was 3.0 of 10 on the first day after the operation and gradually declined. At the 6 months post operation, the mean VAS cosmetic score at the costal cartilage harvest site was 0.6 of 10. The mean VSS score was 9.5 out of 10 total, and the mean POSAS score was 23.27 out of 110 total. CONCLUSION: The minimally-invasive chopped costal cartilage harvest technique resulted in acceptable pain, cosmetic concern, and postoperative complications for most patients. There were no major postoperative complications. Costal cartilage is an acceptable donor for mastoid obliteration in canal wall down mastoidectomy, especially in the context of the extremely low donor site morbidity of the minimally-invasive technique presented in the study.

Current Status of Tympanic Membrane Regeneration Using Tissue Engineering Approach / 대한이비인후과학회지

Tympanic membrane (TM) perforation is common. Acute persistent or chronic TM perforations require surgical interventions such as myringoplasty or tympanoplasty. Current strategies of tissue engineering are focused on the regeneration of TM perforation instead of surgical interventions. To regenerate TM tissue or restore acoustic-mechanical property, bioscaffold or growth factors are necessary that will act as a temporary matrix for cell proliferation and extracellular matrix deposition, with subsequent ingrowths. In recent years, various scaffolds, biomolecules have been used for TM tissue engineering. Cells in combination with supportive scaffolds have rarely reported. TM regeneration by tissue engineering approach may be considered the greatest advances in otology. This review examines the current evidence for their use and the limitations of knowledge.

A Case of Incudal Osteoma Accompanied by Primary Acquired Cholesteatoma / 대한이비인후과학회지

Osteomas in the middle ear are very rare. To date, there are 23 cases of osteomas of the middle ear reported in the English literature. Of these, five osteomas arose from the ossicles, but those accompanied by cholesteatoma is extremly rare. There are only two cases that are all congenital cholesteatoma. Ossicular osteoma with primary acquired cholesteatoma has not been reported previously. We present a case of osteoma of the incus accompanied by primary acquired cholesteatoma, which was diagnosed incidentally in the middle ear.

A Case of Inverted Papilloma Originating from Posterior Nasal Septum

Inverted papilloma is an uncommon benign nasal tumor which usually occurs on the lateral nasal wall. An inverted papilloma originating from the medial nasal cavity, especially the nasal septum, is considered very rare. A 47-year-old male was referred with a 1-month history of snoring. On endoscopic examination, a nasal mass was observed in the left posterior septum. The mass filled the left nasal cavity and extended choanae and nasopharynx. The histopathologic examination of the nasal mass showed inverted papilloma, which was completely removed by endoscopic surgery. Herein, the authors report a case of inverted papilloma originating from the posterior nasal septum as well as a review of literature.

Comparative Study of Sensation with or without Preservation of Great Auricular Nerve during Parotidectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Whether to sacrifice the posterior branch of great auricular nerve (GAN) during parotidectomy is disputatious. This study was to provide a guideline for decision-making. SUBJECTS AND METHOD: Thirty-two patients who underwent parotidectomy due to parotid mass were randomized into two groups. Three patients who underwent further treatment were excluded. Fourteen patients underwent classic parotidectomy by sacrificing GAN whereas 15 patients underwent surgery that preserved the nerve. A two-point discrimination test, sensation of light touch, sharp instrument, blunt instrument and temperature were evaluated preoperatively, and at 7 days, 1, 3, 6, 12 months and 45 months, postoperatively. Patients' preference for the operation time to preserve the nerve was also evaluated. RESULTS: The mean preservation time was 156 seconds. There was no difference in touch sensation, preoperatively, between the two groups. The two-point discrimination test of the infra-auricular area showed significant differences at 1 week postoperatively (p<0.05). The two-point discrimination test of lobule showed significant differences at 1 month (p<0.05), but these differences disappeared at 1 and 3 months. All measured data had no statistically significant differences at 3 and 6 months. At one year, light touch sensation of lobule and temperature sensation of infra-auricular area showed significant differences (p<0.05). Differences in temperature were found at 45 months of follow-up. Of the patients, 95% wanted to preserve the nerve. CONCLUSION: The authors suggest that the posterior branch of GAN was preserved according to patients' preference for the sensation of temperature in the infra-auricular area.