Optimal First-Line Therapy for Acute Low-Tone Sensorineural Hearing Loss

Background and Objectives@#We aimed to analyze treatment outcomes following different initial management approaches and confirm treatment regimens for acute low-tone sensorineural hearing loss (ALHL) that would yield the best results. @*Subjects and Methods@#We retrospectively analyzed the medical records of 106 patients with ALHL who visited a university hospital’s otology clinic from March 2013 to June 2019. Pure-tone averages at the initial visit and at 2 and 4 weeks after the initial visit were evaluated. @*Results@#Forty-nine patients were enrolled in this study; of them, 41 (83.7%) exhibited complete recovery (CR) at 2 weeks and 43 (87.8%) exhibited CR at 1 month after the initial visit. Regression analysis revealed that CR at 2 weeks after the initial visit was associated with diuretic use [Exp(B): 10.309, 95% confidence interval (CI): 1.007-100]. An initial daily low-dose steroid use was marginally significant [Exp(B): 1.042, 95% CI: 0.997-1.092; p=0.066]. Isolated diuretic use [Exp(B): 25.641, 95% CI: 1.121-90.909; p=0.039] was an independent, good prognostic factor at 1 month after the initial visit. However, other treatment regimens did not affect the final results. @*Conclusions@#A combination of initial daily administration of ≤30 mg prednisolone plus diuretics was sufficient as the first-line treatment for ALHL. High-dose steroids and salvage intratympanic steroid injections can be applied as a second choice; however, the predicted outcome would not be good in that case.

Normal Mastoid Air Cell System Geometry: Has Surface Area Been Overestimated?

OBJECTIVES: The aim of this study was to emphasize the necessity of a standard in segmentation threshold and algorithm for measuring volume and surface area of mastoid air cell system (MACS). METHODS: First, we obtained axial computed tomography scans of 54 normal temporal bones from 27 subjects. Then, we manipulated Hounsfield units (HU) image data in DICOM (digital imaging and communications in medicine) files directly using our program. The volume and surface area of MACS were computed and compared at segmentation thresholds (HU) from -700 to 0 at intervals of 50 using 2 algorithms; square pixel based (SP) algorithm and marching square (MS) algorithm. RESULTS: No significant difference was found between the volumes computed by SP and MS algorithms at each segmentation threshold. The surface area computed by SP algorithm, however, was significantly larger than that by MS algorithm. We could minimize this significant difference through a modification of the SP algorithm. As the lower HU threshold value was set, the smaller volume was measured. The surface area showed a plateau at a threshold of approximately -200 HU. The segmentation threshold had greater influence on the measured volume of MACS than the algorithm did. CONCLUSION: A standard method for measuring volume and surface area of MACS is thought to be necessary. We suggest that the MS algorithm and -200 HU of the threshold could be a standard in the measurement of volume and surface area of MACS.

Treatment of Verruca Vulgaris in Both External Auditory Canals Using Bleomycin Injections

Verruca vulgaris is caused by human papillomavirus (HPV) infections. Verruca in the external auditory canal (EAC) has rarely been reported. A previous case report introduced surgical excision as a treatment for verruca in the EAC. We present a case of verruca vulgaris in both EACs that was successfully treated with an intralesional bleomycin injection. A 32-year-old male patient presented with ear fullness and palpable lumps in both EACs. Both of his canals were filled with multiple pinkish, papillomatous masses. Verruca vulgaris was confirmed by skin biopsy. An otolaryngologist referred this patient and recommended surgical excision. However, we performed intralesional bleomycin injections for treatment. Twice intralesional bleomycin injections at one-month intervals had excellent results without recurrence, ulceration or scar formation. This result indicates that bleomycin injections may prove to be an effective first-line treatment of verruca in the EAC.

Molecular Diagnosis of Streptococcus pneumoniae in Middle Ear Fluids from Children with Otitis Media with Effusion

PURPOSE: The long-term administration of antibiotics interferes with bacterial culture in the middle ear fluids (MEFs) of young children with otitis media with effusion (OME). The purpose of this study is to determine whether molecular diagnostics can be used for rapid and direct detection of the bacterial pathogen in culture-negative MEFs. METHODS: The specificity and sensitivity of both polymerase chain reaction (PCR) and loop-mediated isothermal amplification (LAMP) to the lytA gene of Streptococcus pneumoniae were comparatively tested and then applied for pneumococcal detection in the clinical MEFs. RESULTS: The detection limit of the PCR assay was approximately 10(4) colony forming units (CFU), whereas that of LAMP was less than 10 CFU for the detection of S. pneumoniae. Both PCR and LAMP did not amplify nucleic acid at over 10(6) CFU of H. influenzae or M. catarrhalis, both of which were irrelevant bacterial species. Of 22 culture-negative MEFs from children with OME, LAMP positivity was found in twelve MEFs (54.5%, 12/22), only three of which were PCR-positive (25%, 3/12). Our results showed that the ability of LAMP to detect pneumococcal DNA is over four times higher than that of PCR (P<0.01). CONCLUSIONS: As a high-resolution tool able to detect nucleic acid levels equivalent to <10 CFU of S. pneumoniae in MEFs without any cross-reaction with other pathogens, lytA-specific LAMP may be applied for diagnosing pneumococcus infection in OME as well as evaluating the impact of a pneumococcal conjugate vaccine against OME.

Analysis of Age-Related Changes in Asian Facial Skeletons Using 3D Vector Mathematics on Picture Archiving and Communication System Computed Tomography

PURPOSE: There are marked differences in facial skeletal characteristics between Asian and Caucasian. However, ethnic differences in age-related facial skeletal changes have not yet been fully established. The aims of this study were to evaluate age-related changes in Asian midfacial skeletons and to explore ethnic differences in facial skeletal structures with aging between Caucasian and Asian. MATERIALS AND METHODS: The study included 108 men (aged 20-79 years) and 115 women (aged 20-81 years). Axial CT images with a gantry tilt angle of 0 were analyzed. We measured three-dimensional (3D) coordinates at each point with a pixel lens cursor in a picture archiving and communication system (PACS), and angles and widths between the points were calculated using 3D vector mathematics. We analyzed angular changes in 4 bony regions, including the glabellar, orbital, maxillary, and pyriform aperture regions, and changes in the orbital aperture width (distance from the posterior lacrimal crest to the frontozygomatic suture) and the pyriform width (between both upper margins of the pyriform aperture). RESULTS: All 4 midfacial angles in females and glabellar and maxillary angles in males showed statistically significant decreases with aging. On the other hand, the orbital and pyriform widths did not show statistically significant changes with aging. CONCLUSION: The results of this study suggest that Asian midfacial skeletons may change continuously throughout life, and that there may be significant differences in the midfacial skeleton between both sexes and between ethnic groups.

Complementation of Disability Rating System on Hearing Injury: Application of Linear Regression Analysis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: According to the correlation between hearing injury and McBride disability rating presented by previous studies, there are over/underestimated cases particularly in the 40 dB hearing range compared to other ranges. In this study, we reviewed the overestimated and underestimated data and propose a complementation scheme for a disability rating system by using the linear regression analysis. SUBJECTS AND METHOD: For the past 14 years, we have provided legal advisory for 121 cases of hearing injury, for which disability had to be rated. We reviewed all but excluded 11 cases for the aggravation of disability. A regression equation was produced from a linear regression analysis that used the percent of hearing handicap (AAO-HNS/AMA-1979 formula) as an independent variable (x) and McBride disability rating (%) as a dependent variable (y), following the Pearson correlation test. Iterative calculation was performed for overestimated (18) and underestimated (8) cases. RESULTS: Appropriate disability ratings were 14% for the cases overestimated to 20% and 11% for those underestimated to 5%. Appropriate disability ratings for the 20% of overestimated cases were changed to 14%, and for the 5% of the underestimated cases, the disability ratinb 11%. Iterative calculation showed that the Pearson correlation index was improved from 0.8866 to 0.9065 and the determination coefficient of regression analysis (adjusted R-square) was improved from 0.784 to 0.8202. CONCLUSION: The common range of hearing injury, which falls between 30-40 dB corresponds to the percentage of hearing handicap of 7.5-22.5%. A fairer assessment of ability rating would be possible by complementing some parts of this hearing range.

Hearing Injury Evaluation: Current Status and Medicolegal Considerations / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In disability rating of hearing injury, there are some medicolegal considerations, such as discrepancy in estimating values between McBride system and the American Medical Association system, and difficulties in judging the hearing level in boundary cases. We have therefore felt the need of complementary hearing disability evaluation methods that reflect reality. As a first step, we have pointed out current situation and problems in legal advisory cases of hearing injury. SUBJECTS AND METHOD: For the past 14 years, we have provided legal advisory on hearing injury for 121 cases for courts (group A) or insurance companies (group B). Eleven cases of 'aggravation of disability' were excluded. Data were summarized and tested statistically. We have used unpaired t-test for continuous variables such as age, hearing, hearing disability, disability rating, Fisher's exact test for dichotomous variable such as gender, group (A/B), and Pearson's correlation test for correlation coefficients between continuous variables. RESULTS: Subjects were more frequently males (3:1) and in the fifth decade of life. The averages of audiometry were around 40 dB. There were significant differences in hearing and disability rating between younger and older group. Group B is significantly older than group A. The type of disability or accident did not influence hearing and disability rating. CONCLUSION: This paper could help figure out the current situation with respect to medicolegal considerations of hearing injury discrepancies in disability rating and could also serve well to recognize the necessity for a complementary hearing disability evaluation method, especially for borderline hearing level.

Medicolegal Considerations in Hearing Injury with an Aggravation of Disability / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: When a disability is superimposed on a previous disability, the concept of aggravation of disability should be applied. In rating the disability for hearing loss, we focused on the aggravation of disability and the methods of assessment. SUBJECTS AND METHOD: For the past 12 years, we have provided legal advisory for 111 cases of hearing injury, for which disability had to be rated. In 11 of those 111 cases, disability was assessed in consideration of aggravation of disability. We assessed disability using three rating methods: they were based on 1) a change of hearing level from assumed normal, 2) apportionment of new hearing injury in final hearing, and 3) a change in disability rating. We evaluated for significant differences and correlations between the values obtained by each method. RESULTS: There was a significant difference between the results by the methods 1 and 2. The disability rating by the method 2 showed good correlations with those assessed by the methods 1 and 3. CONCLUSION: When considering aggravation of disability in hearing, the method 2 could be a good alternative when the standard method 3 is inappropriate.

The Development of an Automatic Chronic Otitis Media Operation Recording System with Concurrent Data Input Process / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It takes considerable time and effort to make an operation record for the chronic otitis media. Also there are risks of incorrectness or omission of data. We developed an automatic operation recording system in order to reduce the burden of the resident keeping the record and to give completeness to the operation data. SUBJECTS AND METHOD: The model-view-controller (MVC) pattern isolates the domain logic (controller) from the user interface (data model-view), permitting independent development. We used the MVC pattern to design the program it since it matched with the feature of the operation recording system. RESULTS: We implemented this system using the Python programming language, which is composed of 98 fields and 4 different types of widgets linked to those fields. The outputs of the 4 views can be easily copied and pasted to the word processor and the electronic medical recorder. In the pilot test, this system reduced significant amount of time and effort needed for operation recording. CONCLUSION: The automatic operation recording system reduces the resident's works and the operation data loss. Furthermore, it could be applied to other types of operation records.

Alteration of Olfactory Function in Chronic Viral Hepatitis Patients

BACKGROUND AND OBJECTIVES: Alterations of olfactory function among patients with cirrhosis of the liver, acute viral hepatitis or alcoholic liver disease have been reported. The goal of this study is to evaluate the alteration of olfactory function among chronic viral hepatitis patients. MATERIALS AND METHODS: The study group consisted of 21 patients with chronic active viral hepatitis and 32 normal subjects. Between December 2006 and January 2008, olfactory function among the study groups was evaluated using the Connecticut Chemosensory Clinical Research Center and the Cross Cultural Smell Identification Test. Then, correlations between the olfactory function test scores and serological data were analyzed. RESULTS: Hepatitis patients had significantly lower smell identification test scores. Only serum total bilirubin level had negative correlation with smell identification test scores. CONCLUSION: Chronic viral hepatitis appears to influence olfactory function.

Three-Dimensional Computer Graphics in Otology / 대한이비인후과학회지

No abstract available.

A Mathematical Consideration on the Dix-Hallpike maneuver

BACKGROUND AND OBJECTIVES: At the beginning of the Dix-Hallpike maneuver, one of the two functional pair planes of the vertical canals is presumed to lie in the sagittal plane. However, this presumption is not correct. This paper aims to describe this problem more clearly and speculate on clinical implications. Mathematical and theoretical reasoning will be discussed. MATERIALS AND METHODS: Two sets, each composed of three perpendicular planes, were modeled for simplified semicircular canals in the anatomical position with a 3D modeler. After a yaw rotation of 45 degrees, the surface normal of the vertical canal plane is compared with that of the true sagittal plane. RESULTS: The angle between the two normals was approximately 21.1 degrees. The theoretical vertical canal plane did not lie in the sagittal plane at the beginning position of Dix-Hallpike maneuver. CONCLUSIONS: More exact Dix-Hallpike maneuvers may require a roll tilting about 20 degrees toward the affected side.

Compromises between the Frequencies of the Colloquial Phonemes and Those of a New Monosyllabic Words List in Korean / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Several investigators have developed word lists for Korean speech audiometry. Many variations of the lists were identified in previous survey. A committee was organized to develop standard word lists for Korean speech audiometry. In this study, we propose new monosyllabic and bisyllabic word lists, whose performances can be compared with those of previous word lists, verified in clinical situations, and revised in future with proper reasons. We also report why some compromises have been made in the words number and the phoneme frequencies of the new monosyllabic word lists. There was no compromise in those of the new bisyllabic word list. MATERIALS AND METHOD: The target frequencies of new lists were determined by the previous references. In the Korean dictionary, 410 familiar monosyllabic words were available for the lists. These words were arranged in a matrix of initial consonants and vowels to meet the phonetic balance condition. RESULTS: Two monosyllabic word lists were developed with abovementioned compromises for the lack of monosyllabic words with final consonants. One bisyllabic word list could be made without compromise. CONCLUSION: The arrangement method in this report has some advantages in diversifying syllable distribution and satisfying the phonetic balance condition. The new monosyllabic and bisyllabic word lists have been designated with identification codes 'KsoM-07' and 'KsoB-07', respectively.

Evaluation of Internal Laryngeal Muscles Related to Phonation and the Compensatory Mechanism in Patients with Unilateral Vocal Cord Paralysis Using (18)F-Fluorodeoxyglucose-Positron Emission Tomography / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES : Several studies have reported that (18)F-fluorodeoxyglucose (FDG) uptake in positron emission tomography (PET) imaging is physiologically increased at the intact vocal cord in patients with unilateral vocal cord paralysis, which is explained by a compensatory mechanism of the intact vocal cord. We aimed to evaluate internal laryngeal muscles related to phonation and the compensatory mechanism in patients with unilateral vocal cord paralysis. SUBJECTS AND METHOD : We performed (18)FDG-PET imaging and neck computed tomography (CT) scan in the normal control group composed of 13 subjects and the paralyzed group composed of 11 patients with unilateral vocal cord paralysis. The two groups were divided into two groups, phonating and silent, before performing (18)FDG-PET. (18)FDG-PET and neck CT images by Syntegra. A specialist in nuclear medicine performed all the test measurements, the standardized uptake value (SUV) in the interarytenoid muscle (IA), both thyroarytenoid muscles (TA), and both lateral cricoarytenoid muscles (LCA). The mean SUVs were statistically analyzed. RESULTS : In the Normal-Phonating group, the mean SUV of IA was the highest, with 3.68+/-0.96 (Mean+/-SD), followed by that of LCA, with 2.34+/-0.67. However, when compared with the same muscles in the Phonating-Silent group, only the SUV of IA was significantly increased by phonation. In the Paralyzed-Silent group, the SUV of TA in the intact side was the highest, with 2.30+/-0.39. In the Paralyzed-Phonating group, the SUV of TA in the intact side, IA, and LCA in the intact side were 5.88+/-2.65, 3.92+/-1.65, and 3.87+/-1.37, respectively. When compared with the same muscles in the Phonating-Silent group, the SUVs of TA and IA were significantly increased. CONCLUSION : The muscle related to the compensatory mechanism in patients with unilateral vocal cord paralysis is thyroarytenoid muscle in the intact side. The interarytenoid muscle plays a major role in the mechanism of phonation in humans.

Jongkees' Formula Reevaluated: Mathematical Significance of CP and Negative SCV Value

BACKGROUND AND OBJECTIVES: In caloric test, the CP (canal paresis) value was derived from Jongkees formula. The input parameters of the formula were initially nystagmus duration (seconds), which were replaced later with more stable parameters : slow component velocity (SCV, deg/sec). The nystagmus duration cannot be negative value, but SCV can be, especially in acute vestibular loss with excessive spontaneous nystagmus (SN) which is not overcome by caloric nystagmus. This study aims to investigate the occurrence of negative SCV, to check proper processing of negative SCV values in nystagmography software, and to consider the mathematical significance of CP and negative SCV values. MATERIALS AND METHOD: Tests with negative SCV values were examined in 690 alternate binaural bithermal caloric tests (open loop system). RESULTS: Nine percents (62 of 690 tests) showed negative SCV values. The reported CP was erroneously calculated from debased zero SCV values instead of negative SCV values. The underestimated CP (mean 52.1%, SD 21.8%) can be corrected (mean 80.9%, SD 21.8%) by recalculations with negative SCV values. CONCLUSION: To produce correct CP values in caloric tests, negative values should be properly processed about the SCV value of caloric nystagmus with opposite direction of physiologic response. The mathematical significance of CP was horizontal coordinate of intersection point of the warm line (LW-RW) and cold line (LC-RC) in butterfly pattern calorigram. Detailed description is presented in figures.

Excessive Post-Obstruent Tensing in Korean Spondee Word List: Comparison between the Colloquial Korean Language and Hahm's List / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study investigated the frequencies of phonemes in the colloquial Korean language and compared them with those of the Korean spondee word list (KSWL). MATERIALS AND METHOD: One hundred fifty nine scripts (2, 312, 651 syllables) from several television dramas and news in Korean were selected as study materials. A computer program was developed and used to estimate the frequencies of phonemes from the pronunciated notation of the materials and KSWL. RESULTS: All materials except KSWL showed similar trends in the frequency of phonemes. The vowel distribution of KSWL mostly corresponded with the colloquial language. More (86.1% vs. 35.8%) final consonant phonemes were present in KSWL than in the colloquial Korean. The most prominent discrepancy existed in the initial consonant phonemes which had excessive post-obstruent tensing. CONCLUSION: The results of the present study recommend that KSWL needs to be modified in order to have more similar frequencies of phonemes with the actual frequencies of the colloquial Korean language.

A Survey of Phonetically Balanced Words Lists Used in Training Hospitals in Korea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although several Korean PB (phonetically balanced) word lists were proposed by many investigators, there is not yet a standard PB word list established in Korea. This study aims to study the actual condition of Korean PB word lists, to investigate the frequencies of Korean phonemes and to delineate the commonly used monosyllabic words among them. MATERIALS AND METHOD: The study materials were collected from 80 training hospitals in Korea. The frequencies of the initial consonants, vowels and final consonants in the collected lists were calculated with a computer program. Common monosyllabic words were summarized in a table according to their incidences in the lists. RESULTS: Thirteen lists were used in 80 training hospitals. Hahm's list was most commonly used. Most lists showed a similar trend in the phoneme frequencies. The most common monosyllabic words were /gang/, /nun/, and /don/. CONCLUSION: These results might be valuable information for the production of a new standard Korean PB word list.

Regulation of Cytokine and Cyclooxygenase Expression in Palatine Tonsils from Recurrent Tonsillitis in Children / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Prostanoids are converted from arachidonic acid via cyclooxygenase (COX), which has two isoforms, COX-1 and COX-2. It has recently been shown that prostanoids may have a novel role in mediating cytokine release in some cells. We investigated the baseline expression and regulation of interleukin (IL)-6, IL-8, COX-1 and COX-2 in palatine tonsils from pediatric recurrent tonsillitis. MATERIALS AND METHOD: Palatine tonsils were obtained from 12 children with recurrent tonsillitis during elective tonsillectomy and adenoidectomy. Tonsil cells were incubated with culture media only or with proinflammatory cytokines (IL-1beta and TNF-alpha) or inhibitors of transcription (actinomycin D) or translation (cycloheximide). In these groups, IL-6, IL-8, COX-1, COX-2 mRNAs and COX-1, COX-2 proteins were analyzed by reverse transcriptasepolymerase chain reaction and Western blot, respectively. RESULTS: The baseline expressions of IL-6, IL-8, COX-1 and COX-2 mRNAs were detected although tonsillectomy was done in the silent phase without acute infection. The culture of tonsil cells with pro-inflammatory cytokines increased the expression of IL-6, IL-8 and COX-2 mRNAs and COX-2 protein. The expressions of IL-6, IL-8 and COX-2 mRNAs and COX-2 protein induced by pro-inflammatory cytokines was significantly inhibited by actinomycin D, not by cycloheximide. CONCLUSION: Tonsil cells isolated from pediatric recurrent tonsillitis are in constantly inflamed state. The expression of COX-2 mRNA induced by pro-inflammatory cytokines is accompanied by the induction of IL- 6 and IL-8 mRNAs. The regulation of these effects occurs at the transcriptional level. Furthermore, the regulation of cytokines and COX-2 may provide an understanding of mechanism of prostanoids synthesis in chronic tonsillitis.

Is It Possible to Replace Alternative Binaural Bithermal Caloric Test by Monothermal Caloric Test in the Diagnosis of Dizzy Patients? / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The alternative binaural bithermal (ABB) caloric test by Fitzgerald and Hallpike has become a standard procedure in caloric tests. But it brings patient discomfort and is a time consuming procedure. This study was aimed to investigate the efficacy of the monothermal caloric test as a replacement of ABB caloric test. MATERIALS AND METHOD: The results of 690 complete ABB caloric tests collected from 1997 through 1999 were analyzed retrospectively. We have examined the correlations between canal paresis value (CP) derived from an ABB caloric test and compared with the canal paresis value (CPmono) derived from the monothermal caloric component of a bithermal caloric test. RESULTS: There was a stronger correlation between CP and CPmono of warm monothermal component (Pearson correlation coefficient=0.86) than that of cold monothermal caloric test (Pearson correlation coefficient=0.55). Excluding cases with spontaneous nystagmus (n=553), similar results was observed. A warm monothermal caloric test has higher sensitivity and specificity than a cold monothermal caloric test. When the sensitivity of warm monothermal caloric test was more than 90%, the false positive rate was more than about 20%. The false positive rate was unacceptably high. CONCLUSION: The monothermal caloric test cannot be used as a replacement of ABB caloric test.

Frequencies of Korean Syllables and the Distribution of Syllables of PB Word List / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There can be 3, 192 syllables in Korean language but the frequencies of each syllables are variable. This study was aimed to investigate the frequencies of each Korean syllable in the everyday dialogue and to compare the result with the existing Korean phonetically balanced (PB) word list, which can provide the basic data for the standardization of Korean PB word list. MATERIALS AND METHOD: Using 33 materials (total 537, 245 syllables) collected from TV drama (MBC Best Theater), the author calculated the frequencies of each Korean syllables composed of initial consonant and vowel and compared with existing PB word list by computer program. RESULTS: Each syllable appeared in the different frequency pattern. The 138 of 399 syllables represented the 95% of everyday dialogue. CONCLUSION: This study showed that established PB word list was made relatively well but needs somewhat modification to reflect the actual frequencies of syllable in colloquialism.