Tumor Growth and Hearing Changes in the Natural Progress of Vestibular Schwannoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#Vestibular schwannoma is a benign neoplasm originating from the vestibular nerve, and the most common symptom caused by the tumor is unilateral hearing loss. This study is aimed to review the clinical outcomes of tumor growth and hearing changes in the natural progress of vestibular schwannoma.SUBJECTS AND METHOD: We retrospectively reviewed 28 patients who were diagnosed with vestibular schwannoma and treated with the ‘wait and scan’ modality for more than a year. We analyzed the patients' audiological changes and tumor growth by reviewing the temporal bone MR images. Patients were classified into an intrameatal group and extrameatal group according to the involvement of the cerebropontine angle.@*RESULTS@#The overall mean follow-up was 45.6±25.8 months. Among the 28 patients, 6 (21.4%) showed tumor growth after ‘wait and scan.’ Hearing thresholds and speech discrimination scores showed deterioration after ‘wait and scan’ in both groups. Among the 12 patients with serviceable hearing at initial diagnosis, 9 (75.0%) preserved serviceable hearing after ‘wait and scan.’ When the pure tone average and speech discrimination scores were applied to the scattergram, most values were positioned near the center of the scattergram, which implied slight changes after ‘wait and scan.’@*CONCLUSION@#The percentage of patients showing tumor growth after the ‘wait and scan’ policy was low. Patients with serviceable hearing at diagnosis would most likely preserve their hearing after ‘wait and scan.’ Considering the limited tumor growth and minimal hearing changes, rather than microsurgery or radiation surgery, the conservative ‘wait and scan’ policy can be an alternative treatment modality in patients with small-sized, non-growing vestibular schwannomas.

The Comparison of Short-Term Therapeutic Effects of Acute Low-Tone Sensorineural Hearing Loss according to Steroid Capacity / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Acute low-tone sensorineural hearing loss refers to a condition wherein thresholds increase only at low frequencies in pure-tone audiometry. Systemic steroid treatment is commonly used for acute low-tone sensorineural hearing loss without vertigo, but there has been no established treatment in most clinical researches. The purpose of this study is to compare and analyze the short-term effects of high- and half-dose oral steroid therapy on patients suffering from acute low-tone sensorineural hearing loss without vertigo. SUBJECTS AND METHOD: Forty-six patients diagnosed with acute low-tone sensorineural hearing loss were divided into two groups and treated with high-dose (24 patients) and half-dose (22 patients) steroids, respectively. A retrospective analysis was conducted on their medical records. RESULTS: There were no significant differences between the two groups in any of the following: age, sex ratio, duration of symptoms before treatment, pure-tone hearing thresholds, low frequency hearing thresholds and speech intelligibility. However, both groups showed significant differences in hearing thresholds before and after treatment. In addition, no significant difference was noted in the recovery and recurrence rate between the two groups. CONCLUSION: According to the results of this study, there is no difference in treatment effect between the high- and half-dose groups. Therefore, half-dose steroids may be used as a treatment option for acute low tone sensorineural hearing loss.

Clinical Features of Patients with Labyrinthine Concussion after Head Trauma

OBJECTIVE: Blunt head injury can lead to isolated damage of the inner ear (cochlear labyrinthine concussion) or damage of the otolith organ (vestibular labyrinthine concussion) due to a bone conduction pressure. We evaluated the clinical characteristics of hearing impairment in patients who suffered from a blunt head trauma without any organic problems, including temporal bone fracture or intracranial hemorrhage. METHODS: This retrospective study examined 9 patients presenting with hearing impairment after blunt head trauma within recent 5 years. This study included only patients without temporal bone fracture or intracranial hemorrhage. RESULTS: Most patients complained of associated auditory symptoms including tinnitus, dizziness, earfullness, and otalgia. Twelve ears of 9 patients showed sensorineural hearing loss; mild (1 ear), moderate (3 ears), moderate-severe (4 ears), severe (2 ears), and profound (2 ears). After high-dose steroid therapy, 2 ears had a significant hearing gain, but 10 ears showed no improvement of hearing. CONCLUSION: Blunt head injury is one of the most common causes of the neurologic disorders. It is important to perform thorough assessment of auditory symptoms as soon as possible. Otologic consultation should be sought in all cases for appropriate management.

A Case of En Plaque Meningioma of Jugular Foramen with Image Findings of Differential Diagnosis

Primary meningioma of jugular foramen is extremely rare, while paraganglioma or nerve sheath tumor are relatively common in jugular foramen. We reported a case of primary meningioma of jugular foramen. A 79-year-old female who had left tinnitus and hearing loss for three month came to the department of otorhinolaryngology. Temporal bone computed tomography scan showed sclerotic change and slightly irregular margins of left jugular foramen with relatively preservation of bony architecture. Temporal bone magnetic resonance image showed well defined homogeneous enhancing mass in left jugular foramen with extension to carotid space on gadolinium enhanced T1 weighted image. Prominent dural tail was also noted. On T2 weighted image, this mass showed intermediated signal intensity with no vascular signal voids. Meningioma was confirmed by pathology. In this article, we describe a case of primary en plaque meningioma of jugular foramen and review image findings of differential diagnosis.

Volumetric Changes in the Bony External Auditory Canal in Unilateral Chronic Otitis Media

BACKGROUND AND OBJECTIVES: Pneumatization of air cells in the mastoid bone is decreased in chronic otitis media (COM). A decrease in the size of the external auditory canal (EAC) is also found frequently in patients with COM, but this has been little studied. We compared the size of affected bony EACs and the contralateral side in patients with single-side COM using high-resolution computed tomography. SUBJECTS AND METHODS: In total, 99 patients with single-side COM were included. Four indicators related to the size of the bony EAC and IAC were measured using high-resolution computed tomography: the axial and coronal lengths of the tympanic membrane, the length of the isthmus, and the area of the bony ear canal. We also compared both internal auditory canals as negative controls. These assessments were made by radiologists who were blinded to the objective of this study. RESULTS: In patients with single-side COM, the axial length of the tympanic membrane was significantly shorter than normal, and the volume of the EAC was also significantly smaller. The length of the isthmus of the EAC was shorter on the affected side, but the difference was not significant. The IAC volume showed no difference between the two sides. CONCLUSIONS: COM affects general temporal bony development, including the bony EAC and mastoid bone. Therefore, whether to correct this should be considered when preparing for COM surgery.

Is a Solitary Fibrous Tumor in the External Auditory Canal Benign?

A solitary fibrous tumor (SFT) is an extremely rare, distinct otological soft-tissue tumor. Only two such tumors in the external auditory canal have been reported. A SFT related to hemangiopericytomas (HPC), which commonly arise in the central nervous system. HPCs act malignant in many cases, while SFTs at other sites are mainly benign. A 25-year-old female presented with highly vascular tumor at the right external auditory meatus and bleeding from the mass when a crust was removed from its surface. After excisional biopsy followed by pre-operative embolization, this tumor confirmed with SFT. The recurrence rate of SFT is very low after complete resection, with a slightly increased risk of recurrence with extrathoracic tumors. We describe the third case of SFT in the external auditory canal and review the literature.

Combination Therapy with Systemic Steroids, an Antiviral Agent, Anticoagulants, and Stellate Ganglion Block for Treatment of Sudden Sensorineural Hearing Loss

BACKGROUND AND OBJECTIVES: Sudden sensorineural hearing loss (SSNHL) is commonly defined as a loss of at least 30 dB in three contiguous frequencies occurring within 3 days. Systemic steroid administration has become the most widely accepted treatment option for SSNHL. Since viral infection and vascular compromise are considered specific causes of SSNHL, antiviral agents, anticoagulants, and stellate ganglion block have been used for its treatment, although the evidence of their effectiveness is weak. The present study evaluated the hearing recovery rate in the combination therapy group (systemic steroids, antiviral agent, anticoagulants, and stellate ganglion block) in comparison with patients treated with systemic steroids alone. SUBJECTS AND METHODS: A total of 85 patients diagnosed with SSNHL were treated with combination therapy (group A, 46 patients) or systemic steroids only (group B, 39 patients). Hearing improvement was defined as a hearing gain of more than slight improvement using Siegel's criteria. All patients were treated with a 10-day course of systemic steroids (10-mg dexamethasone for 5 days, followed by tapering for 5 days). Acyclovir, heparin, and stellate ganglion block were included in the group A treatment regimen. RESULTS: The overall rate of hearing improvement was 60.9% (28/46 patients) in group A, which was significantly higher than that (38.5%, 15/39 patients) in group B. The distribution of prognostic factors was not significantly different between the two groups with the exception of the degree of initial hearing loss, which was more severe in group A. Upon analysis according to prognostic factors, group A showed a better hearing improvement recovery rate than group B in patients with hearing loss >70 dB, age >41 years, dizziness, and early treatment (<1 week). CONCLUSIONS: Thus SSNHL patients treated with combination therapy have a higher likelihood of hearing improvement than those treated with systemic steroids alone.

Mupirocin Ointment Prevents Early Post-Tympanostomy Tube Otorrhea: A Preliminary Study

BACKGROUND AND OBJECTIVES: The most common complication of tympanostomy tube (T-tube) insertion is the development of postoperative otorrhea. Post-tympanostomy tube otorrhea (PTTO) is defined as active drainage through an existing T-tube. Many surgeons routinely use topical antibiotics as prophylaxis against early PTTO. Mupirocin calcium ointment is a topical antimicrobial agent with broad-spectrum antimicrobial activity against many Gram-positive organisms. This study evaluated the clinical effectiveness of topical mupirocin ointment in reducing early PTTO. SUBJECTS AND METHODS: The study included 98 ears (67 patients, mean age 32.9 years) that had a T-tube inserted because of chronic middle ear effusion or atelectatic otitis media. A Paparella type-I polyethylene-tube coated with mupirocin was inserted through the tympanostomy. Patients were instructed not to use otic drops or any other medications. All patients were seen by day 14 postoperatively. RESULTS: Early PTTO occurred in one case (1.5%). No early PTTO was seen with a middle ear effusion. Nineteen children were treated under general anesthesia; none developed early PTTO. CONCLUSIONS: Insertion of a T-tube coated with mupirocin ointment could be effective at preventing early PTTO.

Mupirocin Ointment Prevents Early Post-Tympanostomy Tube Otorrhea: A Preliminary Study

BACKGROUND AND OBJECTIVES: The most common complication of tympanostomy tube (T-tube) insertion is the development of postoperative otorrhea. Post-tympanostomy tube otorrhea (PTTO) is defined as active drainage through an existing T-tube. Many surgeons routinely use topical antibiotics as prophylaxis against early PTTO. Mupirocin calcium ointment is a topical antimicrobial agent with broad-spectrum antimicrobial activity against many Gram-positive organisms. This study evaluated the clinical effectiveness of topical mupirocin ointment in reducing early PTTO. SUBJECTS AND METHODS: The study included 98 ears (67 patients, mean age 32.9 years) that had a T-tube inserted because of chronic middle ear effusion or atelectatic otitis media. A Paparella type-I polyethylene-tube coated with mupirocin was inserted through the tympanostomy. Patients were instructed not to use otic drops or any other medications. All patients were seen by day 14 postoperatively. RESULTS: Early PTTO occurred in one case (1.5%). No early PTTO was seen with a middle ear effusion. Nineteen children were treated under general anesthesia; none developed early PTTO. CONCLUSIONS: Insertion of a T-tube coated with mupirocin ointment could be effective at preventing early PTTO.

Protective Effect of Minocycline Against Cisplatin-induced Ototoxicity

OBJECTIVES: Cisplatin, a widely used chemotherapeutic agent, has serious side effects, including nephrotoxicity and ototoxicity. Minocycline is a semisynthetic second-generation tetracycline that exerts anti-inflammatory and neuroprotective effects. The purpose of this study was to elucidate the protective effect of minocycline against cisplatin-induced ototoxicity in the auditory hair cell. METHODS: The House Ear Institute-Organ of Corti 1 (HEI-OC1) cell line and guinea pigs were used for in vitro and in vivo experiments. Cells were exposed to cisplatin with or without pre-treatment with minocycline. Cell survival was analyzed using MTT (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide). Whole-cell lysates were collected and immunoblotted with antibodies against Bcl-2, p-c-Jun, active caspase-3, cleaved poly (ADP-ribose) polymerase (PARP), and apoptosis-inducing factor (AIF). The guinea pigs received intraperitoneal injections of cisplatin alone or following minocycline pretreatment. The auditory brainstem response was tested and the cochleae were harvested and evaluated using scanning electron microscopy. RESULTS: Survival significantly increased in cells pretreated with minocycline compared with cells exposed to cisplatin alone. Cisplatin treatment increased the expression of active caspase 3, p-c Jun, PARP, and AIF, and pretreatment with minocycline attenuated this response. In animal study, the threshold shift by cisplatin injection in the auditory brainstem response was less pronounced in animals pretreated with minocycline. Scanning electron microscopy revealed more severe damage to the outer hair cells at the basal and middle turns than the apical turn. CONCLUSION: Minocycline partially protects against cisplatin-induced ototoxicity via both caspase-dependent and independent apoptosis pathways.

Evaluation of the Interaural Attenuation for Pure Tone Audiometry in Korean

BACKGROUND AND OBJECTIVES: The masking should be used in pure tone audiometry when the difference between the air-conduction threshold of the tested ear and the bone-conduction threshold of the non-tested ear is more than interaural attenuation (IA). But the standardized average value of IA in Korean has not been evaluated until now. The purpose of this study is to evaluate the interaural attenuation in Korean population. SUBJECTS AND METHODS: Of the patients who visited our department from March, 2007 to August, 2009, 44 patients were selected who had unilateral severe sensorineural hearing loss or deafness and contralateral normal hearing. When the difference between air-conduction threshold with and without masking was more than 10 dB, the interaural attenuation at each frequency was obtained by subtracting the contralateral bone conduction from the air-conduction threshold without masking. RESULTS: The interaural attenuations at each frequency were 45-75 dB (250 Hz), 50-75 dB (500 Hz), 40-75 dB (1 kHz), 45-85 dB (2 kHz), 50-90 dB (4 kHz). 77.2% of the subjects showed interaural attenuation of 55-65 dB at 250 Hz, and 80.9% in 50-60 dB at 500 Hz, 79.5% in 55-65 dB at 1 kHz, 83.4% in 45-60 dB at 2 kHz, and 76.4% in 50-65 dB at 4 kHz. Most of the patients were distributed 15-25 dB higher than the minimal interaural attenuation at 1 kHz. At 2 kHz and 4 kHz, most of the patients were distributed around 15 dB of the minimal interaural attenuation. CONCLUSIONS: These results can be used as reference values for masking of pure tone audiometry. But, further studies with large population should be done to get more precise results and contributing factors to IA values.

Intratympanic Steroids in Severe to Profound Sudden Sensorineural Hearing Loss as Salvage Treatment

OBJECTIVES: Intratympanic steroids are being increasingly used in the treatment of sudden sensorineural hearing loss (SSNHL) after the failure of systemic therapy. This study evaluated the efficacy of administering intratympanic dexamethasone (ITD) as a salvage treatment for severe to profound SSNHL. METHODS: We reviewed the medical records of patients who presented with severe to profound SSNHL between January 2007 and December 2009. ITD was given about 14 days after the initial systemic treatment. Successful recovery was defined as complete or partial recovery using Sigel's criteria. We compared the results of treatment between the severe SSNHL (S-SSNHL) and profound SSNHL (P-SSNHL) groups. RESULTS: All the patients in the S-SSNHL group showed significant improvement, as compared to the P-SSNHL group (P=0.017). The recovery rate after the initial systemic treatment was 36% (9/25) in the S-SSNHL group and 18.1% (4/22) in the P-SSNHL group (P=0.207). In comparison, the recovery rate of ITD as a salvage treatment was 37.5% (6/16) in the S-SSNHL group and 5.5% (1/18) in the P-SSNHL group (P=0.03). CONCLUSION: Our comparative study dose not support the efficacy of ITD as salvage treatment for patients with P-SSNHL as compared with that for S-SSNHL. We recommend that patients with P-SSNHL be informed about the low efficacy of ITD as a salvage treatment.

A Case of Unilateral Conductive Hearing Loss Treated with Stapedial Tenotomy / 대한이비인후과학회지

The ossification of stapedial tendon is a rare disorder of middle ear that results in conductive hearing loss. It might be easily misdiagnosed as otosclerosis, and only exploratory tympanotomy can indicate cases where the mobility of stapes is not fixed or has increased. Cutting of the tendon results in nearly normal ossicular mobility and hearing improvement. A 41-year-old patient visited our clinic with slowly progressive hearing loss. Hearing evaluation revealed that he had a conductive hearing loss with intact tympanic membrane. The mobility of stapes was enhanced by cutting of the tendon through exploratory tympanotomy ; hearing was improved thereafter.

A Case of Acoustic Neuroma Presenting as an External Auditory Canal Tumor / 대한이비인후과학회지

Acoustic neuromas arise frequently within the internal auditory canal and cerebellopontine angle. Rarely, a schwannoma may occur primarily within the labyrinth or may extend secondarily into the labyrinth from the internal auditory canal. The authors experienced a very rare case of acoustic neuroma presenting as a tumor of the external auditory canal in a 43 year-old woman. Tumor was removed by a transotic approach and found to be present in the external auditory canal, middle ear, labyrinth, internal auditory canal and cerebellopotine angle. Subtotal resection of the tumor was performed due to severe adhesions to the facial nerve in the proximal internal auditory canal. Serial magnetic resonance imaging is planned to follow up the residual tumor.

A Case of Nevus Sebaceous in the External Ear / 대한이비인후과학회지

Nevus sebaceous is a rare tumor in the external ear. It is clinically important because this tumor has chance to progress to benign or malignant neoplasm. This change generally occurs after adolescent age. The most common malignant neoplasm arising in this lesion is basal cell carcinoma. Therefore, many authorities recommend complete excision before puberty. A 9-year-old boy visited our clinic with multiple nevi sebaceous involving the pinna and external auditory canal. The tumors were removed completely and the defect was covered with skin graft. There has been no evidence of recurrence as of 10 months following the surgery. We report this case with a review of literature.

Vaccinations with Dendritic Cells Can Elicit Preventive Immunity in a Squamous Cell Carcinoma Animal Model / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Dendritic cells (DC) can effectively mediate the prevention and regression of a variety of solid malignancies when they are properly primed with tumor antigens. However, little has been determined about the efficacy of DCbased vaccine for the prevention of squamous cell carcinoma (SCC). SUBJECTS AND METHOD: Bone marrow derived DC of C3H mouse were pulsed with ultraviolet B-irradiated apoptotic SCCVII cells, which are known as a poorly immunogenic SCC cell line. After vaccinations with those DC, a tumorigenic dosage of healthy SCCVII cells were challenged into the flank of animals and the tumor growth was assessed in a blinded and coded fashion. RESULTS: DC pulsed with apoptotic SCCVII cells effectively prevented the formation of solid tumor in 81% of vaccinated animals and mediated significant retardation of tumor growth (p=0.0029) in 19% of vaccinated animals when compared to control groups. SCCVII cell-specific T-cell response (IFN-gamma production) was observed in the immunized mice. CONCLUSION: Adoptive transfer of DC primed with apoptotic SCCVII cells can serve as an effective preventive vaccine in the poorly immunogenic SCC animal model.

Sinus CT Findings of Antrochoanal Polyp / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Antrochoanal polyp (ACP) is defined as a polyp that originates in the maxillary sinus and passes through the sinus ostia. Physical examination and radiologic findings are the two most important aspects in the diagnosis and treatment of ACPs. However, there have been little attempts to describe the OMU CT findings of ACPs. In this study, authors reviewed the preoperative OMU CT findings of ACPS. MATERIALS AND METHOD: A total of 21 patients without the history of any previous nasal operations were entered into the study. The following seven radiologic parameters were reviewed: presence of polyp, origin of ACP, identification of accessory ostium, destruction in the OMU area, bony changes of the medial maxillary sinus wall, shapes of ACP that extended into nasopharynx in relation with sinusitis. RESULTS: ACPs were classified into three stages according to the level of extension. Of those 21 patients, polyps were observed in 20 patients, destructive changes only in 2 patients and bony changes of the medial wall in 17 patients. Lobulated contour in shape was observed in 24% of the patients. CONCLUSION: ACP is originated in the maxillary sinus and it grows into the nasal cavity via the posterior fontanelle area. It may regress due to insufficient blood supply, but its shape is retained.

The Histopathologic Findings as a Prognostic Indicator after Endoscopic Sinus Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There have been many studies concerning prognosis after endoscopic sinus surgery showing that the prognosis showing that chronic sinusitis patients with asthma is poorer than those without asthma. But, there are only a few reports about histopathology of chronic sinusitis with asthma and correlation between prognosis. The aim of this study is to investigate histopathology of chronic sinusitis and relevance of prognosis after surgery. MATERIALS AND METHOD: A retrospective review of medical records was carried out on 83 chronic sinusitis patients who had undergone endoscopic sinus surgery from 1995 through 1997 at our institution. We compared 7 parameters of sinus mucosal histophathology, allergy and OMC CT between grups with good and poor outcomes. RESULTS: The study revealed no statistical differences on the presence of allergy, OMC CT. However, the poor outcome group showed significant lymphocytes and eosinophils infiltrations with univariant analysis, whereas asthma was proved to be statistically different with multivariant analysis. CONCLUSION: The more lymphocytes and eosinophils infiltrate the mucosa, the poorer the prognosis after endoscopic sinus surgery in the chronic sinusitis patients get. We assume that there will be a good prognostic factor after surgery, and that adequate management and careful follow-up should be taken of patients showing such histopathologic findings.

A Case of Ameloblastic Carcinoma of the Maxilla / 대한이비인후과학회지

Ameloblastic carcinoma is a rare odontogenic tumor. The histologic classification of odontogenic carcinomas has been debated for many years and is still under revision. The term `ameloblastic carcinoma' is used to describe those ameloblastomas with histological evidences of malignancy in the primary, recurrent or metastatic tumors. The mandible is known to be the most common site of ameloblastic carcinoma. Authors report a very rare case of ameloblastic carcinoma of the maxilla with a review of literature.

Histopathologic Characteristics of Chronic Sinusitis with Asthma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Chronic sinusitis has been closely related to bronchial asthma. Patients with both sinusitis and asthma have showed somewhat different mucosal appearance and pathology, compared to those without asthma. We investigated histopathological features of these patients. SUBJECTS AND METHOD: 19 sinusitis patients with asthma who had undergone endoscopic sinus surgery from April, 1995 through September, 1997, and 53 patients without asthma who had undergone surgery from January, 1997 through July, 1997 were evaluated. We compared the following 7 parameters of sinus mucosal histopathology between the asthma and non-asthma group by reviewing histopathological slides: basement membrane thickening, goblet cell hyperplasia, subepithelial edema, submucous gland formation, eosinophilic infiltration, lymphocyte infiltration, polymorphonuclear leukocyte infiltration. We also compared preoperative disease extent, evaluated by degree of polyposis and OMC CT findings, and presence of allergy, which might affect the sinus mucosal pathology. RESULTS: There revealed no statistical difference between two groups on presence of allergy, preoperative polyposis, and OMC CT scores. However, the asthma group showed significant basement membrane thickening, goblet cell hyperplasia, and eosinophilic infiltration, which was statistically significant. No difference was found between subepithelial edema, submucous gland formation, lymphocyte infiltration, and polymorphonuclear leukocyte infiltration. CONCLUSION: Significant histopathological features such as basement membrane thickening, goblet cell hyperplasia, and eosinophil infiltration characterized chronic sinusitis with asthma; however, there were no differences owing to the presence of allergy or the extent of preoperative disease. Adequate preoperative management, close attention during surgery and careful follow-up would be necessary.