Extratympanic Observation of Middle and Inner Ear Structures in Rodents Using Optical Coherence Tomography

Objectives@#. This study aimed to investigate whether optical coherence tomography (OCT) provides useful information about the microstructures of the middle and inner ear via extratympanic approach and thereby could be utilized as an alternative diagnostic technology in ear imaging. @*Methods@#. Five rats and mice were included, and the swept-source OCT system was applied to confirm the extent of visibility of the middle and inner ear and measure the length or thickness of the microstructures in the ear. The cochlea was subsequently dissected following OCT and histologically evaluated to compare with the OCT images. @*Results@#. The middle ear microstructures such as ossicles, stapedial artery and oval window through the tympanic membrane with the OCT could be confirmed in both rats and mice. It was also possible to obtain the inner ear images such as each compartment of the cochlea in the mice, but the bone covering bulla needed to be removed to visualize the inner ear structures in the rats which had thicker bulla. The bony thickness covering the cochlea could be measured, which showed no significant differences between OCT and histologic image at all turns of cochlea. @*Conclusion@#. OCT has been shown a promising technology to assess real-time middle and inner ear microstructures noninvasively with a high-resolution in the animal model. Therefore, OCT could be utilized to provide additional diagnostic information about the diseases of the middle and inner ear.

Angioleiomyoma Originating from the Auricle / 대한이비인후과학회지

Angioleiomyoma is a benign tumor which arises from vascular smooth muscle. It originates primarily in the upper and lower extremities, but several isolated cases have been described. Although angioleiomyoma has a benign nature, there is a potential risk of malignant change and recurrence in case of incomplete resection. We acknowledge that venous type angioleiomyoma on the posterior surface of auricle has not been reported in the Korean literature. We report a rare case of 49-year-old male who had angioleiomyoma originating from the auricle along with a literature review.

Development of a Korean-Type Qualitative Case History Tinnitus Questionnaire / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Qualitative and quantitative data of tinnitus are both important to obtain necessary information for assessing tinnitus evaluation. But contrary to quantitative questionnaire, qualitative data is not standardized in Korea. This study aimed to standardize the qualitative data of tinnitus by developing a Korean-type integrated qualitative tinnitus questionnaires. SUBJECTS AND METHOD: A cross-sectional survey of Korean otolaryngologists was performed. The questionnaires were administered to otologists who were registered as participants in the tinnitus study group of otology research interest group (ORIG). RESULTS: Most of the otologists (100% of responders) have used the quantitative tinnitus questionnaire measurement (90.5%), but only 76% have used qualitative tinnitus questionnaire. From the responses of otologists who regularly use qualitative questionnaire, 25 items were adopted from the 35 item list. Questionnaire items were selected according to the frequency of listed items in the individual lists. CONCLUSION: We made a qualitative questionnaire consisting of 25 items that were essential and widely accepted. We expect this work will integrate and standardize qualitative tinnitus questionnaires in Korea.

Application of Mohs Surgery to the Treatment of Basosquamous Cell Carcinoma Originating from the Auricle / 대한이비인후과학회지

Complete removal is most important in treating the malignant tumor from the auricle, but the cosmetic and reconstructive plan after removal should also be considered because auricular appearance contributes enormously to the facial aesthetics. Mohs micrographic surgery (MMS), which is commonly used in dermatology, is considered as minimal marginal surgery that offers superior cure rates in the treatment of facial skin cancer. Therefore, MMS could provide a minimally invasive way to manage the malignant tumor of the auricle. This article reports that basosquamous cell carcinoma arising in the auricle was treated with wide resection combined with MMS. Conclusively, we could accomplish the surgical purpose of both completely removing the tumor and maintaining the auricular aesthetic shape by additionally introducing MMS in the treatment.

A Case of Posterior Semicircular Canal Dehiscence Caused by High Jugular Bulb / 대한이비인후과학회지

Posterior semicircular canal dehiscence represents a third-window lesion manifesting as hearing loss with vestibular dysfunction. Computed tomography findings of a dehiscent posterior canal can be verified with increased vestibular evoked myogenic potential responses as in other third-window lesions. The jugular bulb is the bulbiform connection between the sigmoid sinus and the internal jugular vein at the skull base. High jugular bulb can erode into inner ear structures. According to the literature review, there has been no case report about posterior semicircular canal dehiscence caused by high jugular bulb in Asia. Therefore, the authors report a case with a review of literature.

The Significance of Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as Markers for Prognosis in Idiopathic Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The cause of idiopathic sudden sensorineural hearing loss (ISSNHL) is still unclear, but recently, chronic inflammation and thrombosis have received attention. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are some of the markers that show the state of inflammation and ischemia, which are measured routinely in the complete blood cell count (CBC) test. The aim of this study were to investigate the relevance of NLR and PLR with ISSNHL. SUBJECTS AND METHOD: Enrolled in our retrospective analysis were 103 patients diagnosed with ISSNHL. Blood samples were taken from the patients and hearing assessments were performed. NLR and PLR were calculated using the CBC results. Then the patients were divided into 4 groups using Sigel's criteria according to their response to the treatment, which were again classified two groups, the “recovered” and “unrecovered” group. RESULTS: NLR, PLR, and neutrophil values of the unrecovered group were significantly higher than the recovered group (p=0.002, p=0.009, and p=0.038, respectively). On the other hand, lymphocyte values were significantly higher in the recovered group (p=0.007). After adjustment in a multivariate logistic regression analysis, NLR was associated with the recovery of ISSNHL (Odds ratio=1.290, p=0.042). In addition, NLR and PLR values were also significantly different between the groups classified by the Sigel's criteria (p=0.009 and p=0.029, respectively). CONCLUSION: PLR values may be useful in predicting hearing recovery after treatment in patients with ISSNH. It is also expected to be a potential marker for predicting the prognosis and determining further treatment options.

Angioleiomyoma Originating from the Auricle / 대한이비인후과학회지

Angioleiomyoma is a benign tumor which arises from vascular smooth muscle. It originates primarily in the upper and lower extremities, but several isolated cases have been described. Although angioleiomyoma has a benign nature, there is a potential risk of malignant change and recurrence in case of incomplete resection. We acknowledge that venous type angioleiomyoma on the posterior surface of auricle has not been reported in the Korean literature. We report a rare case of 49-year-old male who had angioleiomyoma originating from the auricle along with a literature review.

Multiple Dural Arteriovenous Fistulas Presenting as Pulsatile Tinnitus Treated with External Manual Compression

Dural arteriovenous fistula (DAVF) have been treated by transarterial or transvenous embolization, surgery, and radiosurgery. Besides these treatment options, the external compression technique is a non-invasive, low-cost form of treatment. This article reports that a 60-year-old man with DAVF between multiple arterial branches and transverse/sigmoid sinus was treated by repeated external manual compression method.

Multiple Dural Arteriovenous Fistulas Presenting as Pulsatile Tinnitus Treated with External Manual Compression

Dural arteriovenous fistula (DAVF) have been treated by transarterial or transvenous embolization, surgery, and radiosurgery. Besides these treatment options, the external compression technique is a non-invasive, low-cost form of treatment. This article reports that a 60-year-old man with DAVF between multiple arterial branches and transverse/sigmoid sinus was treated by repeated external manual compression method.

Multicenter Randomized Study on the Efficacy of Isosorbide in Patients with Mèniére's Disease / 대한평형의학회지

OBJECTIVES: Mèniére's disease is one of the most common causes of episodic vestibular syndrome that shows symptom complexes of recurrent vertigo, hearing loss, tinnitus and ear fullness. Isosorbide (Isobide) is a osmotic diuretics which has been used for Meniere's disease to reduce the endolymphatic pressure. The purpose of this study was to evaluate the efficacy of isosorbide in the treatment of Mèniére's disease by comparing the combined therapy of isosorbide and betahistine (Meniace) to betahistine only. METHODS: Among 220 patients enrolled with Mèniére's disease from 9 centers, 187 patients completed this clinical study. Patients were randomly subjected either to betahistine alone therapy at dose of 6 mg three times a day (n=97) or to combined therapy with isosorbide (dose of 30 mL three times a day) and betahistine (n=90) for 12 weeks. Two groups were compared at 4 and 12 weeks after treatment on frequency of vertigo, hearing level (pure tone audiometry, speech audiometry), electocochleography (ECoG), tinnitus (Tinnitus Handicap Inventory, THI) and quality of life (Korean functional level scale, Korean dizziness handicap inventory). RESULTS: During first 4 weeks after treatment, the frequency of vertigo was not reduced in either betahistine alone therapy group or combined therapy group. However, between 8 and 12 weeks, the frequency of vertigo was significantly reduced in either group, and in the combined group frequency of vertigo was more significantly reduced than in the betahistine alone therapy group (p=0.041). The hearing level, ECoG, tinnitus and quality of life was not significantly different between two groups. CONCLUSION: Isosorbide and betahistine combined therapy were more effective for vertigo control than betahistine alone therapy. Isosorbide is an effective diuretic in vertigo control in definite Mèniére's disease.

Human Immunodeficiency Virus Diagnosed from Bilateral Facial Nerve Paralysis as the First Symptom / 대한이비인후과학회지

The incidence of neurological complication has subsequently increased with the rise of human immunodeficiency virus (HIV) infection. Peripheral facial palsy, one of the presenting symptoms of neurological complications, is caused by HIV infection. Worldwide reported cases of bilateral facial palsy associated with HIV are extremely rare, with just 20 cases reported. In this case, bilateral facial palsy occurred during the first clinical manifestation of the HIV infection. It is important to recognize bilateral facial palsy as the first sign of HIV infection due to its significance for early diagnosis and treatment of HIV.

A Case of Cochlear Implantation in Neurofibromatosis Type II / 대한이비인후과학회지

Patients with neurofibromatosis type 2 (NF2) develop bilateral vestibular schwannomas that can cause binaural progressive hearing loss in most individuals. Auditory rehabilitation for bilateral profound sensorineural hearing loss in patients with NF2 poses a great therapeutic challenge. An auditory brainstem implantation may be an option after tumor excision, but its hearing results are still relatively unsatisfactory. A cochlear implantation (CI) may be another option in those cases where the cochlear nerve has been left intact after tumor excision or in those cases that have been kept stable after treating with Gamma-Knife. Here we report a case of undergoing CI after having been treated with Gamma-Knife in NF2 and showing improved open-set speech perception.

Anatomical Relationships between Eustachian Tube and Internal Carotid Artery Using Computed Tomography / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is important to figure out the location between the internal carotid artery (ICA) and the Eustachian tube (ET) for conducting safe ET surgery. Using computed tomography (CT), this study was aimed to evaluate the anatomical relationship between ET and ICA according to age and gender. SUBJECTS AND METHOD: Contrast enhanced CT scans of the paranasal sinus taken between January 2005 and December 2010 were reviewed retrospectively. A total of 216 patients (432 ears) were enrolled. In each patient, we measuresed the distance from the anterior cushion of torus tubarius to ICA (AC-ICA), the distance from the posterior cushion of torus tubarius to ICA (PC-ICA), the distance from the Rosenmuller fossa to ICA, the shortest distance from ET lumen to ICA (ET-ICA), and the angle between the imaginary lines from the orifice of ET to the posterior end point of nasal septum to point ICA (ET-NS-ICA). Patients were divided into 10 groups based on age difference of 15-years. RESULTS: For the female patients aged 65 to 80 years old, AC-ICA, PC-ICA were closest from the nasopharynx. For this group, at p<0.05, the distances of AC-ICA, PC-ICA and ET-ICA showed a negative correlation with increasing age, whereasET-NS-ICA (p<0.05) showed a positive correlation, indicating a tendency of medicalization with increased age. CONCLUSION: The distance between ET and ICA represents a variety of distribution according to gender and age. When performing a surgery for the nasopharyngeal portion of ET, the surgeon should be aware of the location of ICA in the preoperative CT findings.

Balance Problem after Cochlear Implantation / 대한평형의학회지

Cochlear implantations are very popularly performed for hearing rehabilitation of profound hearing loss recently. Postoperative dizziness is one of common complications of cochlear implantation, and one-third of recipients complaint of experience a dizziness after cochlear implantation. The patients should be informed about postimplantation vertigo symptoms. Aims of this article are to provide the basis for preoperative counseling, decrease of postoperative dizziness and postoperative vestibular therapy to cochlear implant recipients with literature review.

Treatment of Meningoencephalocele of Temporal Bone Occurred after Open Cavity Mastoidectomy / 대한이비인후과학회지

Meningoenceophalic herniation into the external auditory canal is a rare and potentially life threatening condition that needs a surgical treatment. It can lead to potential infectious sequelae including meningitis, encephalitis, otologic brain abscess and dysfunctional herniated brain tissue can trigger epilepsy. It is caused by chronic otitis media, cholesteatoma, middle ear surgery, trauma, congenital skull base defect and irradiation. We present a case of meningoencephalic herniation into the external auditory canal that had occurred 8 years after open cavity tympanomastoidectomy, which was treated with subtemporal middle cranial fossa approach.

A Case of Marked Hearing Improvement after Surgical Removal of Vestibular Schwannoma with Profound Hearing Loss / 대한이비인후과학회지

The preoperative hearing status is one of the important factors to determine the method of surgical approach to the vestibular schwannoma. It has been widely recognized that the hearing preservation surgery is not valuable if the patient has no serviceable hearing. The worldwide reported cases of hearing improvement after surgical removal of vestibular schwannoma with profound hearing disturbance are extremely rare, and so far, there have been no domestic cases reported. The authors have experienced a case of significant hearing improvement after surgical removal of vestibular schwannoma with preoperative unilateral total deafness but with normal otoacoustic emission response. We report this case with literature review.

Recurrent Benign Myoepithelioma of the Auricle

Myoepithelioma, a generally benign tumor comprised of myoepithlial cells, is an uncommon salivary gland tumor. Myoepithelioma originates primarily in the parotid gland, but several isolated cases have been described. Although myoepithelioma has a benign nature, but there is a potential risk of malignant change and recurrence in case of incomplete resection. We acknowledge that benign myoepithelioma originating from the auricle has not been reported in the English literature. We present a rare case of 27-year-old female who had recurrent benign myoepithelioma originating from the auricle and already had been given twice operations at the other clinic.

Development of Simplified Version of Korean-Type Tinnitus Handicap Inventory / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The Tinnitus Handicap Inventory (THI) is a useful measure to evaluate the tinnitus and to quantify the functional and psychosocial consequences of tinnitus. However, it can be difficult for patients to understand the items of questionnaire and may take 10 to 15 minutes for them to complete the questionnaire, which can be problematic. The objective of this study is to develop a simplified version of the Korean type Tinnitus Handicap Inventory (THIS). SUBJECTS AND METHOD: A retrospective clinical study was conducted to analyze the THI-S cutoff score used for referral purpose and the level of predictability between the THI and the THIS. 100 patients participated. The subject samples were drawn from outpatients who reported tinnitus as their primary complaints at the time of the initial audiology and otolaryngology evaluations. The 10-item THI-S, selected by using Cronbach's alpha coefficient, showed a high correlation with the scores of the THI. Based on their clinical experiences, the four otologists developed their own screening versions of THI, which were designated as THI-A, B, C and D. The Pearson product-moment correlation was used to assess the comparability of the scores between the THI and the THI-S, A, B, C and D. RESULTS: The results showed that there is a higher correlation between the THIS and the THI-S. A high comparability was shown in the comparison between the THI and the THI-S. CONCLUSION: Further studies will be needed if the THI-S can be applied for clinical use.

Multicenter Study on the Clinician's Diagnostic and Therapeutic Approaches for Benign Paroxysmal Positional Vertigo in Korea / 대한평형의학회지

BACKGROUND AND OBJECTIVES: It is necessary to establish the most efficient diagnostic and therapeutic method for benign paroxysmal positional vertigo (BPPV), which is appropriate for Korean healthcare system. We aimed to evaluate current state of Korean clinician's diagnostic and therapeutic approaches for BPPV. MATERIALS AND METHODS: A 16-item survey was emailed to the members of dizziness department of Otology Research Interest Group in the Korean Otologic Society (n=68). 43 were returned and analyzed. RESULTS: All respondents (100%) used Dix-Hallpike test as a diagnostic tool for vertical canal-BPPV. Supine roll test was used for diagnosing lateral canal BPPV in nearly all the respondents (97.7%). Epley maneuver was chosen as otolith repositioning maneuver (ORM) for posterior canal BPPV in all respondents and barbecue rotation (BBQ) was used for treating lateral canal BPPV with geotropic nystagmus in 95.3% of respondents. Extreme variation was noted for therapeutic approach of lateral canal BPPV with ageotropic nystagmus BBQ, with 4 kinds of ORM and adjunctive measures to liberate otolith from cupula, while BBQ was again the most commonly used ORM (76.7%). CONCLUSION: The development of practical and efficient ORM for lateral canal BPPV with ageotropic nystagmus is necessary.

A Case of Glomus Tumor Presented with a Polypoid Mass in the External Auditory Canal / 대한이비인후과학회지

Glomus tumors, also called paragangliomas, originate from nonchromaffin cells. They are slow-growing benign lesions and represent the most common primary neoplasm of the middle ear. It is worth mentioning that the most common symptoms are pulsating tinnitus and hearing loss. Imaging studies (CT and MRI) are necessary for diagnosis. Although most of cases are limited to the middle ear, this article reports a glomus tumor presented with a polypoid mass in the external auditory canal.