Current Treatments for Congenital Aural Atresia

Congenital aural atresia is an ear malformation evident at birth, involving various degrees of failed external ear canal development. A true external ear canal is desirable, as devices that replace the canal are inconvenient and expensive. Therefore, an optimal surgical technique is required. Here, we review useful preoperative and operative techniques. Surgical correction is often not the preferred treatment; the hearing outcome is no better than the outcomes afforded by bone-conduction devices, and surgery may be associated with recurrence or complications such as meatal stenosis. Preoperative evaluation and appropriate management are important. Several means of preventing meatal stenosis are discussed in this review.

Primary carcinoid tumor in the external auditory canal

A 39-year-old man visited the department of otolaryngology due to an ongoing hearing disturbance that had lasted for 1 year. Temporal bone computed tomography revealed soft tissue density nearly obliterating the left external auditory canal (EAC). The mass was composed of sheets of round tumor cells containing moderate amounts of fine granular cytoplasm and salt and pepper chromatin. Neither mitosis nor necrosis was found. The Ki-67 proliferation index was less than 2%. Cells were positive for CD56 and synaptophysin but negative for chromogranin, cytokeratin (CK) 20, and CK7. Based on these findings, the tumor was diagnosed as a carcinoid tumor, well differentiated neuroendocrine carcinoma, grade 1 (G1) according to current World Health Organization (WHO) classification of head and neck tumors; and a neuroendocrine tumor, G1 according to neuroendocrine neoplasm (NEN)-2018 WHO standard classification. He remained free of local recurrence and metastasis after 20 months of follow up. To date, only six cases of primary NENs in the EAC have been reported. Metastatic tumor should be included in the differential diagnoses. Because of its rarity, the prognosis and treatment have not yet been clarified.

Translation and Linguistic Validation of Korean Version of Musical Background Questionnaire / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#The Musical Background Questionnaire (MBQ) has been developed to assess formal musical training and listening enjoyment. The aims of this study were to translate MBQ into Korean with subsequent linguistic validation and to evaluate the effectiveness of the Korean version of MBQ (K-MBQ).SUBJECTS AND METHOD: Between 2013 and 2014, a panel affiliated with the questionnaire committee of the Korean Audiological Society reconciled the first draft K-MBQ translated by a bilingual person. A separate bilingual translator, who had never seen the original MBQ, translated the draft K-MBQ back into English, and subsequently, the panel reviewed its equivalence to the original one. K-MBQ was administered to 29 adults (M:F=15:14; aged 21 to 76 years) for cognitive debriefing. Pure tone and speech audiometry were performed in all participants.@*RESULTS@#The translation of K-MBQ was completed through a multi-step process of forward translation, reconciliation, reverse translation, cognitive debriefing and proofreading. Thirteen (45%) of 29 subjects reported formal musical training, and 16 participants (55%) judged themselves as having no musical education and background. No significant correlation was found between musical background and hearing level, whereas self-perceived quality of music and self-perception of music elements quantified by K-MBQ were associated with hearing ability in terms of pure-tone and speech audiometry.@*CONCLUSION@#K-MBQ was translated and linguistically validated. The use of this questionnaire can provide further evaluation of musical background in patients with hearing loss or cochlear implant users.

Microbiological Results From Middle Ear Effusion in Pediatric Patients Receiving Ventilation Tube Insertion: Multicenter Registry Study on the Effectiveness of Ventilation Tube Insertion in Pediatric Patients With Chronic Otitis Media With Effusion: Part

OBJECTIVES: The aim of this multicenter registry study was to investigate the effectiveness of ventilation tube insertion and the microbiology of otitis media with effusion (OME) in children. This part I study was conducted to evaluate the microbiological profile of children with OME who needed ventilation tube insertion. METHODS: Patients < 15 years old who were diagnosed as having OME and received ventilation tube insertion were prospectively enrolled in 16 tertiary hospitals from June 2014 to December 2016. After excluding patients with missing data, the data of 397 patients were analyzed among a total of 433 enrolled patients. The clinical symptoms, findings of the tympanic membrane, hearing level, and microbiological findings were collected. RESULTS: In 103 patients (25.9%), antibiotics were used within 3 weeks before surgery. Ventilation tube insertion was performed in a total of 710 ears (626 in both ears in 313 patients, 55 in the left ear only, and 29 in the right ear only). Culture of middle ear effusion was done in at least one ear in 221 patients (55.7%), and in a total of 346 ears. Only 46 ears (13.3%) showed positive results in middle ear effusion culture. Haemophilus influenzae (17.3%, followed by coagulase-negative Staphylococcus and Staphylococcus auricularis) was the most common bacteria detected. CONCLUSION: H. influenzae was the most commonly found bacteria in middle ear effusion. Relatively low rates of culture positivity were noted in middle ear effusion of patients with OME in Korea.

Identification of Vestibular Organ Originated Information on Spatial Memory in Mice / 대한평형의학회지

OBJECTIVES: We aimed to study the role of vestibular input on spatial memory performance in mice that had undergone bilateral surgical labyrinthectomy, semicircular canal (SCC) occlusion and 4G hypergravity exposure. METHODS: Twelve to 16 weeks old ICR mice (n=30) were used for the experiment. The experimental group divided into 3 groups. One group had undergone bilateral chemical labyrinthectomy, and the other group had performed SCC occlusion surgery, and the last group was exposed to 4G hypergravity for 2 weeks. The movement of mice was recorded using camera in Y maze which had 3 radial arms (35 cm long, 7 cm high, 10 cm wide). We counted the number of visiting arms and analyzed the information of arm selection using program we developed before and after procedure. RESULTS: The bilateral labyrinthectomy group which semicircular canal and otolithic function was impaired showed low behavioral performance and spacial memory. The semicircular canal occlusion with CO₂ laser group which only semicircular canal function was impaired showed no difference in performance activity and spatial memory. However the hypergravity exposure group in which only otolithic function impaired showed spatial memory function was affected but the behavioral performance was spared. The impairment of spatial memory recovered after a few days after exposure in hypergravity group. CONCLUSIONS: This spatial memory function was affected by bilateral vestibular loss. Space-related information processing seems to be determined by otolithic organ information rather than semicircular canals. Due to otolithic function impairment, spatial learning was impaired after exposure to gravity changes in animals and this impaired performance was compensated after normal gravity exposure.

A Systematic Literature Review for Evaluating the Clinical Usefulness of the Customized Vestibular Exercise / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study aims to evaluate the usefulness of customized vestibular exercise through literature review. MATERIALS AND METHOD: We searched several literature database such as Ovid-MEDLINE, Ovid-EMBASE, and Cochrane Library etc., with the following inclusion criteria: 1) studies of patients with dizziness and balance disorders, 2) studies in which a customized vestibular exercise was performed, and 3) studies in which one or more of the appropriate medical outcomes have been reported. At the same time, we excluded the following: 1) non-human studies and pre-clinical studies, 2) non-original articles, for example, non-systematic reviews, editorial, letter and opinion pieces, 3) research not published in Korean and English, 4) grey literature (thesis, congress or conference materials, abstract etc.), and 5) case studies. Finally, 10 studies were selected and analyzed. RESULTS: The safety of customized vestibular exercise was reported in three documents which reported no side effects related to the procedure. The effectiveness of customized vestibular exercise was proven by the assessment of symptom change, functional change, and other physiological measures based on a total of 10 randomized clinical trial studies. CONCLUSION: For patients with vestibular dysfunction, a customized vestibular exercise can be a safe and effective technique for improving dizziness and balance function.

Validation of the Korean Version of the Abbreviated Profile of Hearing Aid Benefit / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The quantification of hearing aid benefit is important in hearing aid fitting. The abbreviated profile of hearing aid benefit (APHAB) is a useful tool for measuring the benefit of using hearing aids. In this study, we developed a Korean version of APHAB (K-APHAB) and determined its validity and reliability. SUBJECTS AND METHOD: An expert panel translated the original version of APHAB into Korean language. Two bilingual translators back-translated the first translated version into English and it was compared with the original version. After cognitive debriefing, the translation of APHAB into the Korean version was completed. One hundred ninety-seven subjects using hearing aids participated in this study and completed K-APHAB. Reliability was assessed using Cronbach's alpha coefficient, and validity was evaluated by factor analysis and criterion validity. RESULTS: K-APHAB had a good internal consistency (α=0.80). Confirmatory factor analysis showed that K-APHAB is comprised of four subsections, namely ‘communication in daily life’, ‘aversiveness’, communication in ‘background noise’ or ‘reverberation’. CONCLUSION: The K-APHAB is a useful tool for evaluating the benefit of hearing aids in Korean hearing-impaired individuals.

Standardization for a Korean Version of the Speech, Spatial and Qualities of Hearing Scale: Study of Validity and Reliability / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The Speech, Spatial and Qualities of Hearing Scale (SSQ) was designed to measure self-reported auditory disability in a wide variety of listening situations. Its 49 items cover many aspects of speech perception, spatial hearing, and qualities of hearing, which constitute the three parts of SSQ. However, there has been no reliable and valid Korean version of SSQ (K-SSQ), which made the measurement of auditory disability difficult. The aim of this study is to develop a K-SSQ and to determine its reliability and validity for clinical or academic use. SUBJECTS AND METHOD: An expert panel translated the original SSQ into Korean. A bilingual translator back-translated the translated version into English, which was then compared with the original version. After cognitive debriefing, K-SSQ was administered to 400 patients with hearing disability in 14 referral hospitals. Reliability was assessed using Cronbach's alpha coefficient and correlation study. Validity was evaluated by factor analysis and criterion validity based on the results of pure tone audiometry. RESULTS: K-SSQ showed good reliability with high internal consistency (Cronbach's α=0.99), and strong positive correlations across all three parts of SSQ. Construct validity was confirmed by the results of factor analysis and criterion validity demonstrated positive correlations between each part of SSQ and the results of pure tone audiometry. CONCLUSION: The K-SSQ is a reliable and valid tool for use as a behavioral measure of hearing ability in Korean-speaking patients, and it will provide a very useful evaluation tool for both clinicians and researchers.

Translation and Standardization for a Korean Version of the Client Oriented Scale of Improvement / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Client Oriented Scale of Improvement (COSI) has been designed to identify client needs, changes in listening ability, and final listening ability in situations important to each client. The aim of this study was to translate COSI into Korean with subsequent linguistic validation and to determine the reliability of the Korean version of the COSI (K-COSI). SUBJECTS AND METHOD: An expert panel translated the original version of COSI into the Korean language. A bilingual translator back-translated the translated version into English, which was subsequently compared with the original English version. K-COSI was administered at 14 referral hospitals, to 128 patients with hearing disability after cognitive debriefing. Reliability was assessed using correlation study. RESULTS: K-COSI showed an excellent test-retest correlation and high reliability in degree of change (Spearman correlation=0.89, interclass correlation coefficient=0.922). It also showed a fair test-retest correlation and high reliability in final hearing ability (Spearman correlation=0.49, interclass correlation coefficient=0.353) CONCLUSION: K-COSI proved to be highly reliable. The results suggest that the adapted Korean version of COSI is a reliable and valid measure for Korean-speaking patients with hearing loss.

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.

Vestibulo-Ocular Reflex Recordings of Small Rodents using a Novel Marker Array / 대한평형의학회지

OBJECTIVE: Recording the nystagmus of small experimental rodents is an integral technique in vestibular research. Theoretically, the size and the shape of markers strongly affect the analysis of 3 dimensional nystagmus. METHODS: The nystagmus of 6 healthy ICR mice were recorded and their gain values were compared using 200 µm, 300 µm, 400 µm, and 600 µm isosceles triangle markers at the peak velocity of 60°/sec and 100°/sec with the rotational stimulations of 0.1 Hz, 0.2 Hz, and 0.5 Hz. RESULTS: The gain values of 3 different sizes of the markers showed no significant differences in horizontal- vertical-torsional component. However, it was unable to record the nystagmus with 200 µm markers since the markers were too small to be placed and stayed on the center of the pupils. CONCLUSION: Technicians can decide the size of the markers from 200 to 600 µm to record the nystagmus of mice, depending on the technicians' skills.

Otoplasty in Otolaryngology / 대한이비인후과학회지

Otoplasty is known to be a challenging and rewarding area in otolaryngology. Although the physiologic effects of ear deformity are negligible, the aesthetic and psychological impact on the patient can be profound. Protruding, thin auricle of the ear is prone to damage from craniofacial trauma. The degree of damage varies, requiring immediate treatment and management. In order to obtain favorable results from otoplasty, having firm knowledge on the anatomy and embryology of the external ear must be preceded prior to meticulous assessment and assiduous operative planning for deformity of external ear and auricular injury. Anesthetic correction of the ear through diagnosis and subsequent treatment of the affected ear must also be performed. This study summarizes anatomic and embryologic analysis of the external ear and auricular deformities and trauma. In addition, a great number of surgical techniques for the otoplasty is reviewed to provide higher satisfaction for both patients and surgeons.

The Diagnosis Criteria of Meniere's Disease and Related Objective Tests / 대한이비인후과학회지

The etiology and pathophysiology of Meniere's disease (MD) remain controversial and incompletely understood. Diagnosis of MD is decided according to the diagnostic criteria proposed by the American Academy of Otolaryngology-Head and Neck Surgery (AAO) (1995), which is based on clinical symptoms. It would be of great value to have an objective clinical test for the diagnosis of endolymphatic hydrops. Various tests like electrocochleography, vestibular evoke myogenic potential and cochlear hydrops analysis masking procedures have been applied for detecting endolymphatic hydrops. Any of single objective tests is not perfect for the diagnosis of MD. However, considering AAO guideline is not enough for the diagnosis, additive objective tests for MD become essential. We evaluated the objective tests for MD and also surveyed preferred tests among Korean otologic society members.

Vestibulospinal Reflex and Locomotion / 대한이비인후과학회지

Unsteadiness that people may continuously experience in everyday life is closely related to unilateral vestibulopathy. In human bipedal gait related to locomotion, supra-spinal control is responsible for gait rhythm. The vestibular system is involved in stable gait directly by adjusting the tension of the antigravity muscles and indirectly by producing information related to a change in the center of gravity according to the angular velocity and position of the head; thus, vestibular disorder gives rise to vestibular ataxia. Vestibular ataxia arises from vestibulo-spinal reflex impairment that changes the movement of the center of gravity in gait initiation, step length, stance width, the timing of ground reaction force, and pre-swing. In this way, information from studies related to locomotion is very important in vestibular rehabilitation.

Standardization for a Korean Adaptation of the International Outcome Inventory for Hearing Aids: Study of Validity and Reliability / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The evaluation of subjective outcomes of hearing aid fitting is of paramount importance along with audiometric improvement. The aim of this study was to develop a Korean adaptation of the International Outcome Inventory for Hearing Aids (IOI-HA) and to determine its reliability and validity. SUBJECTS AND METHOD: The translation of IOI-HA into the Korean version (K-IOI-HA) was completed through a process of forward translation, reconciliation, reverse translation and cognitive debriefing. K-IOI-HA was administered to 101 patients using hearing aids and visiting any the 10 referral hospitals. Reliability was evaluated by Cronbach's alpha coefficient and by test-retest analysis. Validity was assessed by confirmatory factor analysis and criterion validity based on the results of pure tone audiometry. RESULTS: K-IOI-HA showed a good internal consistency (Cronbach's alpha=0.83) and a high test-retest reliability (r=0.943, p<0.01). Validity checked by confirmatory factor analysis also showed good construct validity. CONCLUSION: The Korean version of IOI-HA is a reliable and valid tool for evaluating subjective outcomes of hearing aids.

Quantification of Vestibulospinal Reflex Under the Stress Condition on Both Soleus Muscles / 대한평형의학회지

BACKGROUND AND OBJECTIVES: Vestibulospinal reflex (VSR), which is measured in static state, tends to be compensated prior to vestibule-ocular reflex. Therefore, by establishing method that enables to track and observe quantified VSR, the reliability of experiment is attempted to be increased. MATERIALS AND METHODS: On five SD Rats to measure electromyogram (EMG), electrodes, in the form of stranded cables composed of seven wires, are chronically implanted on both sides of the soleus muscles. Pre and post operative condition of sitting still, standing, and ladder step walking was compared before, and six and twenty four hours after a unilateral labyrinthectomy with quantified muscle activity in maximal voluntary activity. Simultaneously by using multi modality electric potential plus package, the muscle activity between the two legs was tracked and compared. RESULTS: In the sitting still position, the left/right soleus muscle activities were 25.7/26.0 microV before a unilateral labyrinthectomy which was changed after the surgery with the value of 23.1/8.1 microV and 23.4/14.3 microV when six and twenty four hours passed respectively. In the standing position, 92.8/124.0 microV of preoperative value was changed to 89.6/37.3 microV six hours after the unilateral labyrinthectomy, and it was 97.0/54.7 microV 24 hours after. The preoperative value in ladder step walking test was 56.2/86.0 microV, and postoperative ones were 54.9/21.2 microV and 55.7/38.0 microV after six and twenty four hours respectively. CONCLUSION: VSR assessment method by using quantitative EMG well reflects the process of vestibular compensation, and to maintain the tension of extensor muscles, ladder step walking test is shown to be useful.

Standardization for a Korean Version of Hearing Handicap Inventory for the Elderly / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study has been performed to determine the reliability and validity of the Korean version of Hearing Handicap Inventory for the Elderly (HHIE), which has been adapted to the Korean population. SUBJECTS AND METHOD: For the Korean version of HHIE (K-HHIE), the processes of independent forward translation, backward translation and reconciliation were standardized using subjects older than 65 years old were recruited from the 10 referral-hospitals. Reliability and validity were evaluated by Cronbach's alpha coefficient, confirmatory factor analysis and test-retest analysis. Hearing impairment was assessed using pure tone audiometry, and the result was used as the gold standard. RESULTS: The recruited K-HHIEs were 169. The reliability of K-HHIE, checked by Cronbach's alpha coefficient, was as high as 0.95. Scale-item correlation coefficient was even higher than 0.97, which shows very high reliability of K-HHIE. Test-retest reliability and the correlation coefficients of social/situational, emotional and total scores of K-HHIE were as high as 0.73, 0.82 and 0.78, respectively. The validity of K-HHIE, checked by confirmatory factor analysis, also showed good construct validity. There was high correlation between hearing level and the scores of K-HHIE, which is another indicative result of its high validity. CONCLUSION: We have developed and validated Korean version of HHIE, which has good reliability and validity. It seems to be suitable enough for clinical use and research studies in patients with hearing impairment.

Standardization for a Korean Version of Chronic Ear Survey: Translation and Verification of Validity and Reliability / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The Chronic Ear Survey (CES) has been known to be a valid, disease-specific measure for the evaluation of health status and treatment effectiveness for chronic otitis media patients. As part of this study, we developed a Korean version by adapting from this CES, determined its reliability and validity. MATERIALS AND METHOD: The development of the Korean version of CES (K-CES) included the processes of standard independent translation and cross-cultural adaptation to check for cultural inconsistency. The finalized K-CES was administered to 166 patients visiting 10 referral hospitals in a prospective manner. K-CES was validated by using the Cronbach's alpha coefficient, confirmatory factor analysis and test-retest analysis for reliability and validity. The 36-Item Short Form Health Survey Instrument (SF-36) was assessed and the result was used to evaluate the criterion validity. RESULTS: The K-CES demonstrated good test-retest reliability and internal consistency (Cron-bach's alpha=0.850). Scale-item correlation coefficient was even higher than 1.0, which shows a very high reliability of K-CES. The validity of K-CES, checked by confirmatory factor analysis, also showed good construct validity. There was high correlation between SF-36 and the scores of K-CES, which indicates high criterion validity. CONCLUSION: We concluded that K-CES is a valid tool for clinical use and research studies in Korean patients with chronic otitis media.

Diagnostic Dehydration Testings for Endolymphatic Hydrops / 대한평형의학회지

No abstract available.

Measuring the Behavioral Parameters of Mouse Following Unilateral Labyrinthectomy in Round Free Field Using an Infrared Lamp and a Simple Webcam Camera / 대한평형의학회지

BACKGROUND AND OBJECTIVES: In this research, movements of mouse after labyrinthectomy were analyzed to determine the degree of vestibular dysfunction and compensation. MATERIALS AND METHODS: By using an infrared lamp, mouse movements were recorded for 100 seconds in a dark room. The experimental area was manufactured as a circular space with a diameter of 60 cm. The movements of five mice labyrinthectomized on right side were observed and recorded at 3 hours, 9 hours and 120 hours after the operation, and also the ten mice of control group. RESULTS: The differences between the total moving distances and the rotating angle from the origin that set the center of round field between groups were analyzed with pictures of 1 frame per second. It is concluded that all 4 groups show significant differences between its mean rotation angle and total moving distances statistically. At 9 hours after right labyrinthectomy, mice tended to turn clockwise; but at 120 hours, there was no significant difference between clockwise and counter-clockwise rotation. CONCLUSION: Measuring the movement of mouse in round free field can be the proper method to determine the degree of vestibular dysfunction and vestibular compensation. This test was time-saving and cost-effective method.