Effect of Dexamethasone Combination With Gentamicin in Chemical Labyrinthectomy on Hearing Preservation in Patients With Meniere’s Disease / 대한이비인후과학회지

Chemical labyrinthectomy may be performed in patients with Meniere’s disease who have intractable vertigo that does not respond to drug. By using aminoglycosides, the surgical procedure ablates vestibular type 1 hair cells. However, the risk of hearing loss remains a main concern for clinicians because gentamicin ablates cochlear hair cells as well as vestibular hair cells. To deal with the concern for hearing loss, dexamethasone can be combined with gentamicin during chemical labyrinthectomy. Herein, we show that chemical labyrinthectomy using gentamicin combined with dexamethasone preserve hearing at high-frequency compared to the conventional method.

Eustachian Tube Function Test / 대한이비인후과학회지

Eustachian tube dysfunction (ETD) is a common condition in clinical otolaryngology practice. The eustachian tube (ET) is the only pathway connecting the middle ear cavity and the nasopharynx, and has a ventilation function to equalize the pressure of the middle ear and the atmosphere, a discharge function of middle ear secretions into the nasopharynx, and a defense function to prevent reflux from the nasopharynx. The most important function of the ET is to maintain a consistent middle ear air pressure for efficient sound transmission. Various methods have been used to measure the physiological function of ET. Traditional methods include the Valsalva, Toynbee, and Politzer test. Physiological methods include the 9-step Bluestone inflation-deflation test and sonotubometry. Evaluation of ETD using questionnaires is also being conducted, and currently, imaging tests are also conducted to evaluate the structure of ET. However, no standard protocols have been established until now. In this article, the types, methods, and advantages and disadvantages of the currently available ET function tests are introduced.

Hearing Rehabilitation with Combined Electroacoustic Stimulation and Ossiculoplasty

We report a case of hearing rehabilitation following combined cochlear implantation and ossiculoplasty. A 71-year-old patient visited the clinic for right-sided mixed hearing loss. We targeted neural and conductive components, performing two different operations simultaneously. At two months post-operative, the patient showed satisfactory results with respect to hearing threshold and speech comprehension. Our experience suggests that careful evaluation of patients and consideration of the diverse array of available treatment strategies can be used to provide personalized rehabilitation with maximal effectiveness. To the best of our knowledge, this is the first report to take such an integrated approach to treat hearing impairment and is thus likely to have clinical importance for otologists.

Which Patients With a Unilateral Hearing Aid for Symmetric Sensorineural Hearing Loss Have Auditory Deprivation?

Objectives@#. The aim of study is to find conditions that aggravate auditory deprivation in patients with symmetric hearing loss after unilateral digital, non-linear hearing aid (HA). @*Methods@#. In the retrospective case-comparison study, we assessed 47 patients with symmetric sensorineural hearing loss (SNHL), wearing unilateral conventional HAs. Audiological outcomes were assessed >1 year after HA fitting (mean duration, 31.0 months). Pure-tone audiometry in HA-aided and HA-unaided conditions was performed over time. Word recognition score (WRS) was evaluated at the most comfortable listening level. @*Results@#. The initial pure tone average of four frequency thresholds at 500, 1,000, 2,000, and 4,000 Hz (PTA4) did not show a difference of >5 dB HL between HA-aided and HA-unaided ears. WRS progressively decreased for both HA-aided and HA-unaided ears although the extent of decrease was significantly greater for HA-unaided (7.6%) than for HA-aided ears (5.1%, P<0.05). Notably, auditory deprivation in HA-unaided ears was significantly greater in patients with an initial PTA4 ≥53 dB HL (P<0.001). @*Conclusion@#. Bilateral HAs are strongly recommended, particularly for patients with moderate to severe SNHL to prevent auditory deprivation in the contralateral ear.

Endoscopic-Assisted Infralabyrinthine Approach to Petrous Apex Cholesterol Granuloma / 대한이비인후과학회지

A cholesterol granuloma is the most common primary lesion of the petrous apex, and accounts for 40% of the pathologies that arise in this region. The primary treatment for symptomatic lesions is by surgery to decompress and drain or to completely remove the lesion. Here we describe the use of infralabyrinthine approach to access a lesion through the temporal bone and completely remove it with the assistance of a 0-degree endoscope. A 43-year-old man visited our clinic for diplopia. Magnetic resonance imaging revealed a 2.3-cm cholesterol granuloma located in the left petrous apex that caused deviation of the left abducens nerve. The tumor was completely removed using the endoscopic-assisted infralabyrinthine approach; the patient is currently being followed up, and there is no evidence of disease recurrence. This case report describes the successful completion of a petrous apex cholesterol granuloma that preserved the cochlear and vestibular systems.

Two Cases of Seronegative Paraneoplastic Neurologic Syndrome with Opsoclonus Nystagmus / 대한이비인후과학회지

The dizziness associated with paraneoplastic neurologic syndrome is hard to diagnose clinically because the prevalence of disease is rare, and radiologic and serologic examination result may come out normal. Opsoclonus-myoclonus symdrome is a representative of classical paraneoplastic neurologic syndromes. In this paper, we report 2 cases of paraneoplastic neurologic syndromes with negative serologic auto-antibody test and no brain lesion on MRI. Both cases were eventually diagnosed through PET. Patients with opsoclonus-myoclonus type nystagmus should be evaluated for paraneoplastic neurologic syndrome even if their radiologic and serologic findings are normal.

Two Cases of Seronegative Paraneoplastic Neurologic Syndrome with Opsoclonus Nystagmus / 대한이비인후과학회지

The dizziness associated with paraneoplastic neurologic syndrome is hard to diagnose clinically because the prevalence of disease is rare, and radiologic and serologic examination result may come out normal. Opsoclonus-myoclonus symdrome is a representative of classical paraneoplastic neurologic syndromes. In this paper, we report 2 cases of paraneoplastic neurologic syndromes with negative serologic auto-antibody test and no brain lesion on MRI. Both cases were eventually diagnosed through PET. Patients with opsoclonus-myoclonus type nystagmus should be evaluated for paraneoplastic neurologic syndrome even if their radiologic and serologic findings are normal.

A Case of Acute Vestibular Neuritis with Periodic Alternating Nystagmus / 대한이비인후과학회지

Detection of nystagmus is an important diagnostic clue in patients with acute vertigo. Patients with peripheral disorders exhibit nystagmus with a constant direction whereas those with central disorders exhibit nystagmus with changes in direction with or without gaze fixation. Periodic alternating nystagmus (PAN) is a horizontal or horizontal-rotary jerk-type nystagmus that reverses its direction with time. PAN is typically observed in patients with central disorders, such as cerebellar or pontomedullary lesions, but it is also observed in patients with peripheral disorders, albeit rarely. Here we report a rare case of a 58-year-old patient with vertigo with PAN, which was initially suspected as a central disorder, but eventually diagnosed as a peripheral vestibular disorder. We investigated the characteristics and mechanisms of peripheral PAN in this case. The absence of central disorder symptoms, visual suppression of PAN, normal oculomotor findings, and transient persistence are important diagnostic clues for differentiating peripheral from central PAN.

Hearing Restoration in Neurofibromatosis Type II Patients

Patients with neurofibromatosis type II will eventually succumb to bilateral deafness. For patients with hearing loss, modern medical science technology can provide efficient hearing restoration through a number of various methods. In this article, several hearing restoration methods for patients with neurofibromatosis type II are introduced.

Neuromodulation for the Treatment of Tinnitus / 한양의대학술지

Tinnitus is a perception of sounds in the absence of external noise. Tinnitus can affect an individual's life, prevent productive work or impair the quality of life. There are 2 types of tinnitus, objective and subjective, the latter being the most challenging of hearing disorders. Tinnitus has various forms and it can be difficult to relate a specific event with the appearance of tinnitus. Moreover, detection of tinnitus and evaluation of its severity is impossible. Therefore, treatment is usually based on the patient's own assessment. To date, various forms of treatment have been administered with minimal success. Many different treatments have been attempted and then discontinued. The treatment goal of eliminating symptoms for severe tinnitus is rarely achieved. However, some symptoms of tinnitus can often be reduced to improve the patient's quality of life allowing him or her to work despite residual effects of the disorder. In the present study we evaluated electrical stimulation, including transcranial direct current stimulation, transcranial magnetic stimulation for the treatment of tinnitus.

Otologic Active Middle Ear Implants / 대한이비인후과학회지

Implantable devices for aural rehabilitation are widely developed worldwide. In the manuscript, we review the implantable middle ear hearing devices currently in use, such as the Vibrant Soundbridge system (Med-El Corporation), the MAXUM system (Ototronix LLC), the fourth-generation of Carina prosthesis (Otologics LLC), and the Esteem device. Implantable hearing aids will unquestionably be the major drivers of advancement in otologic practice in early future, improving the quality of life of an increasingly aged population, which will consequently require increased levels of hearing support.

A Case of Recurred Cholesteatoma Removal via Middle Cranial Fossa Approach / 대한이비인후과학회지

Cholesteatoma is a benign disease but it has an aggressive feature that may lead to serious conditions. Many strategies have been introduced for the treatment cholesteatoma, yet no definite single method has been established: it should be treated respectively regarding the completion of cholesteatoma, conservation of tympanic mucosa, proper ventilation of middle ear and preservation of hearing. A 25-year old patient visited our clinic for right-sided facial paralysis of 5 days. The patient underwent canal wall down mastoidectomy 10 years ago due to cholesteatoma and a few revision surgeries under local anesthesia for recurrence. Pre-operative temporal bone CT showed suspected recurred cholesteatoma in internal auditory canal and labyrinthine segment of facial nerve nearby. The patient underwent a removal of cholesteatoma via middle cranial fossa approach. This case report is a successful completion of recurred cholesteatoma, for which no recurrence is shown. Facial nerve function is improved at postoperative 1 year.

A Case of Middle Ear Implantation with Vibroplasty Coupler at the Stapes / 대한이비인후과학회지

Middle ear implantation is an effective treatment for sensorineural, conductive and mixed hearing loss. The active middle ear implant's floating mass transducer (FMT) is placed on the middle ear structure or coupled to the inner ear fluid. Since the device is not directly placed on the external auditory canal, patients are free from feedback phenomenon and occlusion effect resulting from hearing aids. A 66-year-old patient suffered from bilateral hearing loss. The patient had difficulties in adapting to a conventional hearing aid because of feedback phenomenon in the right ear. The patient underwent a middle ear implantation using a CliP-Coupler to connect stapes head and FMT in the left ear. To our knowledge, this is the first case reported in Korea on middle ear implantation with CliP-Coupler at the stapes, for which hearing results were successful at postoperative 7 months.

A Case of Central Origin Vertigo in Breast Cancer with Brain Metastasis / 대한이비인후과학회지

The incidence of symptomatic brain metastasis among women with breast cancer ranges from 10 to 16%. A metastatic spread of breast cancer to either the brain parenchyma or the leptomeninges is generally a late feature of metastatic progression. The present case of a 55-year-old patient had been considered cured from breast cancer. However, she recently complained of severe dizziness, hearing impairment, and headache. Initially, it was considered to be Meniere's disease or vestibular migraine, although later dizziness, hearing impairment, and headache were aggravated in spite of medication. Pure tone audiometry showed left-sided sensorineural hearing loss, but her vestibular function was within normal range. She underwent a Gadolinium-enhanced magnetic resonance imaging, and a metastatic brain lesion was noted. With a review of the literature, we present this case of breast cancer with brain metastasis in a 55-year-old woman with vertigo and hearing loss.

A Case of Inflammatory Pseudotumor in Temporal Bone Treated with Methotraxate / 대한이비인후과학회지

Inflammatory pseudotumor is a pathologically benign condition, but it demonstrates a wide range of clinical features ranging from silent small sized tumors to aggressive features mimicking malignancy. Pseudotumors most commonly occur in the orbital area, and the involvement of the middle ear cavity is extremely rare. Several modalities are known for the treatment of pseudotumors, including complete surgical excision, oral steroid therapy, and radiation therapy. We describe a 35-year-old woman with inflammatory pseudotumor involving the middle ear cavity. The patient was treated with canal wall up tympanomastoidectomy and additional treatments with steroid and radiation therapy. However, she showed side effects to high dose steroid treatment and no response to radiation therapy. Therefore, we decided to use methotrexate with low dose steroid. After treatment, symptoms were completely resolved and there was no evidence of recurrence 1 year after maintaining immunosuppressant treatment.