Difference in Thresholds Between Auditory Brainstem Response Test and Pure Tone Audiometry by Frequency / 대한이비인후과학회지

Background and Objectives@#There is no clear standard for the difference in the thresholds of auditory brainstem response (ABR) and pure tone audiometry (PTA) when using ABR to evaluate the reliability of PTA. Therefore, we assessed the difference in the thresholds of ABR and PTA for each frequency. Consequently, we present here the actual difference values between the two tests that can be used as a reference in the clinic.Subjects and Method We retrospectively assessed the audiometry results of 129 ears. Ears in which the hearing thresholds of each frequency continuously declined were classified as the downward group. We compared the average of differences between the two tests by frequency. The differences were compared for each hearing level from 50 dB or higher. @*Results@#For all ears, the appropriate range of difference value was ±5 dB at 2 kHz. At 1 kHz, the ABR threshold was 10 dB higher than PTA, and it was 10 dB less than PTA at 4 kHz. In the downward group, the difference value increased by 10 dB at 1 kHz and 4 kHz. In the subgroups at each hearing level, the difference value showed similar results (p<0.05). @*Conclusion@#The difference in the threshold, regardless of the severity or tendency of hearing loss, was the smallest at 2 kHz and the range was ±5 dB. ABR was 10 dB higher at 1 kHz and and 10 dB lower at 4 kHz than PTA. In the downward group, the difference at 1 kHz and 4 kHz increased by 10 dB each.

The Relationship Between Tinnitus Frequency and Speech Discrimination in Patients With Hearing Loss / 대한이비인후과학회지

Background and Objectives@#Patients with hearing loss and tinnitus experience difficulty in engaging in daily conversations. However, only few studies have examined how tinnitus affects individual speech discrimination to comprehend speech. This study aimed to analyze the correlation between tinnitus frequency and speech discrimination in patients with hearing loss and tinnitus.Subjects and Method A total of 275 ears with hearing impairment were retrospectively analyzed via audiometry and tinnitogram. The ears were divided into three groups depending on the frequency of their tinnitus. Average pure tone audiometry (PTA), hearing threshold of tinnitus frequency, speech discrimination test (SDT), degree of discrepancy between tinnitus frequency and worst PTA frequency were collected and compared among the three groups. @*Results@#No significant difference was observed in PTA in the three patient groups. Hearing threshold of tinnitus frequency was the highest at 78.27 dB in the high-frequency group and the lowest at 45.14 dB in the low-frequency group. SDT was significantly lower (53.69%) in the low-frequency group. The correlation between tinnitus loudness and SDT was the strongest in the low-frequency group. The degree of discrepancy between tinnitus frequency and worst PTA frequency was also significantly observed in the low-frequency group. @*Conclusion@#Patients who are severely affected by tinnitus are found to have significant discrepancy between tinnitus frequency and worst PTA frequency, indicating decreased SDT.

Test-Retest Differences of the Speech Discrimination Score in Patients with Hearing Loss / 대한이비인후과학회지

Background and Objectives@#The diagnosis of hearing impairment is based on repeated audiometry, including pure tone audiometry (PTA), speech reception threshold test (SRT), and speech discrimination test (SDT). SDT results particularly show a wide discrepancy upon repeated testing, while malingering is suspected when having more than 12% difference between 3 individual SDT results. Therefore, in this study, we compared the proportion of malingering found in repeated SDT with that found in other audiometric tests and analyzed the characteristics of malingering group in order to reevaluate the current criteria of defining malingering.Subjects and Method We retrospectively assessed the audiometry results of 113 patients (226 ears) with hearing impairment. Each ear was divided into a malingering group and a true hearing loss group. The proportion of ears corresponding to each malingering criterion was compared using a chi-square test. An independent sample t-test was performed to identify the differences between the characteristics between the two groups. @*Results@#The number of ears that met the malingering criteria were 19 (8.41%) in PTA, 15 (6.64%) in SRT, and 75 (33.19%) in SDT. There was a significant difference in the proportion of malingering between the 3 hearing test modalities (p<0.001). There was no significant difference in auditory brainstem response, mean age and sex distribution between the malingering group and the true hearing loss group. @*Conclusion@#When conducting repeated SDT, there is a risk of misdiagnosing an actual hearing loss patient as a malingering patient under the current malingering criteria. Therefore, the current criteria on SDT requires reevaluation.

A Case of Painful Post-Traumatic Trigeminal Neuropathy after Endoscopic Sinus Surgery / 대한이비인후과학회지

Painful post-traumatic trigeminal neuropathy (PPTTN) is a distinctive facial pain syndrome characterized by facial and/or oral pain along the sensory distribution of the fifth cranial nerve with a clear history of a traumatic event. To our knowledge, PPTTN after endoscopic sinus surgery (ESS) has not been reported in the literature. We present a case of an elderly woman who experienced unilateral neuralgic pain after undergoing ESS. Following ESS of the left sphenoid sinus to remove suspicious fungus balls, the patient complained of intermittent facial pain occurring in the left periorbital and forehead area. Clinical diagnosis of PPTTN was established after a comprehensive multidisciplinary assessment. The pain disappeared completely after a 5-week medical treatment with gabapentin. Since PPTTN cases associated with ESS are extremely rare, our case demonstrates that PPTTN should be considered in the differential diagnosis of facial pain developing after ESS and can be successfully treated with medical therapy.

Correlation between Body Mass Index and Snoring Time in Obstructive Sleep Apnea Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study was performed to elucidate the relationship between body mass index (BMI) and snoring time (ST) in patients with obstructive sleep apnea (OSA) using a portable sleep monitoring device. SUBJECTS AND METHOD: From May 2011 to December 2015, 492 patients whose apnea-hypopnea index (AHI) was more than 5 were enrolled. Subjects were classified into 3 groups on the basis of the AHI (mild=5≤AHI<15; moderate=15≤AHI<30; severe=30≤AHI). Using the multiple linear regression analysis, the relationship between ST and other variables (BMI, arousal index, O2 desaturation events, age and AHI) were measured in each group. RESULTS: There was significant association between ST and BMI, especially in the severe group (p=0.005). CONCLUSION: In the severe group, reducing BMI is important to improve ST.

A Case of Arachnoid Cyst in the Internal Auditory Canal / 대한이비인후과학회지

Arachnoid cysts are intra-arachnoid collections of cerebrospinal fluid; congenital in origin, they account for about 1% of all atraumatic intracranial mass lesions. Arachnoid cysts confined to the internal auditory canal are extremely rare. In most patients who has arachnoid cysts in the internal auditory canal, no direct intervention is necessary, but if the neurologic symptoms are progressive, the arachnoid cyst could be drained surgically to relieve the symptoms caused by compression of structures adjacent to the cyst. We present one case of a arachnoid cyst in the left internal auditory canal which was diagnosed by a temporal bone magnetic resonance imaging.

Comparison between Group I in Which Non-Supine Apnea-Hypopnea Index> or =5 and Group II in Which Non-Supine Apnea-Hypopnea Index<5 in Patients with Positional Sleep Apnea / 수면정신생리

OBJECTIVES: The aim of this study was to evaluate the differences in patients with positional dependent sleep apnea according to their non-supine apnea-hypopnea index (AHI, > or =5 vs. or =5 ; group II was non-supine AHI having less than 5. Statistical analysis was performed to find the difference between two groups. RESULTS: In 92 patients, the number of group I patients was 11 (12%) and the number of group II patients was 81 (88%). In the severe AHI group, percentage of group I was dominated (70%) and showing a significant difference compared with the mild and moderate AHI groups (p or =5 than non-supine AHI<5.

Correction of Hump Nose Using Radix Augmentation with Silicone / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Hump resection by osteotome or rasp is a commonly used surgical technique in hump correction. However, during this procedure, the structure of the osseous-cartilaginous framework is altered and may lead to an open roof deformity or dorsal irregularity. So we preserved the hump as much as possible, and then augmented the radix with silicone. We compared this result to that of the hump resection group. SUBJECTS AND METHOD: We retrospectively studied 21 patients who underwent rhinoplasty with hump correction. We classified the patients into two groups by operation technique; hump preservation and hump resection. The result of surgery was evaluated by comparing nasal measurements on pre and postoperative photos. Patient's satisfaction about cosmetic results were investigated using the visual analogue scale (VAS). All results were statistically tested. RESULTS: The hump preservation group (N=13) had 12 cases (92.3%) of isolated hump type and one pseudo hump type (7.7%), whereas the hump resection group (N=8) had 5 cases (62.5%) of generalized hump type and 3 isolated hump type (37.5%). The preoperative nasofrontal angle in hump preservation (129.4degrees+/-10.6) was significantly lower than that in the hump resection group (139.3degrees+/-8.2). The nasion/nasal tip depth ratio in the hump preservation group (0.22+/-0.1) was also lower than that in the hump resection group (0.29+/-0.1) preoperatively; but there was no significant difference between the two groups. VAS was improved significantly in both groups after surgery. CONCLUSION: Hump preservation and radix augmentation can be an effective and less complicated surgery for patients who have an acute nasofrontal angle with an isolated hump.

A Study on the Effectiveness of Treatment of Acoustic Trauma Caused by Gunshot Noise / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The effectiveness of many treatment regimens on acoustic trauma has been debated, but there is no established treatment yet. The purpose of this study was to evaluate the efficacy of steroid treatment in acoustic trauma caused by rifles and to find a critical time limit for the treatment to be effective. SUBJECTS AND METHOD: A retrospective review was conducted for 86 conscripted policemen (97 ears) who suffered acoustic trauma after rifle exercise. Pure tone audiograms were compared before and after treatment at 0.5, 1 and 2 kHz (speech-frequency pure tone average, speech-PTA) and at 4, 6 and 8 kHz (high tone pure tone average, high-PTA). Treatment consisted of drugs (steroid, ascorbic acid, gingko biloba, dextran) and carbogen therapy. The patients who came to the hospital after the first 14 days following injury were grouped as control. Hearing outcomes of patients treated within 3 days and within 7 days were compared to the control. Pre-and post-treatment hearing was compared according to the elapsed time before treatment. RESULTS: Hearing outcomes of patients who received treatment within 3 days of acoustic trauma was better than the control group. Speech-frequency did not show any difference. Treatment within 7 days showed no statistical difference compared to the control. Hearing gain was better when treated within 7 days, especially if it was within 3 days. Speech-frequency showed significant spontaneous recovery within 3 days. CONCLUSION: Our data showed a possible effectiveness of treatment of acoustic trauma on the recovery of high frequency hearing when started within 3 days. Speech-frequency seems to recover spontaneously within 3 days.

A Case of Postauricular Dermoid Cyst / 대한이비인후과학회지

Dermoid cysts are congenital anomalies that arise from trapped pouches of the ectoderm near the normal fold or from the surface ectoderm that has failed to separate from the neural tube. Dermoid cysts of head and neck area are relatively rare, whereas those located in the postauricular area are extremely rare. In Korea, only 3 cases of postauricular dermoid cysts have been reported. In this article, we report a case of postauricular dermoid cyst in a 21 year-old man, along with a review of articles.

Comparative Analysis of Diagnostic Tools for Parapharyngeal Tumors / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The parapharyngeal tumors are rare and treated mostly by surgical removal. The preoperative diagnosis of parapharyngeal tumors is very important because the surgical removal of neurogenic tumor, which is the main mass in the parapharyngeal space, can induce severe complications. There are many diagnostic tools for parapharyngeal tumors and their effectiveness are variable. In this study, we focused on the diagnostic accuracy of each diagnostic tool. SUBJECTS AND METHOD: We compared the preoperative diagnostic results with the final pathologic reports of 56 parapharyngeal tumors. Diagnostic tools used were computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography (US), and fine needle aspiration biopsy (FNAB). RESULTS: The diagnostic accuracy of MRI, CT and US was 68.2%, 51.6% and 42.8%, respectively. The sensitivity (83%) and specificity (87.5%) of FNAB for neurogenic tumor are higher than those of MRI (75%, 50%). CONCLUSION: These results suggest that FNAB is the most precise and reliable diagnostic tool and MRI is the most reasonable and effective imaging study.

The Non-Squamous Cell Cancers of the Larynx / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The majority of laryngeal tumors are known to be SCC (squamous cell carcinoma). Non-SCC (non-squamous cell cancers) of the larynx represent a diverse spectrum of diseases with different prognosis and ratio-nales of management from SCC. Therapeutic options to these tumors depend on their histopathological characteristics and clinical behaviors. The purpose of this study was to assess the unique aspects of the non-SCC and to draw diagnosis and provide management options and prognostic variables. MATERIALS AND METHOD: Eleven non-SCC of the larynx from the 212 patients who were diagnosed with larynx cancer during their 3-year visits from 1997 to 2000 were reviewed retrospectively. RESULTS: The incidence of non-SCC was 5.2%. Pathology of non-SCC revealed 3 cases of malignant lymphoma, 2 cases of verrucous cell carcinoma and neuroendocrine carcinoma one case each of basaloid squamous cell carninoma, salivary duct carcinoma, adenocarcinoma, and spindle cell carcinoma. The most common site of origin was supraglottis (6 case, 56.5%), followed by glottis (4 cases, 36.4%) and subglottis (2 cases, 17.2%). Non-Hodgkin's lymphomas and basaloid squamous cell carninoma were treated by chemotherapy. The remaining cases were treated with surgery followed by postoperative radio-therapy or postoperative chemotherapy. The mean follow-up period was 26.8 months (12-43 months). CONCLUSION: Non-SCC accounts for approximately 5.2% of all malignancies of the larynx. Tissue biopsy is the most important diagnostic tool for the non-SCC of the larynx and the tissue sample must be obtained from the deep portion of the submucosal layer. Except for malignant lymphomas, the combined therapy that includes surgery would be the best method of treatment for non-SCC.

The Practical Role of Nasal Bone CT in the diagnosis of Nasal Bone Fractures / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The accurate diagnosis of nasal bone fracture by means of simple radiographs and physical examination is difficult in cases of severe soft tissue swelling or minimally displaced fracture. The purpose of this study is to evaluate the practical effectiveness of nasal bone CT for the diagnosis of nasal bone fracture. MATERIALS AND METHODS: The authors reviewed nasal bone CT and simple radiographs of 11 patients with nasal bone injury who were suspected to have nasal bone fracture after history taking and physical examinations. The nasal bone fracture was classified as one of three types on nasal bone CT : type I (simple fracture), type II (simple fracture with displacement) and type III (comminuted fracture). Associated facial bone injuries were also evaluated and simple radiographs of nasal bone were reviewed for comparison. RESULTS: Nine out of eleven patients showed followingfracture lines on nasal bone CT: 3 cases of type I, 4 cases of type II, and 2 cases of type III. Seven out of eleven patients showed fracture lines on simple radiographs, but one patient out of those seven showed no fracture lines on CT. Four patients showed no fracture lines on simple radiographs, but three of them showed fracture lines on CT. Out of three cases of type I fracture, only two cases were detected on plain radiographs. Four patients showed complicated nasal septal fracture on CT, which could not be detected on simple radiographs. One other patient had fracture of the frontal process of maxilla. Conclusion: Nasal bone CT is a useful tool for diagnosis of nasal bone fracture since it provides accurate identification and evaluation of associated injuries such as nasal septal fracture.