Cochlear Implantation in the Elderly: Speech Performance, Associated Factor, Complication, and Surgical Safety

Background and Objectives@#The guidelines for cochlear implantation (CIs) are expanding, and the number of CI procedures performed on the elderly is increasing. The purpose of this study was to analyze the results and safety of cochlear implantation in the elderly, as well as to evaluate the predictive factors on CI outcomes. @*Subjects and Methods@#The study included 56 patients aged ≥40 years, who received CIs between 2009 and 2020. They were divided into two groups: 27 younger adults (40-64 years) and 29 elderly (>64 years). The study compared their pre- and postoperative speech perception and category of auditory performance (CAP) scores, surgical complications, and hospitalization periods. It also evaluated associated factors in the elderly group by examining categorical and continuous variables and postoperative CAP score. @*Results@#There was a significant improvement in speech recognition tests (both word and sentence) and CAP scores in both groups compared to the pre-implantation scores (p<0.001). Postoperative results were slightly lower in the elderly group than in younger adults for sentence recognition and CAP scores, except for word recognition. No significant associated factors were found on postoperative CAP scores, except for etiology. Postoperative CAP significantly improved in the sudden hearing loss group compared to the groups with other etiologies (p=0.045). The elderly group had more comorbidities than that in the younger adult group (p=0.026), but there were no significant differences in postoperative complications and hospitalization periods. @*Conclusions@#While speech recognition and CAP scores were relatively lower in the elderly group compared to the younger adults, the elderly group showed significant improvements in audiological results after CI. Moreover, CI was safe and well tolerated in elderly patients.

A Case of Sensorineural Hearing Loss Caused by Neurosyphilis in Patient Who Is Treated by Anti-Interleukin 17A Monoclonal Antibody / 대한이비인후과학회지

Syphilis is a sexually transmitted disease caused by Treponema pallidum, which can invade various organs. Syphilis can also cause otologic symptoms such as hearing impairment, tinnitus or dizziness and these otologic symptoms can occur at any stage of syphilis and can be associated with neurosyphilis. We report here a case of rapid progressive neurosyphilis showing hearing impairment in a patient with ankylosing spondylitis. He was treated with anti-interleukin 17A monoclonal antibody. Since syphilis is one of the causes of reversible sensorineural hearing loss and syphilis infection with immunosuppression can cause progressive hearing loss if patients in immunomodulatory therapy have sensorineural hearing loss, the possibility of syphilis should be considered.

Results of Active Middle Ear Implantation in Patients With Mixed Hearing Loss After Middle Ear Surgery: A Prospective Multicenter Study (the ROMEO Study)

Objectives@#. This study was conducted to evaluate the user satisfaction, efficacy, and safety of round window (RW) vibroplasty using the Vibrant Soundbridge (VSB) in patients with persistent mixed hearing loss after mastoidectomy. @*Methods@#. The study included 27 patients (mean age, 58.7 years; age range, 28–76 years; 11 men and 16 women) with mixed hearing loss after mastoidectomy from 15 tertiary referral centers in Korea. The VSB was implanted at the RW. The Korean translation of the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire and the Korean version of the International Outcome Inventory for Hearing Aids (K-IOI-HA) questionnaire were used to evaluate user satisfaction as the primary outcome. The secondary outcome measures were audiological test results and complication rates. @*Results@#. The mean scores for ease of communication (61.3% to 29.7% to 30.2%), reverberation (62.1% to 43.1% to 37.4%), and background noise (63.3% to 37.7% to 34.3%) subscales of the APHAB questionnaire significantly decreased after VSB surgery. The mean K-IOI-HA scores at 3 and 6 months after surgery were significantly higher than the mean preoperative score (18.6 to 27.2 to 28.1). The postoperative VSB-aided thresholds were significantly lower than the preoperative unaided and hearing aid (HA)-aided thresholds. There was no significant difference between preoperative unaided, preoperative HA-aided, and postoperative VSB-aided maximum phonetically balanced word-recognition scores. None of the 27 patients experienced a change in postoperative bone conduction pure tone average. One patient developed temporary facial palsy and two developed surgical wound infections. @*Conclusion@#. RW vibroplasty resulted in improved satisfaction and audiological test results in patients with mixed hearing loss after mastoidectomy, and the complication rate was tolerable.

Sound Processor Replacement in Patients with Cochlear Implant: Analysis of a 30-Year Single-Institutional Experience / 대한이비인후과학회지

Background and Objectives@#The purpose of this study is to investigate the replacement of external sound processors and to help understand the economic burden experienced from cochlear implant users.Subjects and Method Among the 500 cases of cochlear implant surgery from 1992 to 2019, 336 cases from 311 patients who had used a cochlear implant for more than 1 year were enrolled. The period of cochlear implant use, replacement of the sound processor, the number, method, and reason of replacements were examined. @*Results@#One hundred sixty cases (47.62%) replaced the sound processor at least once. There were a total of 213 replacements made in 160 cases. The most common reason for replacing the sound processors was because it could not be repaired (71 replacements, 33.33%), with their period of use being an average of 12 years. The most common replacement method of the sound processors was by purchasing with medical insurance benefits (100 replacements, 46.95%), with the usage period being an average of 11 years and 4 months. @*Conclusion@#Cochlear implant users replaced the sound processor for various reasons and the period of using one sound processor was relatively short. About half of all replacement cases were made by applying for medical insurance benefits. Others purchased directly through a sales company and paid a relatively high cost. Therefore, it is necessary to expand the medical insurance for external sound processor of cochlear implants to include exchange times considering the economic burden of cochlear implant users.

A Case of Pulsatile Tinnitus Related to Idiopathic Intracranial Hypertension / 대한이비인후과학회지

Idiopathic intracranial hypertension (IIH) is a disorder that commonly occurs in obese young women of childbearing age and is characterized by symptoms such as pulsatile tinnitus, dizziness, headache, nausea, vomiting, and visual loss without any structural or vascular abnormalities in the intracranial cavity. We recently experienced a case of a 33-year-old obese woman who presented with right-sided pulsatile tinnitus, which is an early symptom for IIH. The patient was successfully treated with weight reduction and carbonic anhydrase inhibitor (acetazolamide). Pulsatile tinnitus requires thorough diagnosis and examination because it can be cured if the anatomical or functional cause is identified and treated. When obese women of childbearing age present with pulsatile tinnitus at the otorhinolaryngology outpatient department, treatment for IIH should be initiated after appropriate examination and diagnosis as pulsatile tinnitus may be the only symptom for IIH.

Comparison among Three Different Steroid Therapies for Idiopathic Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

Background and Objectives@#The optimal dose or type of systemic steroid for treating idiopathic sudden sensorineural hearing loss (ISSNHL) is unclear. Herein, we compare the efficacy of three steroid treatment protocols.Subjects and Method We reviewed the medical records of 140 adult ISSNHL patients from a tertiary medical center. The patients were divided into three groups based on their treatment regimen: Group 1 received intravenous 10 mg/day dexamethasone combined with intratympanic (IT) steroid injection, followed by prednisolone for 5 days after discharge; Group 2 received 10 mg/day dexamethasone for 5 days, followed by 5 mg/day for 5 days over a 10-day hospitalization period; and Group 3 received 10 mg/day dexamethasone combined with IT steroid injection during a 5-day hospital stay, followed by 5 mg/day dexamethasone for 5 days after discharge. The hearing thresholds were measured using an automatic audiometer at 0.5, 1, 2, 3, 4, and 8 kHz. Hearing recovery on Day 90 was categorized according to Siegel’s criteria. @*Results@#Univariate and multivariate analyses showed that patients in Group 3 had the lowest hearing thresholds, and the best results for speech reception threshold and speech discrimination scores. The impact of favorable thresholds in Group 3 was better among patients with a baseline average hearing threshold of ＜70 dB. Complete recovery was more likely in Group 3 than in the other groups, based on the odds ratios. @*Conclusion@#Administration of dexamethasone-based systemic steroid combined with IT steroid injection and a relatively long hospitalization period produced the most favorable result.

The Influence of Education Level on Tinnitus and Quality of Life in Korean Adults / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#We aimed to evaluate the effect of the level of education on the prevalence of tinnitus and quality of life (QoL) in the Korean population. SUBJECTS AND METHOD: Our study included 3155 participants from a representative sample. Tinnitus was measured using questionnaires that evaluated perception of ringing, buzzing, roaring, or hissing sounds. Participants were asked to indicate “Yes” or “No” to these questions. Participants who felt that the sensation was “A little annoying” or “Very annoying” were considered to have moderate or severe tinnitus, respectively. Hearing thresholds were measured using an automatic audiometer. QoL was evaluated using the EuroQoL (EQ) scale. @*RESULTS@#The number of participants in the low, middle, and high education groups were 1521, 967, and 667, respectively. Participants with any degree of tinnitus or moderate to severe tinnitus increased as the level of education decreased. Multivariate logistic regression analysis showed that the low education group had significantly higher odds ratios compared to the middle or high education groups for moderate to severe tinnitus. Abnormal EQ 5-dimensions (EQ-5D) were higher in participants with tinnitus and a low level of education. For participants, univariate and multivariate analyses showed EQ-5D index and EQ-visual analog scale in the low education group were lower than that in the other groups. @*CONCLUSION@#Our study showed that low education level was associated with moderate to severe tinnitus in the Korean adult population. Participants with tinnitus and a low level of education had poorer QoL than those with tinnitus and a high level of education.

The Influence of Education Level on Tinnitus and Quality of Life in Korean Adults / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We aimed to evaluate the effect of the level of education on the prevalence of tinnitus and quality of life (QoL) in the Korean population. SUBJECTS AND METHOD: Our study included 3155 participants from a representative sample. Tinnitus was measured using questionnaires that evaluated perception of ringing, buzzing, roaring, or hissing sounds. Participants were asked to indicate “Yes” or “No” to these questions. Participants who felt that the sensation was “A little annoying” or “Very annoying” were considered to have moderate or severe tinnitus, respectively. Hearing thresholds were measured using an automatic audiometer. QoL was evaluated using the EuroQoL (EQ) scale. RESULTS: The number of participants in the low, middle, and high education groups were 1521, 967, and 667, respectively. Participants with any degree of tinnitus or moderate to severe tinnitus increased as the level of education decreased. Multivariate logistic regression analysis showed that the low education group had significantly higher odds ratios compared to the middle or high education groups for moderate to severe tinnitus. Abnormal EQ 5-dimensions (EQ-5D) were higher in participants with tinnitus and a low level of education. For participants, univariate and multivariate analyses showed EQ-5D index and EQ-visual analog scale in the low education group were lower than that in the other groups. CONCLUSION: Our study showed that low education level was associated with moderate to severe tinnitus in the Korean adult population. Participants with tinnitus and a low level of education had poorer QoL than those with tinnitus and a high level of education.

Spontaneous migration of a congenital intratympanic membrane cholesteatoma / 영남의대학술지

Congenital intratympanic membrane cholesteatoma (ITMC) is a rare type of congenital cholesteatoma located within the tympanic membrane. This lesion tends to increase in size over time. The development of ITMC can cause several complications such as hearing impairment, dizziness, facial palsy, and intracranial complications, similar to any other cholesteatoma. The treatment of congenital cholesteatoma requires the removal of the lesion through surgery, because disease progression induces bony destruction of the nearby tissue. Most patients presenting with this cholesteatoma type are also treated with primary surgical removal. However, we recently experienced a case of an ITMC that showed a natural transition to an external auditory canal cholesteatoma.

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.

Spontaneous migration of a congenital intratympanic membrane cholesteatoma / 영남의대학술지

Congenital intratympanic membrane cholesteatoma (ITMC) is a rare type of congenital cholesteatoma located within the tympanic membrane. This lesion tends to increase in size over time. The development of ITMC can cause several complications such as hearing impairment, dizziness, facial palsy, and intracranial complications, similar to any other cholesteatoma. The treatment of congenital cholesteatoma requires the removal of the lesion through surgery, because disease progression induces bony destruction of the nearby tissue. Most patients presenting with this cholesteatoma type are also treated with primary surgical removal. However, we recently experienced a case of an ITMC that showed a natural transition to an external auditory canal cholesteatoma.

Association Between Hearing Impairment and Albuminuria With or Without Diabetes Mellitus

OBJECTIVES: Few studies have evaluated the accurate association between hearing loss (HL) and albuminuria in patients with or without diabetes mellitus (DM). The aim of our study was to identify the clinical effects of albuminuria on HL with or without DM. METHODS: This study included 9,762 patients from the Korean National Health and Nutrition Examination Survey between 2011 and 2013. Participants were divided into 4 groups based on DM and urine albumin/creatinine ratio levels: group 1 included participants with neither DM nor albuminuria, group 2 included participants without DM and with albuminuria, group 3 included patients with DM and without albuminuria, and group 4 included patients with both DM and albuminuria. The low- or mid-frequency and high-frequency, and average hearing threshold values were obtained. RESULTS: There were 7,508, 545, 1,325, and 384 participants in groups 1, 2, 3, and 4, respectively. Univariate and multivariate analyses showed that the 3 hearing thresholds in group 1 were the lowest and those in group 4 were the highest among the 4 groups. No significant differences were observed in those thresholds between groups 2 and 3. Group 4 was associated with HL compared with the other groups, but moderate to severe HL was not associated with DM or albuminuria. CONCLUSION: The presence of albuminuria was associated with a modest effect on hearing thresholds regardless of presence of DM.

A Novel Frameshift Mutation of SLC26A4 in a Korean Family With Nonsyndromic Hearing Loss and Enlarged Vestibular Aqueduct

OBJECTIVES: We aimed to identify the causative mutation for siblings in a Korean family with nonsyndromic hearing loss (HL) and enlarged vestibular aqueduct (EVA). The siblings were a 19-year-old female with bilateral profound HL and an 11-year-old male with bilateral moderately severe HL. METHODS: We extracted genomic DNA from blood samples of the siblings with HL, their parents, and 100 controls. We performed mutation analysis for SLC26A4 using direct sequencing. RESULTS: The two siblings were compound heterozygotes with the novel mutation p.I713LfsX8 and the previously described mutation p.H723R. Their parents had heterozygous mono-allelic mutations. Father had p.I713LfsX8 mutation as heterozygous, and mother had p.H723R mutation as heterozygous. However, novel mutation p.I713LfsX8 was not detected in 100 unrelated controls. CONCLUSION: Both mutations identified in this study were located in the sulfate transporter and anti-sigma factor antagonist domain, the core region for membrane targeting of SulP/SLC26 anion transporters, which strongly suggests that failure in membrane trafficking by SLC26A4 is a direct cause of HL in this family. Our study could therefore provide a foundation for further investigations elucidating the SLC26A4-related mechanisms of HL.

Association of Bone Mineral Density With Hearing Impairment in Postmenopausal Women in Korea

OBJECTIVES: Previous studies examining the association between osteoporosis (OP) and hearing loss (HL) have shown conflicting results. The objective of the present study was to examine the association between hearing impairment and OP in postmenopausal women, using appropriate statistical analyses. METHODS: Total 1,009 participants were included in the current study. The propensity score matched (PSM) cohort was defined as the cohort including participants diagnosed with OP and participants without OP. Three statistical models were developed where model 1 was unadjusted, model 2 included age, and model 3 included age, body mass index, alcohol intake, smoking habit, diabetes mellitus, hypertension, high density lipoprotein cholesterol, triglyceride level, vitamin D, and alkaline phosphatase. RESULTS: There were 776 and 233 participants in the groups diagnosed without and with OP, respectively. For propensity score matching, 233 pairs were selected from the 776 participants without OP. In the total cohort, using statistical models 2 and 3, no significant difference in the four hearing thresholds was identified between the 2 groups. Logistic regression indicated that, in model 3, participants with OP had a 1.128 (P=0.323) increased risk HL. A significant HL risk was not observed in participants with OP. Using statistical model 3, there were no significant associations among lumbar spine or femoral neck T-scores and changes in the hearing thresholds. In the PSM cohort, statistical models also showed similar results. CONCLUSION: The current study did not demonstrate and association between bone mineral density and hearing impairment in the study population of postmenopausal Korean women.

Prediction of Cochlear Implant Outcomes in Patients With Prelingual Deafness

OBJECTIVES: To evaluate the factors that limit post-cochlear implantation (CI) speech perception in prelingually deaf children. METHODS: Patients with CI were divided into two groups according to Category of Auditory Performance (CAP) scores 3 years post-CI: the poor performance group (poor performance group, CAP scores≤4, n=41) and the good performance group (good performance group, CAP scores≥5, n=85). The distribution and contribution of the potential limiting factors related to post-CI speech perception was compared. RESULTS: Perinatal problems, inner ear anomalies, narrow bony cochlear nerve canal (BCNC), and intraoperative problems was significantly higher in the poor performance group than the good performance group (P=0.010, P=0.003, P=0.001, and P=0.045, respectively). The mean number of limiting factors was significantly higher in the poor performance group (1.98±1.04) than the good performance group (1.25±1.11, P=0.001). The odds ratios for perinatal problems and narrow bony cochlear nerve canal in the poor performance group in comparison with the good performance group were 4.878 (95% confidence interval, 0.067 to 0.625; P=0.005) and 4.785 (95% confidence interval, 0.045 to 0.972; P=0.046). CONCLUSION: This study highlights the comprehensive prediction of speech perception after CI and provides otologic surgeons with useful information for individualized preoperative counseling of CI candidates.

Is Body Mass Index Associated With the Development of Age-Related Hearing Impairment in Koreans? The Korean National Health and Nutrition Examination Survey 2009-2012

OBJECTIVES: The aim of this study was to evaluate whether body mass index (BMI) is associated with age-related hearing loss (ARHL) in the Asian elderly population. METHODS: Data from the Korean National Health and Nutrition Examination Survey 2009-2012 were used for the analyses. The pure tones at 0.5 and 1 kHz of both ears of each subject were averaged to obtain the low-frequency, those at 2 and 3 kHz were averaged to obtain the mid-frequency, and those at 4 and 6 kHz were averaged to obtain the high-frequency. The average hearing threshold (AHT) was calculated as pure tone average at 4 frequencies in the better ear. ARHL was defined as the AHT >25 dB. RESULTS: Univariate analyses revealed an increase in the BMI tertile in men was associated with a decreased low-frequency threshold, while an increase in the BMI tertile in women was associated with decreased mid- and high-frequency thresholds. Multivariate analyses adjusted for confounders show no significant differences in low-, mid-, or high-frequency. There was no significant difference in the prevalence of ARHL by BMI tertiles. Linear regression analyses show no association between BMI and low-, mid-, and high-frequency or AHTs. The area under the receiver operating characteristic curve values for AHT was 0.515 in men and 0.522 in women. The logistic regression analyses showed no association between BMI and ARHL in either sex. CONCLUSION: BMI is not advantageous for the prediction of ARHL. In future epidemiological studies, BMI as a covariate of obesity may be replaced by other active metabolic parameters that have better predictive ability of ARHL than BMI.

Clinical Aspects and Surgical Outcomes of Congenital Cholesteatoma in 93 Children: Increasing Trends of Congenital Cholesteatoma from 1997 through 2012

BACKGROUND AND OBJECTIVES: The recent increase in the reported incidence of congenital cholesteatoma (CC) may be secondary to the widespread use of otoendoscopy as well as an increased awareness of these lesions among primary care physicians. However, little research about CC has been conducted in a large group of patients. This study aimed to analyze the clinical characteristics of CC including the annual number of patients, symptoms, age at diagnosis, stage and type of disease, surgical techniques, recurrence, and postoperative complications. SUBJECTS AND METHODS: Retrospective chart review was performed for patients who met the inclusion criteria between January 1997 and June 2012. RESULTS: Ninety-three patients underwent surgery for CC. The age at operation ranged from 12 months to 17 years (mean age, 6.1 years). The number of patients was less than 4 per year until 2005, but increased to more than 10 per year since 2008. CC was most commonly reported as an incidental finding (58.1%). The operative procedures included the transcanal myringotomy approach (46.2%), canal wall up mastoidectomy (37.6%), tympanoplasty (8.6%), and canal wall down mastoidectomy (7.5%). The recurrence rate was 20.4% and the complication rate was 12.9%. No patients with stage I CC had complications. CONCLUSIONS: This study showed that the incidence of CC has recently increased notably. Most patients with stage I and II CC were completely cured by transtympanic surgery, and complication and recurrence rates increased according to the extent of disease. Early detection of CC is important to facilitate minimally invasive surgery and to reduce complication and recurrence rates.

Language Development in Profoundly Prelingually Deaf Children with Cochlear Implantation: Long-Term Outcomes / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is well established that cochlear implantation provides significant benefits for prelingually profound deaf children. However, there are few studies that examined the long-term outcome of cochlear implantation beyond 10 years in prelingually deaf children. The purpose of this study was to examine the long-term benefit of cochlear implantation for children with more than 10 years of experience of using cochlear implantation, regarding auditory performance and academic status. We then determined the age effect of cochlear implantation on auditory performance for prelingually deaf children. SUBJECTS AND METHOD: The longitudinal development of auditory performance of 119 deaf children was analyzed after cochlear implantation. Among the 119 children, 58 were included for analysis. RESULTS: The children who received cochlear implanst at younger age showed significantly better auditory performance. Age at which implantation had been performed had a significant effect on the development of auditory performance before 4 years of age. Many children continued to demonstrate improvements of auditory performance upto five years of implant use. Some showed development of auditory performance upto 10 years cochlear implantation. CONCLUSION: The present result indicates that speech perception and performance for children continue to improve over time from 5 upto 10 years while using cochlear implant. The use of earlier cochlear implantation was demonstrated to provide better auditory performance. The age at which implantation was performed was one of the important factors influencing the long-term outcome of cochlear implantation.

Comparative Analyses between Receiver in the Canal Hearing Aids and Closed Fit Hearing Aids: Preliminary Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to compare the degree of satisfaction of the patients, hearing loss type and severity, and satisfactory and unsatisfactory factors between closed fit hearing aid (HA) and receiver in the canal (RIC) HA. SUBJECTS AND METHOD: Seventeen patients with hearing loss participated in this study. All patients had used closed fit HAs prior to the study, with the ratio of those using in the canal (ITC) types and completely in the canal (CIC) types being 4:13. After a 2-week trial period of using RIC HAs, patients were evaluated for their satisfaction of using RIC HAs by filling out the questionnaire on the Korean version International Outcome Inventory for hearing aids (K-IOI-HA). RESULTS: The visual analogue scale (VAS) score of closed fit HA was higher in the RIC-HAdissatisfied group (5, n=9). The K-IOI-HA score of closed fit HA was higher than that of RIC HA in the RIC-HA-dissatisfied group and similar in the RIC-HA-satisfied group. Audiologically, air conduction and bone conduction thresholds at 500 Hz were lower in the RIC-HA-satisfied group than in the RIC-HA-dissatisfied group. In addition, the VAS score of RIC HA was negatively correlated with air and bone conduction thresholds and the K-IOI-HA score of RIC HA was positively correlated with speech discrimination score, whereas the VAS and K-IOI-HA scores of closed fit HA were not. CONCLUSION: Among the patients with closed fit HA, some patients indicated RIC HA to be suitable and showed intention to change. The HA should be prescribed firstly based on audiologic criteria, which could increase the subjective satisfaction and prevent poor compliance due to incongruity.

A Case of a Cholesterol Granuloma Occluding the External Auditory Canal in a 12-Year-Old Girl

Cholesterol granulomas are benign granulomatous lesions caused by tissue reaction to a foreign body such as cholesterol crystals. These crystals have been are associated with pathological conditions of pneumatized spaces, including those causing inadequate aeration, obstruction of drainage, and hemorrhage in pneumatized spaces, and where materials trapping materials, such as hemosiderin or cholesterol become trapped, and then forming a cholesterol granuloma. Cholesterol granulomas are frequently found in the temporal bones, with the middle ear, mastoid caverna, and petrous apex being the most commonly affected sites. As there have been few reported cases of cholesterol granulomas presenting as a mass in the external acoustic canal (EAC), a cholesterol granuloma occluding the entire EAC in a pediatric patient is considered quite rare. We encountered a large cholesterol granuloma occupying the entire EAC, resulting in total EAC occlusion in a 12-year-old girl. The granuloma was diagnosed via medical imaging and surgically excised.