Changes in the Regional Cerebral Blood Flow in Postlingual Deaf Patients Measured by ECD-SPECT: Preliminary Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cochlear implantation improves hearing ability in adults with profound deafness. Using non-invasive functional brain imaging methods, it is now possible to assess regional blood flow and activity of auditory cortex which might be correlated to the outcome of cochlear implantation. The aim of this study was to measure the regional cerebral blood flow in patients with postlingual deafness utilizing controls in a variety of methods. SUBJECTS AND METHOD: Six postlingual deaf adults who were planned to undertake cochlear implantation and 12 normal controls were examined with technetium-99m-labeled ethyl cysteinate dimer single-photon emission computed tomography (99mTc-ECD-SPECT). Images of the regional cerebral blood flow were processed by statistical parametric mapping and analyzed by unpaired t-test. RESULTS: The analysis of the SPECT images of the 6 deaf patients showed decreased cerebral blood flow in both superior, middle temporal and inferior prefrontal lobes compared with controls (p<0.001). Also this decreased auditory cortical blood flow was greater in left hemisphere in all patients. CONCLUSION: The degree of remaining activity of auditory cortex and the lateralization of the dominant auditory hemisphere, which may influence on the outcome of cochlear implantation, could be measured by ECD-SPECT.

Treatment Response of Modified Tinnitus Retraining Therapy with Medical Therapy in the Patients with Tinnitus / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: According to the neurophysiologic model of tinnitus, emotion and autonomic nervous systems are closely related to generation of tinnitus. We performed this study to evaluate the treatment response of modified tinnitus retraining therapy (TRT) with medication in the patients with sensorineural tinnitus. SUBJECTS AND METHOD: Forty-three tinnitus patients who were diagnosed as sensorineural tinnitus through audiologic evaluation and have normal hearing in speech frequency were included in this study. Tinnitus and psychological status were measured by tinnitus questionnaire, Korean version of Brief Encounter Psychosocial Instrument (BEPSI) scale, Beck Depression Inventory (BDI), Spielberger State Trait Anxiety Inventory (STAI). Patients treated with anxiolytics and microcirculation enhancer were Group 1 and those treated with modified TRT and medications were Group 2. Short-term therapeutic response was analyzed and compared between two groups. RESULTS: Loudness, awareness, annoyance and effect on life of tinnitus and tinnitus handicap score were significantly decreased in Group 2. Relief of tinnitus in more than 2 of 4 subjective parameters was achieved in 4 patients (30.7%) in Group 1 and 15 patients (75%) in Group 2. Stress score was also decreased significantly after treatment in Group 2. CONCLUSION: Tinnitus patients in Group 2 treated with medication and modified TRT showed the higher compliance and the response rate of treatment than the patients in Group 1 treated with medication alone. Modified TRT, in addition to medical therapy, should be considered to increase the therapeutic response in patients with sensorineural tinnitus.

Therapeutic Effect of Multiple Paper Patching for Traumatic Tympanic Membrane Perforation-Trial of Quantitative Analysis Using Image Analyzer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Paper patching for the treatment of traumatic tympanic membrane perforation is a safe, simple, and inexpensive method. This study was designed to evaluate the therapeutic effect of proper paper-patch techniques for traumatic tympanic membrane perforation using more objective measurement of perforated area by image analyzer. SUBJECTS AND METHOD: A prospective study of paper-patch techniques was carried out on 55 patients with traumatic perforations of the tympanic membrane. Objective semiquantitative measurement of the perforated area was performed using computerized image analyzer. Immediate eversion of inverted flaps and single to multiple patching techniques were used in all cases. Treatment results were analyzed according to various variables which may affect the healing rate. RESULTS: The closure rate of tympanic membrane with this paper patching method was 98.2% and the mean healing time was 2.9+/-1.9 weeks. Hearing impairment was correlated with the size of perforation which was measured quantitatively by image analyzer and the healing rate was decreased with infectious signs such as otorrhea. There were no side effects or complications. CONCLUSION: Multiple paper patching with proper technique for traumatic tympanic membrane perforation produced an excellent success rate and could be considered as part of initial therapeutic methods for all cases of large perforation with inverted flap.

Therapeutic Efficacy and Prognostic Factors of Canalith Repositioning Maneuver in the Patients with Benign Paroxysmal Positional Vertigo

BACKGROUND AND OBJECTIVES: The purpose of this study were to evaluate the therapeutic efficacy of canalith repositioning maneuver (CRP) according to accompanying mastoid percussion and to investigate the prognostic factors that may affect successful repositioning maneuver and the recurrence of benign paroxysmal positional vertigo. MATERIALS AND METHOD: A total of 70 patients with canalith type BPPV visiting the dizziness clinic of Kangnam St. Mary's Hospital were included in this study. Variables identified for statistical analysis were patient's age, sex, maneuver method, number of involved canal, number of CRP and dizziness handicap inventory. RESULT: Overall success rate of CRP was 90%. The mean number of maneuver was 1.6 and the recurrence rate was 25.7% during the follow up period. Success rate of CRP (94.9%) was higher than maneuver without mastoid percussion (83.9%) though it was not statistically significant. Successful CRP group showed the significant less number of maneuvers at initial treatment session and less number of involved canal than failed CRP group at the time of one week-follow up visit. Patients with recurrence of BPPV had the more number of CRP during the period of previous BPPV. CONCLUSION: Therapeutic efficacy of CRP with mastoid percussion was higher than CRP without mastoid percussion though it was not statistically significant. Suggesting prognostic factors for effective CRP and recurrence were number of CRP and number of involved canal.