Middle Ear Cholesterol Granuloma without Tympanic Membrane Perforation / 대한이비인후과학회지

Cholesterol granuloma is a histopathologic term used to describe the giant cell reaction to cholesterol deposits that occurs in sequestered, fluid-filled air cells that are normally pneumatized compartments of the temporal bone. It is a benign lesion which is known to be found in the middle ear cavity, mastoid air cells and petrous apex. Although cholesterol granuloma is a pathologic term describing a tissue response to cholesterol crystals, it is now recognized as a clinical disease entity especially in cases of unilateral blue eardrum without tympanic membrane perforation. Three factors are considered to play an important role in the development of cholesterol granulomas: obstruction of ventilation, microhemorrhage, and impaired drainage. Cholesterol granulomas are often found as pathologic lesions like granulation tissue in the middle ear and mastoid cavities during middle ear surgeries in patients with chronic otitis media or cholesteatoma. Cholesterol granulomas of the middle ear typically present as conductive hearing loss and a blue eardrum, whereas those at the petrous apex are incidentally identified or manifest as bony erosion with sensorineural hearing loss, tinnitus, vertigo, or cranial nerve impairment. Cholesterol granulomas in middle ear cavity and mastoid air cells are related with Eustachian tube dysfunction, so initial treatment of cholesterol granuloma is the insertion of ventilation tube in many cases. However, it is often necessary for the complete cure to do excision of the lesion through tympanomastoidectomy surgery.

Middle Ear Surgery in Only Hearing Ears and Postoperative Hearing Rehabilitation

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate surgical interventions and hearing rehabilitation in patients with chronic middle ear disease of only hearing ears. SUBJECTS AND METHODS: Thirty-one patients with chronic middle ear disease of only hearing ears were enrolled in this retrospective study. Patients were classified into three groups according to the hearing level: groups A [pure tone audiometry (PTA) or =70). We evaluated hearing results and patterns of auditory rehabilitation. RESULTS: The main consideration for a surgical procedure was the presence of recurrent otorrhea and structural destruction. The reasons for surgical intervention in only hearing ears were otorrhea caused by chronic otitis media (68%), cholesteatoma (29%), and cholesterol granuloma (3%). The causes of contralateral deaf ears were chronic otitis media (81%) and sensorineural hearing loss (19%). Although there was hearing deterioration in some patients with severe hearing loss (PTA> or =70), all patients achieved dry ears after surgery and functional hearing using auditory rehabilitation. Hearing aids were used in most patients with moderate to moderately severe hearing loss and cochlear implants were used for auditory rehabilitation in patients with severe to profound hearing loss. CONCLUSIONS: Proper evaluation and indications for surgery in only hearing ears are important for successful eradication of inflammation and hearing preservation. Surgical interventions can achieve dry ear and enable further auditory rehabilitations using hearing aids and cochlear implantation.

A Case of Middle Ear Adenoma

Middle ear adenoma can be a rare cause of a middle ear mass. These benign tumors can have epithelial and/or neuroendocrine differentiation. In 1976, Hyams was the first to describe a series of these tumors. It is still thought that these tumors are indistinguishable in composition from each other. We report a case of middle ear adenoma, the clinical and pathologic findings of which illustrate the biological behavior of the middle ear. A 17-year-old male presented with a history of recurrent, bloody otorrhea and high-pitched tinnitus. We diagnosed him with congenital cholesteatoma and performed surgery to remove the entire tumor as well as the incus. However, on postoperative pathology examination, we finally diagnosed the tumor as middle-ear adenoma with neuroendocrine differentiation. In the two years following surgery, the patient's adenoma has not recurred, although long-term observation will be required.

Eosinophilic Otitis Media: CT and MRI Findings and Literature Review

Eosinophilic otitis media (EOM) is a relatively rare, intractable, middle ear disease with extremely viscous mucoid effusion containing eosinophils. EOM is associated with adult bronchial asthma and nasal allergies. Conventional treatments for otitis media with effusion (OME) or for chronic otitis media (COM), like tympanoplasty or mastoidectomy, when performed for the treatment of EOM, can induce severe complications such as deafness. Therefore, it should be differentiated from the usual type of OME or COM. To our knowledge, the clinical and imaging findings of EOM of temporal bone are not well-known to radiologists. We report here the CT and MRI findings of two EOM cases and review the clinical and histopathologic findings of this recently described disease entity.

The Survey of Prevalence of Osteoporosis in Alzheimer's Disease Patients

OBJECTIVES: To evaluate the prevalence of osteoporosis in the Alzheimer's disease patients. METHODS: One hundred and twenty eight patients with Alzheimer's disease were included in this study. The patients are diagnosed with Alzheimer's disease using Korean-Mini Mental Status Examination (K-MMSE) and checked bone mineral density using single-energy (SE) quantitative computed tomography (QCT) in 2010. To define abnormality in terms of QCT of the spine, a bone mineral density (BMD) spine below 80 mg/cm3 is indicative of osteoporosis and BMD between 80 and 120 mg/cm3 is indicative osteopenia. RESULTS: The prevalence of osteoporosis in the control group is 29.73%. The prevalence of osteoporosis in the Alzheimer's disease patients is 96.87%. The prevalence of osteopenia in the Alzheimer's disease patients is 3.12%. The prevalence of severe osteoporosis fracture in the Alzheimer's disease patients is 32.03%. CONCLUSION: The prevalence of osteoporosis in Alzheimer's disease patients is higher than in the control group.

Treatment of Meniere's Disease with Low-Concentration Intratympanic Gentamicin Injection / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Intratympanic gentamicin injection is used as one of the treatment modalities for medically intractable Meniere's disease. But the ideal dosage and concentration of gentamicin were not established in consideration of therapeutic efficacy and the risk of postoperative hearing loss. We analyzed the clinical outcome of low-concentration intratympanic gentamicin injection in patients with Meniere's disease. And we also tried to find factors anticipating for the response to treatment. SUBJECTS AND METHOD: A retrospective review was conducted on 45 subjects who had been diagnosed as 'definite' Meniere's disease (AAO-HNS, 1995) and had no response to medical treatment over 3 months in our clinic. The concentration of gentamicin was 7 mg/cc, which was very low compared with previous studies. We reviewed postoperative changes on vertigo, tinnitus and hearing by questionnaire and pure tone audiometry. We also analyzed preoperative patients' characteristics for acquisition of predictive factors of treatment response. RESULTS: Vertigo was completely disappeared in 37 (82%) patients and there was no vertigo improvement in 8 (18%) patients despite multiple injections. Tinnitus was controlled in 11 (24%) patients, and aggravated in 4 (8%) patients. A significant postoperative hearing loss over 10 dB occurred in only 6 (13%) patients. Preoperative patients' hearing threshold, frequency of vertigo, functional level and finding in electrical test, such as electrocochleogram, were not different regarding treatment response. CONCLUSION: Low-concentration gentamicin was enough to control vertigo and could reduce the risk of postoperative hearing loss in patients with Meniere's disease.

Postoperative Results of Ossiculoplasty over Stapes Head / 대한이비인후과학회지

BACKGROUD AND OBJECTIVES: Incus erosion with intact stapes head was most common ossicular impairment in chronic otitis media. Here, we aimed to investigate hearing and clinical results of the ossiculoplasties when the stapes head was intact. SUBJECTS AND METHOD: We analyzed 281 patients of ossiculoplasties over stapes head performed from 1990 to 2005. Patients were divided into 3 groups: Si group (n=121) included patients with interposition of prosthesis between malleus and stapes; Sc-PORP group (n=99) included patients with columellarization between tympanic membrane and stapes head with PORP; Sc-SC group (n=61) included patients with columellarization with the autologous materials between tympanic membrane and stapes head. Hearing improvement and extrusion rates of three groups were analyzed. RESULTS: At 6 months after the surgery, the postoperative air-bone gap (ABG) level within 20 dB was 45%, 44%, 25% in Si, Sc-PORP, Sc-Sc, respectively. The closure of ABG was statistically better in Si and Sc-PORP compared with Sc-SC. In canal wall-up mastoidectomy, Sc-PORP showed better hearing results than Si, while Si was better than Sc-PORP in canal wall-down mastoidectomy. At 36 months after the surgery, extrusion-free survival according to the type of ossiculoplasty were 100%, 89.6%, 100% in Si, Sc-PORP, Sc-SC, respectively. CONCLUSION: Si and Sc-PORP provide good hearing results. However, Si has lower extrusion rates than Sc-PORP and remains stable over time.

Long Term Changes of Electrical Stimulation Levels in Children with Cochlear Implant / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The goal of mapping after cochlear implantation (CI) is to find a proper range of acoustic signals for the implantees. In young children or infants, however, it is more difficult to obtain reliable responses during mapping procedure. The purpose of this study was to observe the changes of the proper electrical stimulation levels (threshold levels, comfortable levels and dynamic range) in children with the Nucleus 24 cochlear implant system by analyzing postoperative mapping results. SUBJECTS AND METHOD: The maps of 23 children with normal inner ear who received CI were examined at 7 time intervals (1, 6, 12, 24, 36, 48 and 60 months post-connection). RESULTS: The mean value of C levels and DR of 23 children gradually increased according to time from 1 month to 60 months post-connection. The value of T level increased up to 6 months post-connection and then stabilized. CONCLUSION: This study emphasized the need for frequent mapping in the first 6 months of implant use in children. Protocol for regular mapping schedule from 1 year to 5 year post-connection would be necessary.

Clinical Comparison of the Auditory Steady-State Response with the Click Auditory Brainstem Response in Infants

OBJECTIVES: Our goal was to determine the effectiveness of using the auditory steady state response (ASSR) as a measure of hearing thresholds in infants who are suspected of having significant hearing loss, as compared with using the click-auditory brainstem response (C-ABR). METHODS: We retrospectively analyzed the audiologic profiles of 76 infants (46 boys and 30 girls, a total of 151 ears) who ranged in age from 1 to 12 months (average age: 5.7 months). The auditory evaluations in 76 infants who were suspected of having hearing loss were done via the C-ABR and ASSR. In addition, for reference, the mean ASSR thresholds were compared to those of 39 ears of infants and 39 ears of adults with normal hearing at 0.5, 1, 2, and 4 kHz. RESULTS: The highest correlation between the C-ABR and ASSR thresholds was observed at an average of 2-4 kHz (r=0.94). On comparison between the hearing of infants and adults at 0.5, 1, 2, and 4 kHz, the mean ASSR threshold in infants was 12, 7, 8, and 7 dB higher, respectively, than that in adults. CONCLUSION: ASSR testing may provide additional audiometric information for accurately predicting the hearing sensitivity, and this is essential for the management of infants with severe to profound hearing loss.

The Validity Using Two-stage Automated Auditory Brainstem Response as a Universal Newborn Hearing Screening Protocol : Experiences in Asan Medical Center / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Universal newborn hearing screening is widely accepted due to socioeconomic harm of congenital hearing loss. The aim of this study was to assess whether two-stage automated auditory brainstem response (AABR) is acceptable method for newborn hearing screening and to check the presence of potential false negative cases by using another criterion considering sweep number. SUBJECTS AND METHOD: Among 3761 neonates who were born from March 2004 to December 2005, 3053 healthy neonates (81.18%) whose parents agreed to hearing screening protocol were screened with AABR. Failed neonates ('refer') at first stage test and neonates showing high sweep number (>4000) on repeated test were received second stage retest within 24 hours from the first test. Neonates whose retest AABR results were failed or high sweep number continuously were tested with conventional ABR as a confirmative study within 3 months. RESULTS: 94 neonates (3.08%) were failed and 180 neonates (5.89%) showed high sweep number on first stage AABR test. On second stage AABR test, neonates with 'final refer' result were 46 (1.51%) and neonates with 'final high sweep number' result were 44 (1.44%). Neonates with threshold of over 30 dB at ABR were 14 among final refer group and 5 among final high sweep number group. Three bilateral profound hearing loss cases were detected and proper management was done. Nine false negative cases were detected and of these, 3 neonates showed moderate hearing loss. There is no clear relationship between predicting false negative case and sweep number. CONCLUSION: Our current two stage AABR test is useful tool for newborn hearing screening with acceptable referral rate and positive predictive value. False negative cases detected through our protocol have no clear relationship with high sweep number.

Magnet Displacement Following Cochlear Implantation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: To describe a rare complication of cochlear implantation, such as magnet displacement which can be diagnosed easily with simple skull radiographs and treated with minimal surgery. MATERIALS AND METHOD: The record of male who experienced CI magnet dislodgement was reviewed. RESULTS: The patient was seen with a displaced magnet under the skin 15 days after a head trauma (1 month after implantation). The patient was implanted with the Nucleus 24 device at the age of 3 years. Plain skull radiographs showed the dislocated magnet. Surgery was limited to the revision of the receiver/stimulator site and reinsertion of the magnet to its pocket. Intraoperative neural response telemetry was normal in the patient. Postoperative auditory responses were as good as those measured before the complication. CONCLUSION: The displaced magnet can be successfully managed by a simple revision procedure. The possibility of magnet migration should be considered in cases of device malfunction.

A Case of Cochlear Implantation in Otosclerosis / 대한이비인후과학회지

Otosclerosis is known to be rare in orientals, but there have been a few reports of the clinically suspicious otosclerosis cases in Korea. Otosclerosis is a bony disorder involving endochondral bone of the otic and labyrinthine capsule. Advanced and very advanced otosclerosis are conditions in which the otosclerotic involvement of the otic capsule has progressed to result in profound deafness with undetectable bone and air conduction thresholds. The patients, who have severe to profound hearing loss due to otosclerosis, potentially benefit from a stapes surgery and optimal hearing aid fitting. But there are a few reports that cochlear implantation may provide these patients with a superior outcome. We report a 58 year-old man with severe to profound hearing loss, which was a first reported case of cochlear implantation employed to treat otosclerosis in Korea. We present this with a review of the related literature.

Clinical Usefulness of Vestibular Evoked Myogenic Potential in Unilateral Meniere's Disease / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Because the saccule, next to the cochlea, is the second most frequent site of hydrops formation, we evaluated whether vestibular evoked myogenic potential (VEMP) responses can reflect the diagnosis and the stage of Meniere's disease. SUBJECTS AND METHOD: Retrospectively, we analyzed the results of VEMP in 40 patients (11 men and 29 women) with unilateral definite Meniere's disease. All subjects underwent VEMP testing using ipsilateral 500 Hz-tone burst sound with 90 dBnHL (rise/fall time=2 msec, plateau time=3 msec). RESULTS: VEMP was present in 92.5% of Meniere's affected ear (37/40). The latency of p13 of affected ears in patients with Meniere's disease was significantly prolonged than that of normal ears in the control group (p=0.05). However, no relationship was found in latencies of p13, n23, and interpeak latency among groups classified by the stage of Meniere's disease. In the patients with Meniere's disease, the mean interaural amplitude difference (IAD) ratio was 23.9+/-16.9%. The IAD ratio of patients with Meniere's disease was larger than that of the control group, but it is statistically insignificant (p=0.133). CONCLUSION: Prolonged p13 latency of VEMP was a pathognomic finding for Meniere's disease in this study.

Analysis of Therapeutic Effects of Lipo-Prostaglandin E1 for Treatment of Sudden Sensorineural Hearing Loss in Patients with Type 2 Diabetes / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES : Diabetes mellitus (DM) is a risk factor for sudden sensorineural hearing loss (SSNHL), possibly due to microvascular damage as well as increased blood viscosity and embolic and thrombotic episodes. To perform a prospective, randomized clinical trial to evaluate the therapeutic effect of lipo-prostaglandin E(1) (lipo-PGE(1)) on SSNHL in Korean patients with type 2 diabetes. MATERIALS AND METHOD : The study group consisted of 270 patients (130 males, 140 females) consecutively diagnosed with SSNHL. Patients were classified as diabetic or nondiabetic by the new American Diabetes Association criteria. With the approval of the institute ethics committee, patients were randomly assigned to treatment with a continuous infusion of 10 L lipo-PGE(1) (lipo-PGE(1) group) or saline (placebo group). In addition, all patients studied were treated with 48 mg methylprednisolone for 5 days. RESULTS : The overall recovery rates after treatment were 51.5% in diabetic and 64.2% in nondiabetic patients. In diabetic patients, there was a significantly higher rate of hearing improvement in the lipo-PGE(1) group (64.7%) than in the placebo group (37.5%), whereas, in nondiabetic patients, there was no significant difference in the rate of hearing improvement between the lipo-PGE(1) group (70.3%) and the placebo group (58.3%). CONCLUSION : Lipo-PGE(1) may have beneficial effects in the treatment of SSNHL in Korean patients with type 2 diabetes.

The Diagnostic Value of Magnetic Resonance Imaging in Patients with Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

OBJECTIVES: To evaluate the diagnostic value of magnetic resonance imaging (MRI) of patients with sudden sensorineural hearing loss (SSNHL) and to analyze the various clinical aspects and treatments of the patients with abnormal MRI findings. SUBJECTS AND METHOD: We retrospectively reviewed medical and radiological records of patients with SSNHL over 5-year period. All consecutive patients took gadolinium-enhanced MRI including whole brain and all MRIs were evaluated by experienced independent investigators. RESULTS: Twelve patients (8.0%) had obvious etiologies of SSNHL, which consisted of 5 cases of vestibular schwannoma, 3 cases of tumors of cerebellopontine angle, 3 cases of pontine infarction, and 1 case of inflammatory granuloma of internal auditory canal. One patient (0.7%) had possible etiologies of SSNHL, which was labyrinthitis ossificans. CONCLUSION: Gadolinium-enhanced magnetic resonance imaging (MRI) including whole brain seems to be an essential examination in patients with SSNHL and we recommend its application.

The Correlation between Pure Tone Audiometry and Auditory Steady State Response according to the Hearing Level and Frequency / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study is to assess the correlation between hearing thresholds in pure tone audiometry (PTA) and auditory steady state response (ASSR) according to the hearing level and frequency. SUBJECTS AND METHOD: A total of 105 subjects (178 ears, 64 male and 41 female) were enrolled in this study. None of the subjects had middle ear diseases and PTA and ASSR were performed on the same day for each subject. Ninety-eight subjects (168 ears) were finally enrolled in the analysis of this study. RESULTS: The correlation coefficient (r) of mean hearing threshold between PTA and ASSR was 0.96 and the mean hearing threshold of PTA can be calculated from the mean hearing threshold of ASSR (PTA=1.05 x ASSR-7.6). When analyzed according to frequency, the correlation coefficients were 0.94, 0.95, 0.94, and 0.92 for 500, 1,000, 2,000, and 4,000 Hz panels, respectively. CONCLUSION: This study showed that ASSR and PTA had very close correlation and ASSR could be used to estimate hearing thresholds with reliable accuracy in various cases where subjective hearing measurement including PTA could not be performed.

A Comparison according to Insertion Method for Intramedullary Nailing in Proximal Tibial Fractures

PURPOSE: To compare clinical and radiological results between standard insertion method and semiextended method which was designed to improve proximal fixation and alignment in proximal tibia fracture. MATERIALS AND METHODS: A retrospective review from May 2000 to February 2004, identified 24 extraarticular fractures in proximal tibia, initially treated with locked intramedullary nails at least 1 year follow up. There were 12 open injuries, 4 segmental, 3 butterfly fragments and 17 comminuted. Semiextended method was used in 10 fratures and standard insertion method which is cephalad to tibial tubercle in 14. Follow up clinical assessment consisted of review of associated injuries and complications and these two methods were compared by postoperative angulation and displacement in anteroposterior and lateral radiographs. Data were analysed by t-tests. RESULTS: In semiextended group, average angulation was 2.3 degrees in coronal and 2.8 degrees in sagittal plane and average displacement was 4.5 mm in coronal and 5.3 mm in sagittal. In ordinary group, average angulation was 5.1 degrees in coronal and 7.4 degrees in sagittal plane and average displacement was 6.1 mm in coronal and 5.3 mm in sagittal. In semiextended group, there were significant reduction in coronal angulation (p=0.006) and sagittal angulation (p=0.001), but there was no significant difference in coronal (p=0.344) and sagittal (p=0.99) displacement. Both groups showed anterior, valgus angulation and posterolateral displacement in most cases. There were 14 associated injuries and one patient developed nonunion and was treated by nail exchange with autogenous bone graft. CONCLUSION: Our retrospective analysis demonstrated that semiextended method is effective for reducing coronal and sagittal angulation, but is not helpful for reducing displacement in both planes.

Differences of Bone Mineral Density between Spine and Hip in Osteoporotic Patients

PURPOSE: To evaluate differences and correlations of spine and hip region BMD in osteoporotic patients with or without spine fracture. MATERIALS AND METHODS: From January 1999 to December 2002, We measured and evaluated BMD of L3 and hip by DXA in 52 patients with spine fracture (fracture group) and 96 osteoporotic patients without spine fracture (non-fracture group) above 60 years. RESULTS: The average age of patients with spine fracture is 72.1 years and without spine fracture is 66.9 years. There were no statistical significant differences of BMD of spine, neck of femur and trochanteric area between 2 groups. But the BMD of Ward triangle of fracture group decreased significantly in statistics. The correlation coefficient between the lumbar spine and trochanteric area were 0.674 in fracture group and 0.794 in non-fracture group. They had statistical significance (<0.01). CONCLUSION: The BMD of Ward triangle of fracture group had lower value, but the BMD of lumbar spine had no differences between 2 groups. Therefore in these persons who have decreased BMD in Ward triangle should be concerned about high vertebral compression fracture risk vertebral compression fracture.

Osteochondroma of the Cervical Spine: A Case Report / 대한정형외과학회잡지

A solitary osteochondroma needs to be considered when making a differential diagnosis of an expansile posterior spinal lesion along with an aneurysmal bone cyst, osteoblastoma and giant cell tumor. An osteochondroma can be found in the cervical spine even though it is considered to be very rare. We report a case of an osteochondroma that was in the posterior element of the cervical spine. Although unusual, an osteochondroma should be considered when making a differential diagnosis of benign appearing tumors in the cervical spine.

Management of Chronic Middle Ear Disease in Only Hearing Ear / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: he objectives of chronic middle ear surgery are two folds: control of the disease and preservation of hearing. The surgery for middle ear surgery where only one ear is good is difficult because hearing preservation must be considered more seriously. In this study, we tried to review the preoperative management, surgical indications, and postoperative hearing changes and complications in chronic middle ear disease with only one hearing ear. SUBJECTS AND METHOD: The medical records of 13 patients with only one hearing ear who received operation by the same surgeon from January 1994 to June 2002 were retrospectively reviewed with regards to hearing level and disease control. Preoperative managements including bacteriologic culture for otorrhea and antibiotic medication were performed, and CT scan was used for evaluating bony destruction. Preoperative and postoperative pure tone hearing levels were compared. RESULTS: Compared to the preoperative air conduction hearing level, one case of canal wall-up and one case of canal wall-down procedures presented decreased hearing level postoperatively. During the follow-up period for 1 year, no recurrence was observed except for one case of tympanic membrane perforation, which was resolved after myringoplasty. CONCLUSION: Preoperative therapeutic principles and proper surgical indication are necessary for successful control of the disease and preservation of hearing in the only hearing ear. Also, either canal wall-up or wall-down mastoidectomy can be used for chronic middle ear disease in the only hearing ear. However, it must be kept in mind that even the conservative middle ear surgery does not always guarantee a good outcome in the only hearing ear.