Outcomes of Endoscopic Tympanoplasty for Large Perforations: A Multicenter Retrospective Study in South Korea

Objectives@#. Endoscopic tympanoplasty (ET) provides minimally invasive transcanal access to the middle ear and improves middle ear visibility for the treatment of tympanic membrane (TM) perforations. However, the literature on surgical outcomes for large TM perforations is lacking and limited to small series. This study aimed to evaluate the clinical benefits of ET for large TM perforations. @*Methods@#. This retrospective cohort study was conducted at nine tertiary referral hospitals in South Korea, where 252 patients who underwent ET as primary surgery from September 2019 to August 2021 were included. The outcome measures included the graft success rate and pre- and postoperative audiometric data. @*Results@#. In 239 patients, the graft success rate of ET for large or subtotal perforations was 86.2% (206 patients), while the graft failure rate was 13.8% (33 patients). The graft failure rate was directly correlated with surgical techniques, including overlay and medial or lateral underlay tympanoplasty (P=0.027). Lateral underlay tympanoplasty showed the most favorable results. Sex, laterality, etiology, site and size of perforation, operation time, and graft materials did not vary significantly between the graft success and failure groups (P>0.05). The mean air-bone gap (ABG) improved significantly in both groups (graft success group: 10.0±0.6 dB and graft failure group: 7.7±0.3 dB; P<0.001). However, the ABG improvement did not significantly differ between the groups. Analysis of covariance revealed that the postoperative 500-Hz bone conduction threshold improved after successful ET (adjusted coefficient, –11.351; 95% confidence interval, –21.491 to –1.212; P=0.028). @*Conclusion@#. This study involved the largest population to date of large TM perforations treated by ET. The study findings suggest that ET is feasible and effective in treating large TM perforations.

Diagnostic Validity of Auditory Brainstem Response for the Initial Screening of Vestibular Schwannoma

Background and Objectives@#To investigate the diagnostic validity of auditory brainstem response (ABR) in the screening of vestibular schwannoma (VS). @*Subjects and Methods@#Forty patients diagnosed with VS using magnetic resonance imaging who had undergone ABR before treatment between 2005 and 2015 were included. ABR results were considered positive when findings met at least one of the following criteria: 1) absent evoked response, 2) desynchronization of waves other than wave I, 3) interpeak latency (IPL) between waves I and III >2.5 ms, 4) IPL between waves I and V >4.4 ms, 5) wave V interaural latency difference >0.2 ms, and 6) interaural difference in IPL between waves I and V >0.2 ms. @*Results@#The overall sensitivity of ABR was 85.0%. For tumors measuring 10 mm. The sensitivity of tumors confined to the internal acoustic canal was 73.3% compared with 100.0% for tumors confined to the cerebellopontine angle. In patients with serviceable hearing, the mean tumor size was 7.8±2.9 mm in patients with a normal ABR and 15.1±9.4 mm in patients with an abnormal ABR, indicating a significant difference (p10 mm in patients with serviceable hearing, supporting the need for further active diagnostic and treatment modalities in clinical practice.

Short-Term Experience in Cochlear Implantation with Slim Modiolar Electrode Array (CI532): Comparison to Previous Devices / 대한이비인후과학회지

Background and Objectives@#There have been no reports in Korea regarding cochlear implant surgeries using Cochlear Nucleus Profile Slim Modiolar electrode [CI532 (Cochlear Ltd.)], as it has been recently released in Korea. We aimed to investigate the short-term results of CI532 and compare them with previous devices with perimodiolar or straight electrodes arrays from the same manufacturer.Subjects and Method From August 2018 to July 2019, 52 patients (26 adults; 26 children) who underwent cochlear implantation of CI532 were included. The intraoperative impedance and evoked compound action potential (ECAP) threshold in each electrode were analyzed and compared with the devices with a perimodiolar electrode array [Contour Advance® (Cochlear Ltd.)] and a lateral wall electrode array [CI422 and CI522 (Cochlear Ltd.)]. Postoperative changes of hearing thresholds at each frequency (250, 500, and 1000 Hz) and aided word recognition scores (WRS) were also compared. @*Results@#CI532 showed significantly lower intraoperative impedance in the basal regions compared to the lateral wall electrode array. The ECAP thresholds of CI532 in the apical electrodes were significantly lower than that in the other two groups. After implantation, CI532 showed a significant preservation of hearing thresholds at most frequencies and showed significantly higher preservation rates than the other electrodes. However, there was no difference between the three groups regarding the postoperative short-term aided WRS. @*Conclusion@#CI532 showed lower intraoperative impedances and ECAP thresholds, and better short-term hearing preservation outcomes compared to the other electrodes, suggesting that CI532 electrode might be a better option with less traumatic insertion. However, there was no significant difference in the aided WRS, and further studies with a longer follow-up are necessary to examine the difference of audiologic outcomes.

Assessment of Objective Audiometry to Predict Subjective Satisfaction in Patients With Hearing Aids

Objectives@#. To investigate the correlation of objective audiometry with user satisfaction as measured with the questionnaire scores. @*Methods@#. Twenty patients with hearing loss, who agreed to wear a hearing aid and were referred for hearing aid fitting, were included in this prospective clinical study. All patients used the in-the-canal type of Wide7 hearing aid provided by BSL Co., Ltd. We performed the Korean version of the Hearing Handicap Inventory for the Elderly (K-HHIE) and the International Outcome Inventory for Hearing Aids (K-IOI-HA) before and 1, 3, and 6 months after wearing the hearing aid. We also performed pure tone audiometry (PTA), speech audiometry (SA), functional gain (FG), hearing in noise test (HINT), and central auditory processing disorder tests, such as frequency pattern test (CA-f), duration pattern test (CA-d), and dichotic test (CA-Di). Patients were divided into two groups (group A-HHIE, improved; group B-HHIE, same or worse) by comparing the score of K-HHIE before and 6 months after wearing the hearing aid. In the 6-month K-IOI-HA questionnaire, 21 points were considered as the average score. Based on this, we further divided patients into two groups (group A-IOI, >21 points; group B-IOI, ≤21 points). @*Results@#. Group A-HHIE included six patients and group B-HHIE included 14 patients. In PTA, SA, HINT, CA-d, and CA-Di, group A-HHIE showed higher improvements than group B-HHIE, which were not statistically significant. Group A-IOI included 12 patients and group B-IOI included eight patients. No statistically significant difference was noted in the improvement of audiometric results over a period of 6 months after wearing the hearing aid between groups A-IOI and B-IOI. @*Conclusion@#. There were no significant and consistent audiometric results to reflect patient’s satisfaction with the hearing aid. Therefore, when analyzing the hearing aid-fitting outcome, both the objective audiometric tests and subjective questionnaire should be performed together for validating hearing aid performance.

Comparison of the Clinical Results of Attic Cholesteatoma Treatment: Endoscopic Versus Microscopic Ear Surgery

OBJECTIVES: We aimed to compare clinical outcomes including hearing improvement and cholesteatoma recurrence between endoscopic and conventional microscopic surgeries in patients with attic cholesteatoma. METHODS: We collected data from patients with attic cholesteatoma who were treated using endoscopic (10 patients) and microscopic (10 patients) approaches by a single surgeon. The data were retrospectively reviewed for patient characteristics, intraoperative findings, hearing levels, and follow-up clinical status. Recurrence of the cholesteatoma, improvement of hearing, and operation time were evaluated. RESULTS: Ossiculoplasty was performed in four patients in the endoscopic group and two patients in the microscopic group. Lempert endaural incision II was used in all the patients in the microscopic group, whereas Lempert I incision was used in all the patients in the endoscopic approach group. There were no significant differences between the two groups regarding hearing improvement and operating time. And, there were no recurrences during the follow-up period in both groups. CONCLUSION: The endoscopic approach for the management of attic cholesteatoma is as useful as the microscopic approach.

Prognostic Factors for Recovery from Sudden Sensorineural Hearing Loss: A Retrospective Study

BACKGROUND AND OBJECTIVES: This study aimed to investigate prognostic factors in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). SUBJECTS AND METHODS: From January 2007 to December 2011, a retrospective chart review identified 494 consecutive patients with ISSNHL. Demographic, audiometric, and clinical data were analyzed using a logistic regression test. RESULTS: Hearing recovery from ISSNHL was significantly associated with factors such as age, duration from onset of symptoms to commencement of treatment, severity of the initial pure tone threshold, and the treatment method. Intratympanic (IT) steroid administration alone showed a comparable efficiency to oral steroid administration with or without IT steroid injection. In patients who received IT steroid injection, the duration from onset to treatment, severity of initial hearing loss, and sequential IT steroid injection following systemic steroid administration were statistically associated with hearing improvement. CONCLUSIONS: Age, severity of initial pure tone threshold, duration from onset to treatment, initial speech discrimination, and initial pure tone threshold are statistically significant prognostic factors related to hearing improvement in ISSNHL. IT steroid injection as an initial single treatment is comparable to systemic oral steroid administration.

A Case of Ectopic Salivary Gland with Fistula in the Anterior Neck / 대한이비인후과학회지

Ectopic salivary gland tissue represents an uncommon lesion, usually presenting as a discharging fistula in the anterior lower neck. Though the origin of this entity still remains unclear, it is thought to be a heteroplasia of the epithelium of the precervical sinus of His. We have experienced a case of ectopic salivary gland with cervical fistula in a 10-year-old. This was thought clinically to be the second branchial cleft cyst, but the pathology showed an ectopic salivary gland. This should be considered as one of the causes of a cystic neck mass or fistula in children.

A Case of Bilateral Hearing Loss Following External Ventricular Drainage / 대한이비인후과학회지

The sensorineural hearing loss following extraventricular drainage (EVD) is perhaps an underestimated complication rather than an uncommon event. Changes in the cerebrospinal fluid (CSF) pressure may lead to endolymphatic hydrops through the patent cochlear aqueduct resulting in sensorineural hearing loss. We describe the case of a 9-year-old child suffering from meduloblastoma. Bilateral hearing loss, especially at low frequency was found after emergent extraventricular drainage. At 2 months of treatment, hearing loss improved a little, but not restored to a serviceable hearing. Our experience and a review of articles indicate that early detection and awareness of hearing loss after EVD are important for treatment strategy.

Treatment Strategy for Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

Sudden sensorineural hearing loss is an emergent disease in otologic field. Because the etiology and pathological mechanism were not proven yet, treatment protocol was not established. Therefore, medications, duration, and dosage were different from each institute. In this review, authors collected and analyzed articles on sudden sensorineural hearing loss published during recent 11 years. From those, we described the recommendations on the criteria and method of diagnosis, tools for treatment and their results, and guideline for reporting results and follow up.

Clinical Characteristics of the Benign Paroxysmal Positional Vertigo in the Elderly / 대한평형의학회지

BACKGROUND AND OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) is one of the most common peripheral vestibular disorders. It constitutes the most common vestibular disorder in the elderly with vertigo. Purpose of this study to assess the clinical characteristics and treatment outcome of BPPV in elderly patients. MATERIALS AND METHODS: We reviewed the medical records of 380 patients above age 60 who were treated for BPPV. Collated data of the elderly BPPV patients in terms of involved canals, number of canalith repositioning procedures and their underlying disease were analyzed and compared with the data of national health report in 2008 that represented the general population. RESULTS: Number of BPPV patients was increased along with age. Three hundred and eighty patients (44.9%) of 847 BPPV patients were over 60. Most commonly involved canal was posterior semicircular canal. Lateral semicircular canal was involved much more frequently (46.8%) compared with previous reports. Along the age, involvement of lateral semicircular canal, frequency of multiple canal involvement and cupulolithiasis increased. In patients older than 60, treatment response was worse than younger ages. More canalith reposition procedures were needed in the elderly than younger patients with BPPV. Between patients with BPPV and normal population, no difference was found in prevalence of co-morbities, such as diabetes, cerebrovascular disease, cardiovascular disease, other otologic disease, and psychiatric disease. CONCLUSION: We suggest that more careful diagnosis and intervention should be considered in BPPV of old age due to its complicated natures and lower treatment response.

A Case of Bilateral Sensorineural Hearing Loss after Salicylate Intoxication / 대한이비인후과학회지

Salicylates, such as aspirin, are considered the most commonly used medicine in Korea for its anti-inflammatory, anti-pyretic, and analgesic properties. In spite of its wide range of benefits, aspirin produces unwanted adverse effects such as mucosal bleeding in the gastrointestinal tract, renal and hepatic dysfunction, Reye's syndrome in children, and hypersensitivity reactions, etc. Aspirin can also induce ototoxicity, such as reversible hearing loss and tinnitus. The pattern of hearing loss is typically mild to moderate and bilaterally flat in the absence of preexisting hearing loss. Hearing usually recovers in 72 hours after medication. However, it's rare that salicylate-induced ototoxicity are encountered. So we present this case of bilateral hearing loss that occurred after salicylate intoxication with a review of relevant literature.

Orbital Exenteration in Sinonasal Tumor: Surgical Outcome and Rehabilitation / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The decision whether or not to preserve orbital contents during surgical resection of malignant tumors involving the sinonasal tract and the orbit has been an issue of controversy. The purpose of this study is to review our outcomes of the orbital exenteration and rehabilitations, and to present the usefulness of orbital rehabilitations. SUBJECTS AND METHOD: A retrospective analysis was done for 10 patients who underwent orbital exenteration between Feb 1995 and Apr 2003. RESULTS: The age of patients ranged from 23 to 71 years (mean 49.7 years), and the male: female ratio was 1: 1. The follow-up period after orbital exenteration ranged from 3 to 108 months (mean 33.2 months). Rhabdomyosarcoma and squamous cell carcinoma represented the largest group (three patients respectively). Maxillary sinus was the most common primary site (five patients). Local sinonasal recurrence was noted in two patients, and distant metastasis was observed in one patient. Six patients have survived for more than 20 months. No orbital rehabilitation and reconstruction was done in six patients, silicone orbital prosthesis in two patients, artificial eye in one patient, and free flap in two patients. All patients who had orbital rehabilitation showed great satisfaction. CONCLUSION: Rhabdomyosarcoma and squamous cell carcinoma were the two most common malignancy requiring orbital exenteration. More than half of the patients have survived for 20 months or longer. Rehabilitation such as ocular prosthesis can be considered for better cosmetic appearances.

Gender Differences of Polysomnographic Findings in Snoring Patients

Snoring was considered as a problem limited to male. This study was performed to evaluate the possible differences between female and male patients who have snoring problems. A polysomnography was performed at the Asan Medical Center from Jan.1989 to May.2003 on 145 female and 1065male patients who had complained of snoring at the Asan Medical Center. Multivariate model techniques were used. For female patients, RDI was correlated with BMI (correlation coefficient [r]= 0.342, p<0.001). In male patients, RDI was correlated with BMI (r=0.332, p<0.001) as well. In female patients, there was a significant correlation between age and RDI (r=0.355, p<0.001) In male patients, the correlation was not significant between age and RDI (r=-0.010, p=0.745). In conclusion, both male and female snoring patients have more severe apnea with obesity. In female patients, apnea is more severe with aging but in male patients, there was no correlation between apnea and age.

A Case of Leiomyosarcoma of the Gingiva / 대한이비인후과학회지

Leiomyosarcoma is a malignant mesenchymal tumor that is relatively common in the uterus, the gastrointestinal tract, and the retroperitoneum. Only 3 to 10% of leiomyosarcomas arise in the head and neck. A review of the English-language literature since 1908 revealed 11 cases of primary and one case of metastatic leiomyosarcoma of the gingiva. We report on a case of leiomyosarcoma that arose in a 34-year old male, affecting the mandibular gingiva.