Monthly Variation in Bell's Palsy Based on Population Data of Korea.

INTRODUCTION: Several studies have reported that the number of patients with Bell's palsy varied significantly by month and season. However, few studies have reported the monthly variation in Bell's palsy based on the whole population. We investigated the monthly variation in Bell's palsy in Korea during a long-term period based on whole population data. METHODS: This retrospective study used the data of the National Health Insurance Service of Korea, which included the entire Korean population from 2008 to 2020. The monthly incidence of Bell's palsy per 100,000 was evaluated in total and according to sex, age, and residence. RESULTS: The total average monthly incidence differed significantly by month, with the highest observed in January (9.1 per 100,000) and the lowest in June (7.7 per 100,000) (p < 0.001). The average monthly incidence according to sex, age, and residence also varied significantly by month, with most of the highest values noted in January and the lowest in June. CONCLUSION: There was significant monthly variation in the incidence of Bell's palsy, with the highest in January during the winter and the lowest in June during the summer, based on whole population data over a long-term period in Korea.

Is the cochleovestibular nerve function affected in patients with hemifacial spasm?

Hemifacial spasm (HFS) is a motor disorder caused by the vascular compression of the facial nerve in the posterior fossa. The cochleovestibular nerve is close to the facial nerve and shares the same entry to the periphery, also has disorders caused by vascular compression. We evaluated the cochleovestibular nerve function in patients with HFS based on the hypothesis that vascular compression, which causes HFS, can also affect the nearby cochleovestibular nerve function. The medical charts of 49 patients with surgically confirmed HFS were reviewed retrospectively. The results of the pure-tone threshold, auditory brainstem response (ABR), video head impulse test (vHIT), and magnetic resonance imaging were analyzed. In each patient, the HFS side and the unaffected side were compared in the paired manner. The anterior inferior cerebellar artery was the major offending vessel (69.4%). There were no significant differences in the pure-tone threshold, properties of ABR waves, and vHIT gain. There was no evidence of cochleovestibular nerve compression syndrome in all patients. The angulation of the nerve by the offending vessel was more frequently identified in the HFS side than in the unaffected side (p = 0.040). The effect of HFS on cochleovestibular nerve function is limited.

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.

Positional changes in the uvula tip after adenotonsillectomy in children: preliminary result.

BACKGROUND: Adenotonsillectomy has become the primary treatment for children with sleep-disordered breathing or obstructive sleep apnea. However, few studies have investigated positional changes in the soft palate or uvula after adenotonsillectomy in children. The present study aimed to evaluate positional changes in the uvula tip using cephalometric analyses after adenotonsillectomy in children. METHODS: We analyzed 160 pediatric patients from December 2015 to July 2016, with 94 pediatric patients who underwent adenotonsillectomy as the experimental group and 66 children who were treated and followed up with frequent tonsillitis as the control group. Positional changes in the uvula tip after surgery in the adenotonsillectomy group were investigated using lateral cephalograms obtained within 1 month before surgery and 3-4 months after surgery. Two lateral cephalogram intervals for a few months in the control group who did not undergo adenotonsillectomy were analyzed. RESULTS: The palatal length (23.92 ± 3.47 vs. 24.46 ± 3.26; p = 0.032), palatal angle (43.13 ± 7.76 vs. 46.12 ± 5.91; p < 0.001), and retrouvula length (15.60 ± 3.51 vs. 16.60 ± 2.97; p = 0.009) were significantly increased on postoperative images relative to those on preoperative images. In the control group, there was a significant change in the palatal angle (2.99 ± 5.85 vs. 0.27 ± 4.14; p < 0.001) and retrouvula length (0.99 ± 3.64 vs. 0.05 ± 1.44; p = 0.025), but not in the palatal length (0.58 ± 2.38 vs. 0.043 ± 1.26; p = 0.065). CONCLUSION: The findings of the present study suggest that the uvula tip is displaced in the anteroinferior direction 3 or 4 months after adenotonsillectomy in children. Thus, clinicians should be aware that the retropalatal space may expand after adenotonsillectomy in the pediatric population.

Postoperative results of ventilation tube insertion: a retrospective multicenter study for suggestion of grading system of otitis media with effusion.

BACKGROUND: In otitis media with effusion (OME), it is important to know when to surgically intervene and when careful monitoring is more appropriate. This study aimed to visualize and classify the clinical manifestations of OME and the correlation between the new grading system and postoperative results after ventilation tube insertion (VTI). METHODS: We classified the collective 1,012 ears from 506 patients into six groups: grade 0 (no effusion), grade I (scant effusion, but abnormal), grade II (effusion less than half of the tympanic cavity), grade III (effusion over half of the tympanic cavity, with air bubbles), grade IV (complete effusion), and grade V (retracted tympanic membrane or hemotympanum without air bubbles). RESULTS: The mean age at VTI was 5.2 (±2.9) years and mean duration between diagnosis and operation was 4.1 (±1.8) months. Between the grades, the nature of the middle ear effusion was also significantly different (p < 0.001). The duration of ventilation tube retention after VTI was significantly different when compared between two groups: grade I-IV and grade V (p = 0.019). Our results showed that the recurrence rate, as well as rate of revision VTI, increased as the grade increased (p < 0.001). CONCLUSIONS: The new grading system of OME using endoscopic otoscope evaluation had a significant correlation with the age at VTI, the nature of middle ear effusion, the recurrence rate of OME, and the rate of revision VTI.

Changes of Temporal Processing and Hearing in Noise after Use of a Monoaural Hearing Aid in Patients with Sensorineural Hearing Loss: A Preliminary Study.

BACKGROUND AND OBJECTIVES: The relationship between hearing aid (HA) use and improvement in cognitive function is not fully known. This study aimed to determine whether HAs could recover temporal resolution or hearing in noise functions. Materials and. METHODS: We designed a prospective study with two groups: HA users and controls. Patients older than 45 years, with a pure tone average threshold of worse than 40 dB and a speech discrimination score better than 60% in both ears were eligible. Central auditory processing tests and hearing in noise tests (HINTs) were evaluated at the beginning of the study and 1, 3, 6, and 12 months after the use of a monaural HA in the HA group compared to the control group. The changes in the evaluation parameters were statistically analyzed using the linear mixed model. RESULTS: A total of 26 participants (13 in the HA and 13 in the control group) were included in this study. The frequency (p<0.01) and duration test (p=0.02) scores showed significant improvements in the HA group after 1 year, while the HINT scores showed no significant change. CONCLUSIONS: After using an HA for one year, patients performed better on temporal resolution tests. No improvement was documented with regard to hearing in noise.

Is Ossiculoplasty Necessary in Canal Wall Down Mastoidectomy? Comparison of Clinical Outcomes Between Type 0 Tympanoplasty and Ossiculoplasty.

BACKGROUND AND OBJECTIVES: To assess whether the audiological and clinical outcomes of type 0 tympanoplasty (T0) performed using cartilage were comparable with those of ossiculoplasty in patients who underwent canal wall down mastoidectomy (CWDM). SUBJECTS AND METHODS: This study included patients who had chronic otitis media with cholesteatoma and underwent CWDM with ossiculoplasty involving partial ossicular replacement prosthesis (PORP), total ossicular replacement prosthesis (TORP), or T0. Anatomical success rates and hearing outcomes were analyzed. RESULTS: Seventy-two patients were included in this study; 29 of them underwent CWDM with T0, 27 underwent CWDM with PORP, while 16 underwent CWDM with TORP. The difference in mean improvement in the air-bone gap (ABG) between the groups was not significant. The differences in the rates of ABG closure to ≤10 dB HL (p=0.030) and ≤20 dB HL (p=0.029) were significant. There were significant differences in improvements in the ABG at 3 kHz among the PORP, TORP, and T0 groups. CONCLUSIONS: The audiological outcomes of CWDM with ossiculoplasty seemed to be better than those of CWDM with T0 with no significant difference in the incidence of complications following ossiculoplasty and T0.

One-stage cochlear implantation in patients with chronic otitis media using canal wall up mastoidectomy.

BACKGROUND: Cochlear implantation (CI) with subtotal petrosectomy was recommended to avoid the complications for patients with chronic otitis media (COM). OBJECTIVES: To evaluate the surgical outcomes of CI in patients with COM using a one-stage operation with canal wall up mastoidectomy (CWUM). METHODS: Thirty-five patients with COM who underwent CI with CWUM as a one-stage between 2009 and 2017 were participated. They divided into those with inactive COM and active COM. The anatomical success rate, postoperative complication, and hearing outcomes were analyzed. RESULTS: Twenty-four patients had inactive COM and seven with active COM. Three of the 31 patients (9.7%) had otorrhea from the ear undergone surgery. Two of these three patients had myringitis after CI and their symptoms improved after conservative management. Although infection of the tympanic membrane in the third patient was controlled after conservative management, a perforation was left. Postoperative otorrhea occurred in two patients (8.3%) in the inactive COM group and one patient (14.3%) in the active COM group. CONCLUSION: This study indicates that infection control and successful implantation can be achieved through a one-stage CI operation with CWUM in selected patients with COM.HIGHLIGHTSAlthough COM was once considered a contraindication to CI, CI in patients with COM has been made feasible by STP before CI or simultaneously with CI.Simultaneous CI with CWUM was performed for 31 patients with COM.Three patients (9.7%) had minor complications after the surgery and only one patient experienced device explantation which was due to device failure.

Intratympanic steroid injection for sudden sensorineural hearing loss: Impact of injection interval on therapeutic efficacy.

OBJECTIVE: To compare the effect of injection time intervals of intratympanic (IT) dexamethasone (DEX) in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). METHODS: Seventy-five adults with ISSNHL were grouped into four groups according to the IT DEX interval. In addition to concurrent oral steroid medication for two weeks, patients received IT DEX injections every 1, 2, 3, and four days, respectively. (Group 1, Group 2, Group 3, and Group 4). We evaluated the treatment outcomes according to modified criteria from "Clinical Practice Guideline: Sudden Hearing Loss" of the American Academy of Otolaryngology-Head and Neck Surgery (AAOHNS) to justify treatment success. RESULTS: There were no significant differences in demographic and baseline audiometric data. The mean of pure tone audiometry (PTA) and speech discrimination score (SDSs) were significantly improved after oral steroid and IT DEX treatment in all four groups. Group 1 showed significantly higher improvement than Group 4 in PTA after treatment. There was a significantly higher complete recovery (CR) rate in Group 1 than Group 4. CONCLUSION: We found a statistically significant difference in the complete hearing recovery rate and audiometric results (PTA) between the group with a daily interval of injections and the group with a four-day time interval. Therefore, daily time intervals in intratympanic steroid injection may be considered as an option for better improvement of hearing in patients with ISSNHL.

Musical Hallucination Caused by Ceftazidime in a Woman with a Hearing Impairment.

Musical hallucinations remain a poorly understood clinical phenomenon, possibly because these types of hallucination have multiple causes and are rarely the focus of published reports. Here, the case of a 51-year-old female patient with a hearing impairment who developed musical hallucinations during treatment with ceftazidime, a third-generation cephalosporin, is presented. She responded to the discontinuation of ceftazidime and the initiation of low-dose olanzapine treatment. Musical hallucinations associated with ceftazidime are very rare, and the mechanisms underlying its occurrence remain unknown. Further studies will be necessary to determine the pathophysiology of adverse psychiatric reactions associated with ceftazidime.

Comparison of clinical outcomes between butterfly inlay cartilage tympanoplasty and conventional underlay cartilage tympanoplasty.

OBJECTIVE: To assess the efficacy of butterfly inlay cartilage tympanoplasty and compare it with conventional underlay cartilage tympanoplasty in terms of success rate and hearing outcomes. MATERIALS AND METHODS: The study included 35 patients (36 ears) who underwent butterfly inlay cartilage tympanoplasty (inlay group, 23 ears of 22 patients) or conventional underlay cartilage tympanoplasty (underlay group, 13 ears). The anatomical success rate and hearing outcomes were analysed. RESULTS: Re-perforation occurred in 2 cases (8.7%) in the inlay group and 3 (23.1%) in the underlay group. One patient in the inlay group developed a serious infection, and one in the underlay group developed massive granulation of the tympanic membrane. In the inlay group, the air-bone gap (ABG) decreased from 19.9 (±12.6) dB HL preoperatively to 13.8 (±11.3) dB HL postoperatively (p=0.047), in the underlay group, it decreased from 23.5 (±15.8) dB HL to 18.3 (±20.6) dB HL. Regarding improvement in ABG, the difference between the group was not statistically significant (p=0.968). CONCLUSION: Butterfly inlay cartilage tympanoplasty is comparable with conventional underlay cartilage tympanoplasty in both anatomic and audiological success rates. Owing to its simplicity, shorter operation time, and rapid patient recovery, butterfly inlay cartilage tympanoplasty could be considered a favourable surgical option.

Risk factors for persistent otitis media with effusion in children: a case-control study.

Background: Otitis media with effusion (OME) is defined as middle ear effusion without acute signs of infection. OME usually resolves spontaneously; however, persistent OME may require the insertion of a ventilation tube. This study investigated risk factors for persistent OME in children who undergo ventilation tube insertion. Methods: Children who were admitted to undergo ventilation tube insertion at Jeju National University Hospital between August 2015 and July 2016 were enrolled as the case group. Healthy children without persistent OME from August 2016 to July 2017 were enrolled as the control group. Baseline characteristics and predisposing factor data were collected using an interview questionnaire. Middle ear fluids were collected from the case group. Results: A total of 31 patients underwent ventilation tube insertion. The mean age of the case group was 4.53 years, with a male-to-female ratio of 21:10. Twenty-nine (93.5%) children attended a daycare center, and 21 (67.7%) had experience with bottle feeding. Fifteen (48.4%) children in the case group and 3 (9.7%) in the control group first attended a daycare center at <1 year of age (odds ratio=9.96; 95% confidence interval=2.44-39.70; p=0.001). No bacteria were found in middle ear fluid collected from the 31 operated children. Nasopharyngeal bacterial colonization was found in 13 (41.9%) and 17 (54.8%) children in the case and control groups, respectively. Conclusion: Earlier attendance at a daycare center was the only predisposing factor for ventilation tube insertion in our study. The aseptic nature of middle ear fluids found in children with OME highlights the efficacy of antimicrobial use.

Clinical Characteristics of Patients with Dizziness after Motor Vehicle Accident.

OBJECTIVE: The purpose of this study was to identify the clinical characteristics of dizziness occurring after a motor vehicle accident. MATERIALS AND METHODS: We retrospectively analyzed 217 patients who had visited a tertiary medical center complaining of dizziness after a motor vehicle accident between January 2009 and December 2014. Of the 217 patients, we enrolled 54 patients who had undergone a vestibular function test and had no definite evidence of fracture of the temporal bone or intracranial lesions. Patients were divided into two groups: the dizziness group (group A, 29 patients) and the dizziness with audiological symptoms (hearing disturbance, tinnitus, ear fullness) group (group B, 25 patients). RESULTS: The prevalence of benign paroxysmal positional vertigo was higher in group A. Apart from this finding, the clinical features did not differ significantly between the two groups. Group B had a higher number of patients who exhibited asymmetric hearing on pure tone audiometry, but the difference was not statistically significant. CONCLUSION: There were no notable characteristics in patients with dizziness after motor vehicle accidents, although patients without hearing symptoms tended to have benign paroxysmal positional vertigo, whereas other patients tended to have hearing disturbance. This information may be helpful for clinicians in counseling and managing patients with dizziness and audiological symptoms after motor vehicle accidents.

Percutaneous Drainage and Povidone-Iodine Sclerotherapy of Cervical Lymphatic Malformation.

Lymphatic malformations in cases with macrocystic lesions can be treated with surgical excision or sclerotherapy using alcohol, bleomycin, doxycycline, or OK-432. We report a case of a 24-year-old woman who underwent percutaneous drainage and povidone-iodine sclerotherapy as primary treatment for cervical lymphatic malformation. The patient underwent povidone-iodine sclerotherapy for 3 consecutive days. After 8 months, ultrasonography of the lesion in the neck revealed complete resolution of the cervical lymphatic malformation without any complication. Povidone-iodine sclerotherapy can be a safe and cost-effective treatment option for cervical lymphatic malformation.

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.

Fibrinogen-Based Collagen Fleece Graft Myringoplasty for Traumatic Tympanic Membrane Perforation.

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate how fibrinogen-based collagen fleece (Tachocomb®) graft myringoplasty (FCGM), performed under microscopic guidance, improves both hearing and tympanic membrane tissue repair in patients with traumatic tympanic membrane perforation (TMP). SUBJECTS AND METHODS: Between August 2009 and March 2015, a total of 52 patients with traumatic TMP visited the department of otorhinolaryngology at a secondary medical center. Twenty-nine of these underwent FCGM under microscopic guidance in our outpatient clinic. For each patient, we recorded the location and size of the perforation, the time elapsed from the onset of TMP until the myringoplasty, and the hearing level both before and after myringoplasty. RESULTS: The TMP closed completely in all cases (29 of 29 patients). After myringoplasty, the postoperative air-bone gap (ABG) differed significantly from the preoperative ABG. Three of the 29 patients (10.3%) experienced complications. Specifically, 2 presented with otorrhea after FCGM, but conservative management led to improvement without recurrence of perforation. One patient showed delayed facial palsy 1 week after the procedure. The condition of this patient also improved and the palsy was not permanent. CONCLUSIONS: FCGM may be an effective treatment option in case of traumatic TMP. The procedure requires no hospitalization, and can be used to avoid traditional tympanoplasty.

Diameter of the Medial Side of the Cochlear Aqueduct Is Narrower in Meniere's Disease: A Radiologic Analysis.

OBJECTIVE: This study aimed to measure the radiological dimensions of the cochlear aqueduct in Meniere's disease and in low-frequency hearing loss (LFHL) patients and control patients. MATERIALS AND METHODS: Groups of 26 patients (32 ears, including 6 with bilateral involvement) with Meniere's disease, 14 patients (18 ears) with LFHL, and 23 patients with unilateral chronic otitis media, as controls, were enrolled. For the measurements, high-resolution computed tomography (HRCT) of the temporal bone was performed. The cochlear aqueduct was evaluated for the following six parameters: medial opening (MO), petrous apex (PA), otic capsule (OC), lateral opening (LO), distance of the cochlear aqueduct (DC), and length of the cochlear aqueduct (LC). RESULTS: The PA, OC, DC, and LC were not significantly different between the groups. LO could not be measured because the LO was not visible in all cases. The MO diameter was narrower in the Meniere's disease group than in the LFHL group (p=0.001) and in the controls (p=0.035). When the dimensions of both ears were measured in patients with unilateral Meniere's disease, no statistically significant difference was found. CONCLUSION: Compared to LFHL and controls, the MO of the cochlear aqueduct was significantly smaller in the Meniere's disease group.