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.

Time series analysis of patients seeking orthodontic treatment at Seoul National University Dental Hospital over the past decade / 대한치과교정학회지

OBJECTIVE: This paper describes changes in the characteristics of patients seeking orthodontic treatment over the past decade and the treatment they received, to identify any seasonal variations or trends. METHODS: This single-center retrospective cohort study included all patients who presented to Seoul National University Dental Hospital for orthodontic diagnosis and treatment between January 1, 2005 and December 31, 2015. The study analyzed a set of heterogeneous variables grouped into the following categories: demographic (age, gender, and address), clinical (Angle Classification, anomaly, mode of orthodontic treatment, removable appliances for Phase 1 treatment, fixed appliances for Phase 2 treatment, orthognathic surgery, extraction, mini-plate, mini-implant, and patient transfer) and time-related variables (date of first visit and orthodontic treatment time). Time series analysis was applied to each variable. RESULTS: The sample included 14,510 patients with a median age of 19.5 years. The number of patients and their ages demonstrated a clear seasonal variation, which peaked in the summer and winter. Increasing trends were observed for the proportion of male patients, use of non-extraction treatment modality, use of ceramic brackets, patients from provinces outside the Seoul region at large, patients transferred from private practitioners, and patients who underwent orthognathic surgery performed by university surgeons. Decreasing trends included the use of metal brackets and orthodontic treatment time. CONCLUSIONS: Time series analysis revealed a seasonal variation in some characteristics, and several variables showed changing trends over the past decade.

Headache Characteristics in Rhinologic Patients and the Role of Surgical Treatment

OBJECTIVES: Even though headache is a common symptom in patients with chronic rhinosinusitis (CRS) or nasal septal deviation (NSD), there are very few recent reports investigating headache characteristics in rhinologic patients. Therefore, we investigated the headache characteristics and differences in CRS and NSD patients who were diagnosed by computerized tomography and endoscopic exams. METHODS: We enrolled 257 patients who had undergone nasal and sinus surgery between January 2012 and December 2013. The subjects were divided into a CRS group (n=147) and NSD group (n=110). They were asked to fill out a Sinonasal Outcome Test (SNOT-20) and questionnaire about pre-operation headaches (1 day prior) and post-operation headaches (1 month after) they experienced, to evaluate their sinonasal symptoms and headache characteristics. RESULTS: There was no significant pre-operative difference in rhinologic symptoms and headache characteristics between the CRS and NSD groups. Females experienced more headaches. Both groups reported significant improvements to their headaches after surgery; however, we found no significant differences in the degree of improvement between the two groups. CONCLUSIONS: There was no significant difference in the headache characteristics and the degree of post-operative improvement between the CRS and NSD groups. Surgical treatments appear to reduce headaches in patients with rhinologic diseases.

Vegetable or Pulse Granuloma in the Nasal Cavity

Vegetable granuloma or pulse granuloma results from the implantation of food particles of vegetable origin. Pulse granulomas have mainly been reported in association with lung aspirations, the oral cavity with a history of oral procedures and less frequently in gastrointestinal tracks. We report a 31-year-old woman who presented with right nasal obstruction and was found to have a firm mass in the right nasal cavity. Paranasal sinus computerized tomography scans identified a calcified ring lesion in her right nasal cavity. Endoscopic sinus surgery was performed, and pathology examination revealed a lesion consistent with a pulse granuloma that contains starch granules with cellulose envelopes appearing as hyaline rings surrounded by inflammation cells and concentrically arranged delicate connective tissue. Pulse granuloma is a well described entity with distinct histopathology. However, pulse granulomas are rare, and especially extraoral pulse granulomas are extremely rare. We found that pulse granuloma can be occurred in the nasal cavity through regurgitation.

Relationship between Meteorological Factors and Emergency Department Visits for Epistaxis in Korea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Epistaxis may be related to changes in weather, but this relationship has not been well-defined. We investigated the effects of climate fluctuations (temperature, humidity, and barometric pressure) on the number of emergency department (ED) visits for epistaxis. SUBJECTS AND METHOD: In total, our study population included 1910 patients who visited the ED of a large, urban hospital during a 5-year period for epistaxis. Patients with clear etiology for epistaxis (trauma, iatrogenic, coagulopathy, and/or hypertension) were excluded, leaving 912 patients for subsequent analysis. Daily climate data was collected through the Korea Meteorological Administration. Correlation between epistaxis ED visits and weather variables were investigated using Poisson distribution and multiple regression analysis. The effect of climate factor was evaluated on the day and up to 3 days prior to ED presentation. Additionally, analyses were conducted separately for children ( or =65 years-old). RESULTS: Changes in the lowest temperature 2 days prior to ED presentation significantly increased the number of ED visits for epistaxis (beta=-0.043, p=0.033). No associations were found between the number of ED visits and changes in humidity or atmospheric pressure. However, in children, interday changes in the highest atmospheric pressure between 2 and 3 days prior to ED presentation were both significantly associated with increased number of epistaxis ED visits. CONCLUSION: Cold temperatures 2 days prior to ED presentation were related to the increased incidence of epistaxis. Fluctuations in barometric pressure appear to influence the number of pediatric ED visits for epistaxis.

Changes of Cochlear Nerve Terminals after Temporary Noise-Induced Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Overexposure to intense sound can cause temporary or permanent hearing loss. Post-exposure recovery of thresholds has been assumed to indicate reversal of damage to the inner ear without persistent consequences for auditory function. However, there was a report that acoustic overexposures causing moderate temporary threshold shift caused acute loss of afferent nerve terminals and delayed degeneration of the cochlear ganglion cells while cochlear sensory cells were intact. The purpose of the study was to evaluate the numerical changes of ribbon synapses and efferents to the outer hair cells in ears with temporary noise-induced threshold shifts. MATERIALS AND METHODS: Four-week old CBA mice with normal Preyer's reflexes were used. Mice were exposed to white noise of 110 dB SPL for one hour. Auditory brainstem response (ABR) and distortion-product otoacoustic emission (DPOAE) were recorded before exposure and at four different post-exposure times, 1, 3, 5, and 7 days after noise exposure. Ribbon synapses and efferents near cochlear nerve terminals were stained and calculated in the control group mice at two post-exposure times, 3 and 5 days after the exposure. RESULTS: In the noise-exposed ears, there was no loss of hair cells, in either inner hair cells or outer hair cells. ABR and DPOAE showed maximum threshold shifts after noise-exposure; they returned to the normal pre-exposure values by at day 5. The number of ribbon synapses tended to decrease at 3 days after noise-exposure, but the number of efferent fibers was not statistically different from those of the control mice. CONCLUSION: Our results suggest that the loss of ribbon synapses could be related with the recovery course of temporary threshold shift, even to the point of full hearing recovery.

Tullio Phenomenon Following Spontaneous Intralabyrinthine Gross Hemorrhage / 대한평형의학회지

Tullio phenomenon is a pattern of sound induced unsteadiness, imbalance or vertigo, associated with disturbances of oculomotor and postural control. As a possible cause of sudden sensorineural hearing loss, intralabyrinthine gross hemorrhage has been reported in subjects with bleeding tendency. We report a case of spontaneous intralabyrinthine hemorrhage followed by presentation of Tullio phenomenon. A 35-year-old man presented with sudden left side hearing loss and vertigo. Audiometry results indicated left total deafness and magnetic resonance images revealed left intralabyrinthine hemorrhage. At 1 month after hearing loss, sound and pressure-induced vertigo and disequilibrium newly developed. Follow-up images indicated signs of fibrosis in the left labyrinth and nystagmography results showed induction of nystagmus according to the stapedial reflex. This case suggests possibility of Tullio phenomenon in sudden sensorineural hearing loss patients.

Morphologic Analysis of Crista Galli Using Computed Tomography

OBJECTIVE: We often observe the variation of Crista galli (CG) which lies in the midline above the cribriform plate on computed tomography (CT) scans. We investigated the variations in CG and the factors which affect its pneumatization. MATERIALS AND METHODS: We analyzed the CT images of 818 chronic rhinosinusitis patients between July 2003 and July 2011. We investigated height, position relative to the cribriform plate, degree of pneumatization, and cell origin for the pneumatization in CG. We analyzed the relationship between several factors (age, sex, and position of CG) and pneumatization of CG. RESULTS: The average height of CG was 17.98 mm. In 13.9% of subjects, the base of CG did not extend below the level of the cribriform plate. In 84.2%, CG extended less than 50% of its height below the cribriform plate. In 1.8%, CG extended more than 50% of its height below the cribriform plate. Pneumatization of CG was found in 12.2%. Except one, every pneumatization was connected with the frontal sinus. The rate of pneumatization was significantly different depending on age. CONCLUSION: Our study demonstrated that CG showed various morphology and pneumatizaiton. The pneumatization of CG was mainly originated from frontal sinus and related to aging.

Audiological Follow-up Results after Newborn Hearing Screening Program

OBJECTIVES: To investigate the validity of newborn hearing screening protocol using automated auditory brainstem response (AABR) with a confirmation method using click auditory brainstem response (ABR) and to evaluate changes in hearing status of infants with confirmed congenital hearing loss. METHODS: Neonates in the well-baby nursery were screened by staged AABR. Subjects whose final AABR result was "refer" were tested by diagnostic click ABR and 226 Hz tympanometry within 3 months of age. Changes in hearing status of subjects with confirmed hearing loss were analyzed by follow-up ABR at 3-6 month intervals. RESULTS: Of the 12,193 healthy babies born during this period, 10,879 (89.22%) were screened by AABR. Of 10,879 neonates screened by AABR, 148 (1.36%) were "referred"; of these, 45 subjects showed ABR thresholds over 30 dB nHL in at least one ear. Thirty-four subjects underwent serial follow-up ABR tests, with 11 (32.4%) found to have normal ABR thresholds. Most subjects with mild to moderate hearing loss were found to be normal before 1 year of age, whereas all infants with severe or profound hearing loss were identified as having congenital hearing loss. CONCLUSION: The referral rate and the positive predictive value of our protocol were acceptable. We have also found here that substantial temporary hearing loss can be included in the first confirmative diagnosis. Temporary hearing loss of our study on follow-up give emphasis to need of further differentiation using the testing for bone conduction and middle ear status.

New Guides to the Evaluation of Korean Hearing Impairment in 2012 / 대한이비인후과학회지

The incidence of hearing impairment is increasing due to growth of the population of the elderly, industrialization and noise exposure. Evaluation of hearing impairment are frequently made in purpose of compensation, indemnification or welfare policy of the disabled. Evaluation of hearing impairment is a process to diagnose and to evaluate the disability under objective criteria. Several domestic and international standards have been proposed including legal acts such as the disable welfare law, industrial accident compensation insurance and the national pensions act. There are also medical counsel standards such as Korean academy of medical sciences disability evaluation standards, disability standards of American medical association and disability evaluation of McBride. In order to assess the hearing impairment fairly, thorough understanding about the difference of the purposes and standards of each guideline of hearing impairment is needed. Therefore in this article, the domestic and the international standards for the evaluation method of hearing impairment which was revised recently and their differences are discussed.

The Characteristics of Sinonasal and Psychological Symptoms and Quality of Life in Rhinologic Patients and the Role of Surgical Treatment / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Chronic diseases of the nose and sinuses have been shown to influence patients, not only physically but also psychologically affecting the overall well-being. We evaluated the quality of life of rhinologic patients, and the effect of surgery on them. In addition, we assessed the correlation between the symptom scores and objective findings. SUBJECTS AND METHOD: From November 2009 to January 2011, a total of 194 patients haveing nasal and sinus surgery were enrolled. They were divided into nasal cavity disease (NCD) group (n=103) and chronic rhinosinusitis (CRS) group (n=91). These patients had to fill out a questionnaire at different points, at 1 day, 1 month, 3 and 6 months prior to surgery. The normal control group (n=30) also had to fill out four questionnaires: our questionnaires were Sinonasal Outcome Test-20 (SNOT-20), Rhinosinusitis Disability Index (RSDI), Version 2 of Short-Form 36 item Health Survey (SF-36v2(TM)), Symptom Checklist-90-Revised (SCL-90-R). For the CRS group, Lund-Mackay score was calculated using CT scans. RESULTS: Both experimental groups showed more severe scores than the control group. The CRS group exhibited more severe symptoms than the NCD group. Both experimental groups achieved significant improvements after surgery. CRS group showed more significant improvement than the NCD group in SNOT-20. The Lund-Mackay score showed no significant correlation with the subjective symptom scores. CONCLUSION: Chronic rhinologic diseases affect the quality of life. CRS patients show more severe scores than the NCD patients. CRS patients have more improved effectiveness than NCD patients after surgical treatment. Objective conditions and subjective symptoms may be correlated inconsistently, and the evaluation for the overall quality of life is important to reflect on the therapeutic effect.

Recurrent Bilateral Branch Retinal Artery Occlusion with Hearing Loss and Encephalopathy: The First Case Report of Susac Syndrome in Korea

We report the first case of Susac syndrome in Koreans, in a 23-yr-old female patient who presented with sudden visual loss and associated neurological symptoms. Ophthalmic examination and fluorescein angiography showed multiple areas of branch retinal artery occlusion, which tended to recur in both eyes. Magnetic resonance imaging showed dot-like, diffusion-restricted lesions in the corpus callosum and left fornix, and audiometry showed low-frequency sensory hearing loss, compatible with Susac syndrome. She received immunosuppressive therapy with oral steroid and azathioprine. Three months later all the symptoms disappeared but obstructive vasculitis have been relapsing. This patient demonstrated the entire clinical triad of Susac syndrome, which tends to occur in young females. Although this disorder has rarely been reported in Asian populations, a high index of suspicion is warranted for early diagnosis and timely treatment.

The current state of age-related hearing loss in South Korea

The inevitable deterioration in hearing ability that occurs with age, age-related hearing loss (ARHL) or presbycusis, is a multifactorial process that can vary in severity from mild to profound. The number of cases of age-related hearing loss is growing due to the rapid growth of South Korea's aging population. According to the Korean Health Statistics of 2009, the incidence of unilateral hearing loss in people aged 65 or older is 17.5 percent, while the incidence of bilateral hearing loss exceeds 25.9 percent. Left untreated, age-related hearing loss of a moderate or greater degree affects communication and can decrease quality of life. Comprehensive rehabilitation by hearing aids or cochlear implant are widely available but underused in part because of social attitudes that undervalue the effect of hearing on life, in addition to the cost and stigma associated with hearing aids. Proper screening tests for ARHL should be developed and primary care physicians should screen and refer their elderly patients for assessment and remediation. In addition, development of hearing aids with a low cost of distribution and an increase in the size of government subsidies to hearing aids are imperative.

Changes of Serum Aldosterone Concentration after Noise Exposure in Mice

BACKGROUND AND OBJECTIVES: The study was designed to measure the change of serum aldosterone concentration after noise exposure in BALB/c mice. MATERIALS AND METHODS: BALB/c hybrid mice with < or =25 dB nHL in auditory brainstem responses (ABR) were used. Six mice were exposed to 120 dB SPL broad white band noise for 3 hours per day for 3 consecutive days. ABRs in all mice were examined after noise exposure. Serum aldosterone concentration was checked by radioimmunoassay in three mice without noise exposure, in three mice immediately after noise exposure (0 day after noise group), and in three mice 3 days after noise exposure (3 days after noise group). RESULTS: Permanent noise exposure-related threshold shift was induced in mice of 0 day after noise group and 3 days after noise group (83.3+/-2.9 and 88.3+/-2.9 dB nHL, respectively). The serum aldosterone concentration of the mice after noise exposure was significantly lower than control mice (p=0.046). The changes of aldosterone concentration were 879+/-137.5 pg/mL without noise exposure, 623+/-75.9 pg/mL immediately after noise exposure, and 683+/-49.2 pg/mL 3 days after noise exposure. CONCLUSIONS: In BALB/c mice, serum aldosterone concentration is decreased significantly after noise exposure.

Does the Kyphotic Change Decrease the Risk of Fall?

OBJECTIVES: Falls are a major problem in the elderly. Age-related degeneration of the human balance system increases the risk of falls. Kyphosis is a common condition of curvature of the upper spine in the elderly and its development occurs through degenerative change. However, relatively little is known about the effect of kyphotic changes on balance in the elderly. The aim of this study is to investigate the influence of kyphosis on the balance strategy through use of the motor control test (MCT) in computerized dynamic posturography. METHODS: Fifty healthy subjects who were not affected by other medical disorders that could affect gait or balance were enrolled in the study. By simulation of kyphotic condition through change of the angles of the line connecting the shoulder to the hip and the ankle axis by approximately 30degrees, the latency and amplitude of the MCT were measured in upright and kyphotic condition. RESULTS: In the kyphotic condition, latency was shortened in backward movement. In forward movement, latency was shortened only in large stimulation. The amplitude in forward movement was decreased in kyphotic condition. However, the change of amplitude was not significant in large intensity backward movement in the same condition. CONCLUSION: Kyphotic condition decreases the latency of MCT, especially in backward movement. These findings imply that kyphotic condition may serve as a protective factor against falls.

Clinical Usefulness of Viral IgM Antibody Test in Sudden Sensorineural Hearing Loss Patient / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There are many possible causes of sudden deafness such as viral infection, vascular occlusion, immune-mediated mechanism and abnormal cellular stress response in the cochlea. Viral hypothesis is one of the potential mechanisms for explaining sudden deafness. The aims of this study were to investigate the usefulness of viral IgM antibodies to evaluate the clinical findings and prognosis in sudden sensorineural hearing loss and to identify the more useful viral IgM antibodies. SUBJECTS AND METHOD: A retrospective study was carried out for 283 patients with sudden deafness. The results of serologic tests performed for the following were studied: Ebstein barr virus (EBV), Measles, Mumps, Toxoplasma, Rubella, Cytomegalovirus, Varicella zoster virus, Herpes simplex virus, and human immunodeficiency virus. Results of blood tests and audiologic tests taken initially and 2 months after the onset of sudden deaf were studied as well. RESULTS: Positive ratio of Viral IgM antibodies was 4.9% (13/283). Clincial findings and prognosis of viral IgM positive patients were not different from other sudden deafness patients except for the age factor. EBV Viral capsid antigen, EBV Early antigen-diffuse and restrict complex were common positive viral markers in sudden hearing loss patients. One third of the patients (4/13) had viral markers for Measles, Mumps and Toxoplasma. CONCLUSION: In sudden deafness, the positive ratio of serologic tests for viral IgM antibodies was less than 5% and viral IgM positive patients had similar clinical findings and prognosis to viral IgM negative patients. However, viral origins of Measles, toxoplasam and Mumps as well as EBV should be considered in sudden deafness patients with the symptoms and signs of viral infection.

Clinical Significance of Vibration-induced Nystagmus in Meniere's Disease / 대한평형의학회지

No abstract available.

Efficacy of Oral Prostaglandin I2 in Patients with Chronic Nonspecific Vertigo / 대한평형의학회지

BACKGROUND AND OBJECTIVES: The aim of this study is to evaluate the efficacy of prostaglandin I2 (PGI2) in the patients with chronic nonspecific vertigo using questionnaires of dizziness handicap inventory (DHI) and vertigo symptom scale (VSS). MATERIALS AND METHODS: Forty two patients with chronic nonspecific vertigo from May to December 2010 were enrolled in this study. We administered Berast (synthetic PGI2, beraprost sodium) 2 tablets (0.04 mg) twice a day to patients. Before and after 2, 4 weeks the end of administration patients underwent DHI and VSS for evaluation of state of the vertigo. RESULTS: Twenty four of 42 patients completed this clinical trial. Mean DHI scale score decreased significantly from 23.00 (+/-21.75) to 17.75 (+/-19.78) (p=0.004). All DHI subscales, physical, functional, and emotional factors, decreased after treatment of prostaglandin I2. VSS scale also showed significant decrease from 3.63 (+/-2.55) to 2.50 (+/-2.95) (p=0.044). CONCLUSION: Prostaglandin I2 may be one of the treatments to improve symptoms in the patient s with chronic nonspecific vertigo.

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.

Availability of Korean Hearing in Noise Test (KHINT) in Children / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Individuals with similar degrees of hearing impairment frequently show significantly different speech understanding in noise stimulation. A Korean version of the Hearing in Noise Test (KHINT) has been developed to assess the ability to recognize speech in noise. However, sentences in KHINT have been designed for subjects older than 16 years old and there have been no reports on KHINT related to the effect of age in the children younger than that age. The objective of this study was to evaluate the result of KHINT in children. SUBJECTS AND METHOD: One hundred one children between 7 and 16 years with no otologic history and normal hearing were included in this study. KHINT was conducted under the following four different conditions: speech in the quiet environment, with noise in the front, with noise in the right or in the left. The mean reception threshold for speech (RTS) in the quiet condition and signal to noise ratio (SNR) in the noisy condition were measured under four different conditions. RESULTS: There was no correlation between age and RTS. However, SNR with noise in the front, left and right conditions, as well as composite SNR, showed significant decrease with the decreasing age of children. CONCLUSION: According to KHINT, children showed decreased speech with decreasing age. Therefore, a separate KHINT with correlation factors to assess children's functional hearing ability in noise should be developed.