Gray-tone appearances on 4-hour delayed gadolinium-enhanced magnetic resonance imaging indicate severe inner ear pathology and symptoms in sudden sensorineural hearing loss.

Objective: Hybrid of reversed image of positive endolymph signal and negative image of perilymph signal (HYDROPS) in delayed gadolinium-enhanced magnetic resonance imaging (MRI) typically depicts normal inner ear as "white-tone" and endolymphatic hydrops as "black-transparent" appearances, whereas ears with auditory and vestibular disorders are occasionally depicted as "gray-tone." This study aimed to investigate the pathological basis of sudden sensorineural hearing loss (SSNHL) patients with "gray-tone" appearances on HYDROPS. Methods: Delayed gadolinium-enhanced MRI examinations were conducted on 29 subjects with unilateral SSNHL. We mainly analyzed positive perilymph image (PPI) and positive endolymph image (PEI), which were components HYDROPS. Results: On PPI, signal intensity (SI) values extracted from the cochlear and vestibular region of interest (ROI) were higher in the SSNHL ears with dizziness/vertigo symptom at the first visit compared to the healthy ear. Additionally, the PPI/PEI enhancement pattern in the vestibule was associated with a high prevalence of hearing and vestibular deteriorations at the first visit and poor hearing improvement after treatment. Conclusion: Enhancement on PPI/PEI may result from leakage of gadolinium into the inner ear following breakdown of the blood-labyrinth barrier, with high SI being correlated with the amount of leakage. Particularly, a significant leakage into the endolymphatic space, defined as PPI+/PEI+, indicates severe inner ear pathology. Ultimately, we emphasize that the "gray-tone" appearance in the inner ear on HYDROPS comprises enhancements on both PPI and PEI and propose a new classification for evaluating SSNHL Peri- and Endolymphatic image Enhancement pattern in Delayed gadolinium-enhanced MRI (SPEED). Level of Evidence: 4.

Investigation of endolymphatic hydrops positivity rates in patients with recurrent audiovestibular symptoms using inner ear magnetic resonance imaging.

OBJECTIVES: This study aimed to investigate the endolymphatic hydrops (EH)-positivity rates among patients with recurrent audiovestibular symptoms using intravenous injection of gadolinium-enhanced inner ear magnetic resonance imaging (ieMRI). METHODS: We reviewed 710 successive patients with recurrent audiovestibular symptoms at the Vertigo/Dizziness Center of Nara Medical University and other related hospitals, between May 2014 and April 2020. We performed ieMRI on 153 patients with unilateral recurrent cochleovestibular symptoms (rCV), 51 with recurrent vertigo symptoms (rVO), and 84 with unilateral recurrent cochlear symptoms (rCO). RESULTS: EH was observed in 69.4% of the participants: 81.7% in the rCV group, 19.6% in the rVO group, and 77.4% in the rCO group. The participants were divided into two groups according to the disease duration: short-duration and long-duration groups. In the short-duration group (less than 4 years), EH was observed in 82.3%, 42.9%, and 71.4% of the patients in rCV, rVO, and rCO groups, respectively; in the long-duration group (more than 5 years), EH was observed in 81.1%, 10.8%, and 81.6% of the patients in rCV, rVO, and rCO groups, respectively. CONCLUSIONS: The longer the duration of the disease, the larger the EH-positivity rates in patients with rCO, smaller in those with rVO, and unchanged in those with rCV. Although ieMRI could not detect EH with 100% accuracy in Ménière's disease, the present pathological statistics of patients with recurrent audiovestibular symptoms might be helpful in considering the pathology-based treatment strategy.

A method of transoral finger dissection for a giant epiglottic lipoma.

Background. Subcutaneous lipomas that occur in the trunk and proximal extremities are commonly dissected by low-invasive method. However, a standard surgical method for lipomas of the epiglottis has been absent. Microscopic laryngeal surgery is appropriate to extirpate small epiglottic lipomas. However, microscopic laryngeal surgery may be insufficient for giant epiglottic lipomas because there is restricted visualization of the operating field of the tumor under the microscope. Furthermore, microscopic surgical instruments are very small to manipulate giant lipomas, and it would be excessive to approach these lipomas via external cervical incisions. Case Presentation. A 57-year-old female presented with a giant lipoma on the lingual surface of the epiglottis. Following a tracheotomy, microscopic surgery was inadequate to manipulate the epiglottic lipoma. Instead, we performed macroscopic surgery in which the epiglottic lipoma was pulled into the oral cavity with forceps and then separated from the surrounding tissues using the surgeon's finger to dissect the tumor en bloc. Conclusion. The low-invasive method of transoral finger dissection enabled the giant lipoma to be extirpated without leaving any remnants or causing excessive epiglottic damage.

Residual inhibition of tinnitus induced by 30-kHz bone-conducted ultrasound.

Sounds at frequencies of >24-kHz are classified as ultrasound which cannot be heard by humans if presented by air conduction, but can be perceived if presented by bone conduction. Some research studies involving ultrasonic hearing have reported that tinnitus is masked by bone-conducted ultrasound (BCU). However, little is known about residual inhibition (RI), which is a continuous reduction or disappearance of tinnitus after presentation of BCU. This study investigated whether RI could be induced by BCU. Five types of the masker sounds were used to measure RI in 21 subjects with tinnitus. A bone-conducted 30-kHz pure tone was used as a BCU, and an air-conducted 4-kHz pure tone, narrow-band noise, white noise, and a bone-conducted 4-kHz pure tone were used as controls of audible sounds. The masker intensities of the 30-kHz BCU and audible sounds were set at the minimum masking levels of tinnitus plus 3 and 10 dB, respectively, considering the narrow dynamic range of BCU. The duration of RI induced by the 30-kHz BCU was significantly longer than those induced by the 4-kHz sounds, but was not significantly different from that induced by the white noise. BCU activates the cochlear basal turn in response to the high frequency, which may broadly overlap with the frequency range that included the dominant tinnitus pitch in most of our subjects. The longer RI duration for the 30-kHz BCU was probably derived from this characteristic. These results suggested that the peripheral stimulation characteristic of BCU probably contributed to inducing long RI durations.

Lymph node infarction in classical Hodgkin's lymphoma.

Among lymphoproliferative disorders, lymph node infarction appears to be most frequently seen in diffuse large B-cell lymphoma, followed by follicular lymphoma, with other types being rare. We experienced one such case, classical Hodgkin's lymphoma (cHL) associated with lymph node infarction, in which Reed-Sternberg (RS) cells were positive for CD15, CD30, fascin, PAX-5, p53, latent membrane protein-1 (LMP-1), Bcl-2, and EBV-encoded small non-polyadenylated RNAs. Furthermore, RS cells in the infarcted area were still positive for CD30, fascin, p53, and Bcl-2. For definitive diagnosis of nodal lymphomas including Hodgkin's lymphoma, identification of the effacement of normal nodal architecture is essential. Although this could not be evaluated in our case because of predominant reactive follicular hyperplasia with interfollicular distribution of RS cells, the presence of large cells with RS cell-related molecules together with the distorted distribution of cCD3-positive cells and CD20-positive cells led us to make a definitive diagnosis of cHL. It is, therefore, considered that immunohistochemical evaluation of the infarcted lymph node is, at least on some occasions, still informative for more accurate diagnosis of lymphoid neoplasia. Hodgkin's lymphoma should also be considered when one encounters lymph node infarction.

Functional lateralization of speech processing in adults and children who stutter.

Developmental stuttering is a speech disorder in fluency characterized by repetitions, prolongations, and silent blocks, especially in the initial parts of utterances. Although their symptoms are motor related, people who stutter show abnormal patterns of cerebral hemispheric dominance in both anterior and posterior language areas. It is unknown whether the abnormal functional lateralization in the posterior language area starts during childhood or emerges as a consequence of many years of stuttering. In order to address this issue, we measured the lateralization of hemodynamic responses in the auditory cortex during auditory speech processing in adults and children who stutter, including preschoolers, with near-infrared spectroscopy. We used the analysis-resynthesis technique to prepare two types of stimuli: (i) a phonemic contrast embedded in Japanese spoken words (/itta/ vs. /itte/) and (ii) a prosodic contrast (/itta/ vs. /itta?/). In the baseline blocks, only /itta/ tokens were presented. In phonemic contrast blocks, /itta/ and /itte/ tokens were presented pseudo-randomly, and /itta/ and /itta?/ tokens in prosodic contrast blocks. In adults and children who do not stutter, there was a clear left-hemispheric advantage for the phonemic contrast compared to the prosodic contrast. Adults and children who stutter, however, showed no significant difference between the two stimulus conditions. A subject-by-subject analysis revealed that not a single subject who stutters showed a left advantage in the phonemic contrast over the prosodic contrast condition. These results indicate that the functional lateralization for auditory speech processing is in disarray among those who stutter, even at preschool age. These results shed light on the neural pathophysiology of developmental stuttering.

Comparison between bone-conducted ultrasound and audible sound in speech recognition.

CONCLUSION: This study showed that it is possible to transmit language information using bone-conducted ultrasound (BCU) in normal-hearing subjects. Our results suggest the possibility of a difference in speech recognition between BCU and air-conducted audible sound (ACAS). OBJECTIVE: Ultrasound was audible when delivered by bone conduction. Some profoundly deaf subjects as well as normal-hearing subjects can discriminate BCU whose amplitude is modulated by different speech sounds. These findings suggest the usefulness of developing a bone-conducted ultrasonic hearing aid (BCUHA). However, the characteristics of BCU are still poorly understood. The aim of the present study was to compare BCU and ACAS in terms of their associated speech perception tendency and to investigate the different perceptual characteristics of BCU and ACAS. SUBJECTS AND METHODS: Speech discrimination tests using both BCU and ACAS were performed with normal-hearing subjects. BCU and ACAS were compared for intelligibility and hearing confusion. RESULTS: With BCU, the maximum percentage correct totaled about 75%. Our comparison of the hearing confusion with ACAS and BCU according to the individual syllabic nuclear group showed a clear difference in the incorrect rates. In addition, the stimulus nuclear groups were often perceived in other nuclear groups in BCU.

Estimation of factors influencing the results of tinnitus retraining therapy.

CONCLUSION: The factors of tinnitus loudness and Tinnitus Handicap Inventory (THI) score in tinnitus patients have the potential to relate to therapeutic results of tinnitus retraining therapy (TRT). OBJECTIVES: To confirm what factors in tinnitus influence the results of TRT. PATIENTS AND METHODS: Twelve factors were investigated in 53 patients with tinnitus, examining the relationship between these factors and the results of TRT. A THI score was determined before and 6 months after TRT introduction (pre- and post-TRT). Moreover, the change of THI score from pre- to post-TRT (delta THI) was referred to as the therapeutic effect of TRT. Based on the 12 factors, subjects were respectively divided into two groups, comparing delta THI between groups. RESULTS: Two groups of greater tinnitus loudness and higher THI score showed significant increases in delta THI, indicating that two factors of tinnitus loudness and THI score were related to the therapeutic effect of TRT.

Differential cortical responses in second language learners to different vowel contrasts.

Near-infrared spectroscopy was used to measure hemodynamic responses in Korean subjects learning Japanese as a second-language to Japanese phonemic contrasts that are either phonologically distinctive or non-distinctive in their first-language. These results were compared with those of Japanese native listeners reported previously. Unlike the results observed in the Japanese subjects, the Korean subjects did not show category-specific neural responses to a durational contrast that is non-distinctive in their first-language. The /a-e/ contrast elicited the larger response in the left auditory area, consistent with the results of the Japanese. These phoneme-dependent responses imply that the neuronal networks subserving the first and second-languages are either shared or exclusive according to the mutual relationship between the phonemic properties of the first and second-languages.