Treatment outcomes for idiopathic sudden sensorineural hearing loss in dialysis patients.

Idiopathic sudden sensorineural hearing loss (ISSNHL) is challenging for both nephrologists and otolaryngologists treating patients undergoing dialysis. This single-center, retrospective, observational study investigated the treatment outcomes of patients with ISSNHL undergoing dialysis, enrolling 700 patients (47 undergoing and 653 not undergoing dialysis) diagnosed with ISSNHL between January 2005 and December 2021 at Asan Medical Center, Republic of Korea. To balance pre-existing clinical characteristics, 1:5 propensity score matching (PSM) was performed with the patients who were not undergoing dialysis. Treatment included high-dose systemic steroid therapy or intra-tympanic steroid injections. The pure tone average of the groups was compared before and 2 weeks and 2 months after treatment. The hearing-improvement degree was evaluated using Siegel's criteria. Before PSM, age, prevalence of diabetes or hypertension, initial hearing threshold at each frequency level (0.5, 1, 2, and 4 kHz), and treatment strategies exhibited significant between-group differences. However, in the PS-matched cohort, none of the confounders showed significant between-group differences. Two months after steroid treatment, the non-dialysis patient group demonstrated significantly higher average improvement in pure tone audiometry (P = 0.029) and greater percentage of complete response according to Siegel's criteria. This study suggests that treatment outcomes for ISSNHL are significantly poorer for patients undergoing than for those not undergoing dialysis.

Safety and efficacy of intratympanic histamine injection as an adjuvant to dexamethasone in a noise-induced murine model.

The safety and efficacy of intratympanic (IT) histamine (HIS) injection as an adjuvant to increase the inner ear penetration of dexamethasone (DEX) was investigated in this study. IT injections of DEX-only, 1% HIS+DEX and 4% HIS+DEX were performed in mice with noise-induced hearing loss. An inflammatory reaction in the middle ear was observed only in the 4% HIS+DEX group although no serious cytotoxic effects on the organ of Corti (OC) were observed at that concentration. Compared with the DEX-only group, the perilymphatic concentration of DEX was approximately two times higher in the 1% HIS+DEX group and approximately five times higher in the 4% HIS+DEX group. The expression of the DEX receptor in the cochlea was significantly increased in the 4%-HIS+DEX group. HIS appeared to induce transient damage the microstructure of the RWM with recovery observed within 3 weeks. The 1 and 4% HIS + DEX groups showed a significant recovery of the OC compared with the control group and they also achieved significantly better hearing restoration at 8 kHz in the DPOAE hearing test (P < .05) when compared to the DEX-only group. IT HIS temporarily disrupts the structure of the RWM and middle ear mucosa and significantly enhances the inner ear penetration of DEX. Therefore, IT HIS injection could be a simple and effective adjuvant therapy to increase perilymph concentration of DEX and achieve OC recovery after cochlear damage.

Group Vestibular Rehabilitation Program: A Cost-Effective Outpatient Management Option for Dizzy Patients.

OBJECTIVES: This study was performed to evaluate the effectiveness of our novel group vestibular rehabilitation therapy (G-VRT) and to analyze the factors affecting outcomes. STUDY DESIGN: Retrospective case series. SETTING: Tertiary referral center. PATIENTS: Patients with chronic dizziness who received G-VRT between December 2019 and July 2020. INTERVENTION: The G-VRT program consisted of a 1-hour physical therapy session by an otologist in a small group setting. MAIN OUTCOME MEASURES: Dizziness Handicap Inventory, visual analog scale, functional level scales, and video head impulse test, as well as the compliance to the program, were evaluated. RESULTS: All scores of dizziness questionnaires were significantly improved after G-VRT ( p < 0.001). The overall vestibule-ocular reflex gain calculated by video head impulse test increased compared to the initial scores, whereas the average PR scores of all three semicircular canals significantly decreased from the initial scores, indicating enhanced vestibular compensation ( p < 0.05). Enrolled patients showed high compliance to the program. CONCLUSION: G-VRT program is a cost-effective and efficient way to provide relief for chronic dizzy patients. Further case-control studies in a larger group, as well as comparative studies with generic or customized vestibular exercise, will be needed to validate the clinical value of G-VRT.

Safety and Efficacy of Intratympanic Alpha-Lipoic Acid Injection in a Mouse Model of Noise-Induced Hearing Loss.

Alpha-lipoic acid (ALA) is an antioxidant with oto-protective effects. In the present study, the safety and effectiveness of ALA therapy after noise-induced hearing loss was confirmed based on the administration method. The safety of intratympanic ALA (IT-ALA) was evaluated with oto-endoscopy and middle ear mucosa morphologic study. Perilymph ALA concentrations according to the administration routes were compared, and the efficacy of ALA was investigated through hearing tests and cochlear histological studies. The middle ear mucosa was swollen 1 week after IT-ALA but completely recovered within 3 weeks. ALA concentration in the perilymph was significantly higher in the IT-ALA group. Recovery of organ of Corti morphology and hearing levels were predominant in the IT-ALA group compared with the intraperitoneal injection group (IP-ALA) and showed similar rescue effects in the IT-dexamethasone group (IT-DEX). Interleukin-1 beta and nuclear factor-kappa B expression was significantly downregulated in the IT-ALA group. IT-ALA showed better cochlear recovery from acoustic trauma with higher inner ear penetration rate than IP-ALA. The rescue effect of IT-ALA after noise-induced hearing loss was similar to IT-DEX; however, the ALA and DEX mechanisms are different. IT-ALA appears to be another safe and effective treatment modality after acoustic trauma and comparable to IT-DEX.

Effect of Hearing Rehabilitation Therapy Program in Hearing Aid Users: A Prospective Randomized Controlled Study.

OBJECTIVES: Despite sufficient hearing gains, many patients with hearing loss have difficulty using hearing aids due to poor word recognition ability. This study was performed to introduce our hearing rehabilitation therapy (HRT) program for hearing aid users and to evaluate its effect on hearing improvement. METHODS: In this prospective randomized case-control study, 37 participants with moderate or moderate-severe sensorineural hearing loss who had used bilateral hearing aids for more than 3 months with sufficient functional hearing gain were enrolled in this study. Nineteen participants were randomly assigned to the control group (CG) and 18 patients were assigned to participate in our HRT program once a week for 8 consecutive weeks (hearing rehabilitation therapy group [HRTG]). Their hearing results and questionnaire scores for hearing handicap and hearing aid outcomes were prospectively collected and compared between the two groups. RESULTS: After completing 8 weeks of the HRT program, the HRTG showed a significantly greater improvement in scores for consonant-only and consonant-vowel sound perception than the CG (P<0.05). In addition, the HRTG showed a significant improvement in hearing ability as measured by two questionnaires (p<0.05), while no differences were observed in the CG. However, word and sentence recognition test results did not show significant differences between the two groups. CONCLUSION: Even after short-term HRT, patients had subjectively better hearing outcomes and improved phoneme perception ability; this provides scientific evidence regarding a possible positive role for HRT programs in hearing aid users. Further validation in a larger population through a long-term follow-up study is needed.

Measurement of Loudness Discomfort Levels as a Test for Hyperacusis: Test-Retest Reliability and Its Clinical Value.

OBJECTIVES: The aims of this study were to investigate the test-retest reliability of measurements of loudness discomfort levels (LDLs), to suggest cut-off values for diagnosing patients with hyperacusis, and to evaluate the clinical value of-LDL measurements as a test for monitoring hyperacusis. METHODS: For the test-retest reliability of LDL measurements (study 1), a total of 68 patients who sought consultations at our clinic were subcategorized into four groups: patients with tinnitus (group 1), tinnitus and hearing loss (group 2), hyperacusis (group 3), and normal controls (group 4). Inter-hour and inter-day test-retest reliability values using different stimuli were investigated. For study 2, the clinical value of LDL measurements using pure tone stimuli was analyzed by comparing changes after sound generator use in patients with hyperacusis. RESULTS: In study 1, the group 3 patients showed significantly lower LDLs than the other groups. High test-retest reliability of LDL tests was demonstrated, regardless of the type of stimulus used. The cut-off values for screening patients with hyperacusis were 90 dB HL using pure tone stimuli and 62 dB HL using white-band noise stimuli. In study 2, significantly increased LDLs were correlated with improved symptoms and improved scores on tinnitus questionnaires after sound generator use, indicating that LDL measurement is a reliable test for monitoring hyperacusis during an intervention. CONCLUSION: LDL measurement is a reliable diagnostic tool to reflect the condition of hyperacusis, especially during the course of treatment.

Transtympanic Tripod-shaped Angiocatheter Insertion for Patients With Intractable Patulous Eustachian Tube.

OBJECTIVE: Despite the efforts to treat patients with patulous Eustachian tube (PET), intractable symptoms of PET may require surgical intervention. In this study, we introduce our surgical technique of "transtympanic tripod-shaped angiocatheter" (TTA) insertion and evaluate the safety and efficacy of the procedure in patients with intractable PET. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral center. PATIENTS: Thirty-two cases (26 patients) diagnosed with intractable PET between the years 2011 and 2019 were included in this study. INTERVENTION: All cases were surgically treated with TTA insertion. MAIN OUTCOME MEASURES: The clinical characteristics, surgical results, complication rates, and the level of satisfaction by questionnaires were analyzed for evaluation. RESULTS: The mean age of enrolled patients was 40.9 ±â€Š19.5 years, with slight male gender predominance (59.4% vs. 40.6%). Both ears were operated in six patients, simultaneously in three. All patients successfully received the insertion of TTA, with no immediate complication. Eleven cases were re-inserted after the first insertion due to the recurrence of symptoms or spontaneous extrusion of TTA. No major complications were observed during the follow-up period of 1 to 115 months (mean 37.7 mo). The average Visual Analogue Scale score of PET symptoms was significantly decreased (p < 0.05), along with 92% of patients with relief from autophony symptoms. CONCLUSIONS: TTA insertion is a relatively simple procedure that can be performed in a short period under local anesthesia. Surgical intervention of TTA insertion for patients with intractable PET symptoms seems promising with a high success rate.

Evidence of Tinnitus Development Due to Stress: An Experimental Study in Rats.

OBJECTIVES/HYPOTHESIS: Tinnitus can develop due to, or be aggravated by, stress in a rat model. To investigate stress as a possible causal factor in the development of tinnitus, we designed an animal study that included tinnitus behavior and excitatory/inhibitory neurotransmitter expression after noise exposure as well as restraint stress. STUDY DESIGN: An experimental animal study. METHODS: Wistar rats were grouped according to single or double exposure to noise and restraint stress. The noise exposure (NE) group was subjected to 110 dB sound pressure level (SPL) of 16 kHz narrow-band noise (NBN) for 1 hour, and the restraint stress (RS) group was restrained for 1 hour with or without noise exposure. Gap prepulse inhibition of the acoustic startle (GPIAS) reflex was measured at an NBN of 16 kHz to investigate tinnitus development. Various immunohistopathologic and molecular biologic studies were undertaken to evaluate possible mechanisms of tinnitus development after noise and/or restraint stress. RESULTS: The RS-only group showed a reduced GPIAS response, which is a reliable sign of tinnitus development. In the double-stimulus groups, more tinnitus-development signs of reduced GPIAS responses were observed. The expression of γ-aminobutyric acid A receptor α1 (GABAAR α1) in the hippocampus decreased in the NE│RS group. Increased N-methyl-d-aspartate receptor1 intensities in the NE│RS group and decreased GABAAR α1 intensities in the RS and NE│RS groups were observed in the CA3 region of the hippocampus. CONCLUSIONS: Tinnitus appeared to develop after stress alone in this animal study. An imbalance in excitatory and inhibitory neurotransmitters in the hippocampus may be related to the development of tinnitus after acute NE and/or stress. LEVEL OF EVIDENCE: NA Laryngoscope, 131:2332-2340, 2021.

The Long-Term Stability of Fat-Graft Myringoplasty in the Closure of Tympanic Membrane Perforations and Hearing Restoration.

BACKGROUND/AIMS: This study was conducted to evaluate the long-term stability of fat-graft myringoplasty (FGM) for chronic tympanic membrane perforations, analyzing the perforation closure rate and re-gained hearing outcome with respect to the size and location of the perforations. METHODS: Between August 2007 and June 2018, a total of 193 patients who underwent FGM due to chronic tympanic membrane perforation at a tertiary referral center were enrolled and analyzed. RESULTS: The mean follow-up was 14.6 months (range 6-39). The complete perforation closure rate after FGM was 89.6%, with no statistical difference among the perforation size groups. The mean postoperative air-bone gap (ABG) was 11.0 dB and mean ABG improvement was 4.9 dB. CONCLUSION: Our FGM technique had a favorable tympanic closure rate for small to large perforations, and yielded relatively good hearing improvement in the mid-size perforation cases over long-term follow-up periods. According to the topographic evaluation of FGM, this procedure resulted in a reliable perforation closure rate and audiological results regardless of the perforation site.

Effect of middle ear gelfoam on hearing and healing process after tympanoplasty: A prospective randomized case-control study.

PURPOSE: This prospective randomized case-control study was performed to compare the surgical outcomes of our swing-door overlay tympanoplasty with or without absorbable gelatine sponge (AGS, gelfoam) packing in the middle ear cavity, according to the surgical procedure. METHODS: Fifty-seven patients who underwent swing-door overlay tympanoplasty by a single surgeon were enrolled in the study. The data of 30 patients of the gelfoam-packing group (GPG) and 27 patients of the non-gelfoam-packing group (NGPG) were prospectively collected and compared. RESULTS: Closure of the tympanic membrane was found to be successful in all patients at postoperative 3 months evaluation. NGPG showed a statistically better healing process compared to GPG; earlier epithelialization and less fascia edema in NGPG than in GPG (P < 0.05). The air-bone gap (ABG) measured at postoperative 1 and 2 months was smaller in NGPG than GPG, although there were no statistical differences. CONCLUSION: This study revealed earlier healing process and faster recovery of ABG in NGPG, thereby indicating that the gelfoam in the middle ear may interfere with both hearing recovery and the healing process of neodrum.

Age-related hearing loss in the Korea National Health and Nutrition Examination Survey.

OBJECTIVES: Age-related hearing loss (ARHL), also known as presbycusis, is a chronic disorder characterized by impairment of the transduction of acoustic signals. This study analysed the prevalence and demographic characteristics of ARHL in the Korean population. METHODS: We used the data from the Korea National Health and Nutrition Examination Survey (KNHANES) from 2009 to 2012 and analysed the association between age and hearing impairment. A total of 16,799 adults were selected for the current study. Physical examinations, blood tests, otoscopic examinations, and hearing tests were performed. The demographic variables included age, gender, obesity, economic status, education level, noise exposure history, and underlying diseases. RESULTS: Among 16,799 participants, the prevalence of unilateral hearing loss was 8% (1,349 people), and bilateral hearing loss was 5.9% (989 people). Men were 53.4% more likely to have hearing loss than women. Age and underlying diseases, like hypertension, diabetes, and abdominal obesity, were significantly associated with hearing loss (P < 0.0001). Further, mental health factors, such as cognitive function, depression, and suicidal ideation, were related to hearing loss. The prevalence of hearing loss increased with advancing years, especially in the high frequency of 6 kHz, with a sharply increase in patients aged 65 and over. CONCLUSION: The analysis of auditory performance in the Korean population confirmed the association of high-frequency hearing loss with advancing age. A threshold of 6 kHz should be included to correctly diagnose hearing impairment in elderly patients. Patients with ARHL should be provided with suitable aural rehabilitation that includes active high-frequency control.

Surgical results of infected preauricular sinus: No need for delay.

OBJECTIVES: This study was performed to propose the proper surgical timing of infected preauricular sinus (PAS) by comparing surgical results of active infection PAS group (AIPASG) to infection-controlled/or non-infected PAS group (IC/NIPASG). METHODS: Two hundred and twelve patients with PAS who underwent surgical excision using minimal supra-auricular approach by one surgeon (S.N.P) in a tertiary referral center between Apr 1999 and Dec 2016 were enrolled in this study. Medical records of 36 patients of AIPASG at surgical time point and 176 patients of IC/NIPASG were collected and their surgical results were compared. Postoperative wound infection, recurrence, need of drain insertion or external compression dressing and other clinical parameters including age, sex, follow up duration and previous incision & drainage (I&D) history were investigated and statistically compared between two groups. RESULTS: There were no significant differences of various clinical parameters between two groups, except previous I&D history (24 among 36 patients of AIPASG and 12 among 176 patients of NI/ICPASG, P < 0.05). Post-operative immediate but mild wound erythema was observed in 11 among 212 patients with no statistical difference between two groups (4 among 48 ears of AIPASG and 7 among 219 NI/ICPASG, P = 0.105) and was controlled by short-term antibiotics and conservative management. Only 1 patient of NI/ICPASG needed a revision surgery of wound exploration and curettage. No more recurrence of infection during their long-term follow-up period was observed in both groups. CONCLUSION: There was no significant difference in the surgical results of minimal supra-auricular approach of PAS excision between AIPASG and NI/ICPASG. Therefore, we suggest that this surgical technique can be performed even in the infected PAS which does not quickly respond to the conservative treatment.

Management of palatal myoclonic tinnitus based on clinical characteristics: a large case series study.

Background: Palatal myoclonic tinnitus (PMT) is a rare otological condition caused by rhythmic contractions of soft palate muscles. Due to its rarity, only a few case series studies have been reported in the literature at the present time.Aims: This large case series study reviews treatment outcomes of PMT patients over the past 15 years based on clinical characteristics.Materials and methods: Between the year 2003 and 2018, 54 patients with a diagnosis of PMT were assessed. Clinical characteristics, audiological findings, psychological status, and other relevant medical history were thoroughly reviewed. Response to various treatment modalities were retrospectively analyzed.Results: The mean age of enrolled patients was 29.0 ± 16.4 years, with female gender predominance. All of the patients complained of 'clicky' sounding tinnitus. Twenty-nine patients had comorbid tinnitus of other type. Reassurance and behavior therapy was sufficient for young patients. Medication was effective in 44.4% of the patients. Botulinum toxin injection in the palate led to complete resolution of symptoms in a majority of intractable PMT patients.Conclusions and significance: Management of PMT should be customized according to the individual clinical characteristics of the patients. This study may provide insightful information to establish optimal treatment modalities for PMT.

Typewriter tinnitus: An investigative comparison with middle ear myoclonic tinnitus and its long-term therapeutic response to carbamazepine.

OBJECTIVES: Due to its rarity and similar sound, typewriter tinnitus (TT) can be misdiagnosed as middle ear myoclonic tinnitus (MEMT). We aim to clarify the characteristics of TT compared to MEMT, and the long-term therapeutic response to carbamazepine. METHODS: Fourteen patients with TT and 28 patients with MEMT were enrolled. RESULTS: TT patients were older than MEMT patients, and their tinnitus symptoms were mostly unilateral. Tinnitus symptoms, which is associated with dizziness, facial spasm, and head motion, were more common in TT, whereas MEMT were more related to noise. Acoustic reflex decay perturbation and low loudness discomfort level were diagnostic signs in MEMT patients, while decreased level of wave II in ABR was the most reliable sign in TT patients. All TT patients exhibited partial or complete response to carbamazepine, but there was a relapse rate after withdrawal of the drug was 60%. Increase in age and longer duration of symptoms were the risk factors of relapse of TT. CONCLUSION: The different characteristics observed in this study will be helpful to diagnose TT and MENT. Duration of tinnitus was the most important long-term prognostic factor of the carbamazepine trial, which indicates the importance of its earlier diagnosis.

Clinical efficacy of standard simple elliptical incision following drain-less and subcutaneous suture technique in preauricular sinus surgery.

BACKGROUND: The purpose of this study was to review our surgical strategy and outcomes of drain-less, subcutaneous suture technique in standard simple elliptical incision on preauricular sinus (PAS) cases. METHODS: The clinical records of 198 patients (247 ears) with PASs who were operated via standard simple elliptical incision with drain-less, subcutaneous suture technique by a single surgeon (K.H.P.) between January 2008 and December 2018 were reviewed for analysis. Patients' demographics, location of PASs, previous incision and drainage (I&D) history, previous surgical excision history, duration of follow-up, postoperative infection after surgery, and recurrence after surgery were analysed. RESULTS: Out of 247 PASs, 18 (7.3%) cases had postoperative infections and 11 (4.5%) cases showed recurrence. Postoperative infection rate were higher in previous I&D groups (PIDGs, 9.8%) and previous fistulectomy groups (PFGs, 10%), and also recurrence rates of PFGs (10%) was higher than those of fresh cases. However, there were no statistically significant differences between these groups. In addition, PAS patients with postoperative complications such as infection and recurrence were more common in male patients. CONCLUSION: We report a method of drain-less standard simple elliptical incision for the surgical removal of PAS and the outcomes of the surgery. Our method showed a low recurrence rate and low chance of wound infection postoperatively not only in fresh cases but also in pre-operative I&D cases and even previous fistulectomy cases. In conclusion, our method is proposed as an effective and safe method in all kind of patient groups, without presenting post-operative discomfort to patients.

A Mouse Model of Tinnitus Using Gap Prepulse Inhibition of the Acoustic Startle in an Accelerated Hearing Loss Strain.

HYPOTHESIS: To develop a mouse model for temporary and persistent tinnitus using the gap startle paradigm. BACKGROUND: Behavioral animal models for tinnitus are classified into conditioning- and reflex-based types. Gap prepulse inhibition of the acoustic startle (GPIAS) is based on the acoustic startle modification by a silent gap and gap detection deficit caused by tinnitus gap filling. METHODS: We used C57BL/6J mice inherently susceptible to hearing loss and potentially predisposed to tinnitus. They were divided into the control, salicylate-induced tinnitus, and noise-induced tinnitus groups. Mice were tested with the auditory brainstem response at four frequencies (8, 16, 24, and 32 kHz) and GPIAS in three carrier conditions, 16 and 24 kHz narrow band noises (NBNs) and broadband noise, at multiple time points before and after treatment. The ratio between the gap startle and no-gap startle amplitudes was analyzed by a repeated measures design. In addition, the number of tinnitus-positive mice meeting a specified criterion was counted. RESULTS: Salicylate/unilateral noise trauma resulted in temporary/permanent tinnitus evidenced by GPIAS reduction. GPIAS reduction was the most significant at 16 kHz NBN among the three carriers in both tinnitus groups. Control mice also showed good gap detection performance at 16 kHz NBN, which is in the most sensitive hearing range in mice. CONCLUSION: The GPIAS test in C57BL/6J mice was very reliable at 16 kHz NBN. This tinnitus model developed in the mouse strain of accelerated hearing loss can be used with two options of temporary and persistent tinnitus.

The efficacy of a modified Dix-Hallpike test with a pillow under shoulders.

BACKGROUND: Dix-Hallpike (DH) test is sometimes done in a modified or reduced manner in a clinical setting. However, there has been no study that evaluated the reliability of this modified test. OBJECTIVES: The purposes of this study were to determine whether the efficacy of a modified DH test, named the 'pillow under shoulders' test, was equivalent to the standard DH test and to assess the difference in patient discomfort between the two methods. METHODS: Randomized controlled study at three academic referral hospitals, conducted in compliance with the CONSORT statement. Patients suspected for BPPV based on symptoms were randomly assigned to Group A or Group B. Patients in Group A received a standard DH test initially, followed by a modified DH test with a pillow under shoulders. Patients in Group B also received the two tests, but in the reverse order. The diagnostic results of both tests and patients' subjective scoring for uneasiness (discomfort, pain, anxiety) were statistically analyzed. RESULTS: McNemar's test and Kappa statistics showed a statistically equivalent diagnostic value between standard and modified DH tests (Cohen's kappa = 0.823 and McNemar P = 0.18). The modified DH test had high sensitivity (95.5%) and fairly good specificity (87.9%). There was no statistical significance in the patients' subjective scoring for uneasiness between the two methods, although most patients reported less inconvenience after the modified DH test compared to the standard DH test. CONCLUSIONS: The modified version of the standard DH test, the 'pillow under shoulders' method, may be a reliable, comfortable option to diagnose vertical canal BPPV. We suggest that this method can be used when head hanging is not feasible or sufficient for the standard DH test.

Effect of Task-Specific Lower Extremity Training on Cognitive and Gait Function in Stroke Patients: A Prospective Randomized Controlled Trial.

OBJECTIVE: To elucidate the effect of task-specific lower extremity training (TSLET) on cognitive and gait function in stroke patients. METHODS: Thirty-eight patients were assigned to either the TSLET group or the control group. The individuals of TSLET group went through a TSLET plus conventional physical therapy. The control group received two sessions of conventional physical therapy. The primary outcome involved the assessment with visual and auditory digit span test. The secondary outcome was evaluated by the Korean version of Mini-Mental State Examination (K-MMSE) and Global Deterioration Scale (GDS) for cognitive function, Berg Balance Scale (BBS), Time Up and Go Test (TUG), 10 meters Walking Test (10mWT), 6 minutes Walking Test (6MWT), and Korean version of Modified Barthel Index (K-MBI) for gait, balance, and functional ability. RESULTS: After intervention (3 weeks) and 2 weeks of follow-up, the TSLET group showed statistically significant improvement in the visual digit span test backwards compared with the control group. In secondary outcome, a significant improvement was observed in GDS, BBS, TUG, and 10mWT in the TSLET group. There was no significant difference between the two groups concerning visual digit span test forward, auditory forward and backward digit span tests, K-MMSE, 6MWT, and K-MBI. CONCLUSION: TSLET could be a useful alternative strategy for improving cognitive and gait function in stroke patients.

Precise differential diagnosis of acute bone marrow edema and hemorrhage and trabecular microfractures using naïve and gamma correction pinhole bone scans.

OBJECTIVE: To analyze the performance of sequential naïve pinhole bone scan (nPBS) and gamma correction pinhole bone scan (GCPBS), reinforced by ImageJ densitometry and pixelized microfracture measurement, for making specific diagnoses of bone marrow edema (BME), bone marrow hemorrhage (BMH), and trabecular microfractures (TMF). METHODS: We prospectively examined BME, BMH, TMF, and normal trabeculae in 10 patients using sequential nPBS and GCPBS. The intensity of 99mtechnetium-hydroxydiphosphonate (99mTc-HDP) uptake was measured using a pixelized method and calculated using ImageJ densitometry in terms of arbitrary units (AU). This overall method was termed a visuospatial-mathematic assay (VSMA). We analyzed the ability of the calculated AU values to discriminate between the four states using GraphPad Prism software, with reference to previous morphological data. RESULTS: The calculated values were categorized as ≤50 AU for normal trabecula, 51-100 AU for BME, 101-150 AU for BMH, and ≥151 AU for TMF. The difference in uptake between normal trabecula and BME was significant and the differences among BME, BMH, and TMF were highly significant. CONCLUSION: VSMA is a useful technique for refining objective individual diagnoses and for differentiating and quantitating BME, BMH, and TMF.

A pilot study to investigate the therapeutic effect of Valsalva maneuver on otitis media with effusion in adults.

OBJECTIVE: This pilot study was performed to investigate the therapeutic effect of Valsalva maneuver on otitis media in adults and to evaluate the prognostic factors for the good response. METHODS: Thirty nine ears of 32 adult patients who were diagnosed as otitis media with effusion and managed by one-week Valsalva maneuver (>20/day) without any other medication were included in this study. Its therapeutic efficacy was evaluated and the prognostic factors which predict the response of Valsalva maneuver were analyzed by comparing various clinical and audiological factors between success and failure groups. RESULTS: Mean duration of otitis media in the study subjects was 30.9 days (SD 31.6 days). A success rate of 1-week Valsalva maneuver as a single therapeutic modality was up to 64.1% (25/39 ears) and hearing was significantly recovered in success group. No recurrence or side effects were observed. Successful Valsalva maneuver checked and confirmed as bulging of the tympanic membrane by otoendoscopic examination was an excellent indicator of therapeutic response in a week (p<0.05). Age, sex, duration of otitis media, history of previous upper respiratory tract infection, initial hearing levels and type of audiogram were not significant prognostic factors for the therapeutic efficacy of Valsalva maneuver. CONCLUSION: One-week Valsalva maneuver seems to be considered as a first line therapeutic modality in otitis media with effusion in adult patients who demonstrate the successful maneuver result on oto-endoscopic examination.