Bacteriology and trends of antimicrobial resistance of Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus in otitis media: A retrospective data analysis.

OBJECTIVES: Otitis media (OM) has a high prevalence worldwide and the treatment is crucial because hearing loss in children can lead to growth disorders such as language development disorders. The aim of this study is to analyse the changes in bacterial strains and the trends of antibiotic susceptibility in otitis media with effusion (OME), chronic otitis media (COM) and cholesteatomatous otitis media (Chole OM). DESIGN: This retrospective study involved 2926 patients diagnosed with OME, COM, or Chole OM between January 2000 and December 2020. The clinical data were collected and analysed through chart review from May 2021 to July 2021. SETTING: Two tertiary medical centres. PARTICIPANTS: The 2926 OM patients. MAIN OUTCOMES AND MEASURES: An otorrhea sample was collected on the first day of their hospital visit. Middle ear fluid samples for bacterial culture and antibiotics susceptibility test were collected from patients during middle ear surgery, including ventilation tube insertion. In each type of OM, the distribution of bacterial strains in the 2000s and the 2010s was compared. In addition, changes in the detection rate of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa (PA) and trends in their antibiotic susceptibility over the last 10 years were analysed. RESULTS: The most frequently detected bacterial strains in OME, COM and Chole OM over the study period were coagulase-negative Staphylococcus (CNS) (29.6%), MRSA (24.1%), and PA (20.1%). Compared to the 2000s, the proportion of non-typable Haemophilus influenzae in OME and MRSA in COM increased in the 2010s (27.4%-31.6% and 1.5%-29.5%, respectively). In total three types of OM, although there was no significant trend of change in detection rates of MRSA, PA, and multidrug resistant-P. aeruginosa (MDR-PA) during the last 10 years, resistance to the Quinolone class of MRSA and PA tended to increase (P < .05). CONCLUSIONS: The composition of bacterial strains in each types of OM has changed over the past 20 years. Additionally, the antibiotic resistance of MRSA and PA has increased in the last decade. Therefore, when using empirical antibiotics in necessary situations, it is necessary to change to an appropriate antibiotic through a bacterial culture test and antimicrobial susceptibility test.

A High Neutrophil-to-Lymphocyte Ratio Is Associated with Recovery from Ramsay Hunt Syndrome.

BACKGROUND: Prediction of the severity and outcomes of Ramsay Hunt syndrome (RHS) is difficult. OBJECTIVES: The aim of this study was to evaluate the predictive power of the neutrophil-to-lymphocyte ratio (NLR) for the severity and outcomes of RHS. MATERIAL AND METHODS: From 2007 to 2017, a retrospective study of 102 hospitalized patients with RHS was conducted. The degree of paralysis was assessed by determining the House-Brackmann (H-B) grade. Obesity, hypertension, and diabetes mellitus were assessed, and the blood NLR and platelet-to-lymphocyte ratio were determined. The patients received steroids and antivirals, and were followed in the outpatient department at 1, 4, 12, and 24 weeks. RESULTS: The H-B grade of the high-NLR group was significantly higher than that of the normal-NLR group (p = 0.039), and the probability of complete recovery was significantly lower in the high-NLR group (p = 0.048). CONCLUSIONS: Patients with RHS who have an elevated NLR have poor outcomes in terms of the H-B grade. Therefore, the NLR may be useful for evaluating the prognosis of patients with RHS.

Expression of Endoplasmic Reticulum Stress-Related mRNAs in Chronic Otitis Media.

OBJECTIVES: Unfolded proteins in the endoplasmic reticulum (ER) cause an ER stress response and can result in various pathologic conditions, including inflammation. Otitis media is the most common disease in otolaryngology and is associated with inflammation. The pathophysiology of chronic otitis media is not well understood; we therefore investigated the expression pattern of ER stress-related mRNAs in chronic otitis media. METHODS: Specimens were obtained from 47 patients with chronic otitis media over a period of 2 years. Expression levels of 6 ER stress transcription factors were quantitatively assessed using real-time RT-PCR. RESULTS: The mRNA expression of sXBP1 was significantly higher in the otorrhea present group than in the otorrhea absent group (p < 0.05). ATF6 expression was significantly higher in the ossicle destruction group than in the ossicle intact group (p < 0.05). mRNA expression of the 6 ER stress-related genes did not differ significantly between those patients with positive microbial cultures versus those with negative cultures (p > 0.05) or those with facial nerve dehiscence versus those without facial nerve dehiscence (p > 0.05). CONCLUSIONS: sXBP1 appears to be involved in chronic otitis media-associated inflammation, including otorrhea. ATF6 is associated with the destruction of ossicles. Our results suggest that certain ER stress-related genes are expressed in chronic otitis media-associated inflammation.

Comparative prognosis in patients with Ramsay-Hunt syndrome and Bell's palsy.

PURPOSE: Patients with Ramsay-Hunt syndrome have a poorer prognosis than patients with Bell's palsy. Factors of metabolic syndrome affecting prognosis were therefore compared between patients with Ramsay-Hunt syndrome and those with Bell's palsy. METHODS: This retrospective study included 106 with Ramsay-Hunt syndrome and 182 with Bell's palsy. Age, sex, body mass index, blood pressure, blood test results, and ENoG results, stratified by House-Brackmann grade, were compared in patients with Ramsay-Hunt syndrome and Bell's palsy. Both groups of patients were treated with steroids and the antiviral agent famciclovir. RESULTS: Age, sex, body mass index, dyslipidemia, triglyceride, diabetes, hypertension, and onset of palsy did not differ in patients with Ramsay-Hunt syndrome and Bell's palsy. Rates of favorable recovery in patients with severe facial palsy and DM were lower in patients with Ramsay-Hunt syndrome than with Bell's palsy and were also lower in low-weight, normal weight, and overweight patients with Ramsay-Hunt syndrome than with Bell's palsy. Rates of favorable recovery in patients with severe facial palsy and normal HDL, as well as in patients with severe facial palsy and < 10% ENoG, were lower in patients with Ramsay-Hunt syndrome than with Bell's palsy. CONCLUSIONS: Among patients with severe facial palsy, along with diabetes and < 10% ENoG, unfavorable recovery rates were significantly higher in those with Ramsay-Hunt syndrome than with Bell's palsy.

Recurrent Bell's palsy.

OBJECTIVE: Although recurrent facial palsy was first reported in 1871, the aetiology, definitions, classifications, pathogenesis, treatment options and prognosis have not been clearly determined. There have been no systematic reviews and meta-analyses of recurrent Bell's palsy. The purpose of this study was to evaluate the clinical manifestations of recurrent Bell's palsy through a systematic review and meta-analysis. DESIGN: The SCOPUS, PubMed, Cochrane Library and EBSCO databases were searched through 1 May 2018, using the search terms "recurrent Bell's palsy" and "recurrent facial palsy," for studies involving patients with recurrent Bell's palsy. Reference lists of eligible studies were also reviewed. RESULTS: A search of titles and abstracts in these four databases identified 222 studies; of these, 27 studies, involving 1041 patients from 13 countries, were analysed. The mean percentage of patients who experienced recurrence of Bell's palsy ranged from 0.8% to 19.4%. Five studies that included 191 patients were included in the meta-analysis. CONCLUSIONS: Among patients previously affected by Bell's palsy, the mean incidence of recurrent Bell's palsy was 6.5%. Sidedness of recurrent disease, relative to the side of the original disease, had no effect on patient prognosis. Of all patients with Bell's palsy, 66.0% recovered completely, with the recovery rate lower in patients with recurrent than with primary Bell's palsy.

Prognostic value of the blink reflex test in Bell's palsy and Ramsay-Hunt syndrome.

OBJECTIVE: This study was designed to evaluate the prognostic value of the blink reflex (BR) test in patients with Bell's palsy (BP) or Ramsay Hunt syndrome (RHS). METHODS: The House-Brackmann (HB) grade of patients diagnosed with BP and RHS was determined at first visit and 3 months later. Final HB grade III-VI was defined as an incomplete recovery. Factors evaluated as prognostic of poor recovery included electroneurography (ENoG) degeneration rate (DR)>90%, and absence of BR. Rates of complete and incomplete recovery were calculated and the associations between prognostic factors and recovery were determined. RESULTS: Of the 129 included patients, 98 (76%) had BP and 31 (24%) had RHS. Absence of BR and low mean ENoG value were significantly associated with incomplete recovery in both the BP and RHS groups (p<0.05 each). Initial HB grade V-VI was significantly associated with rate of incomplete recovery in patients with RHS (p<0.05 each). Severe residual palsy (final HB grade V-VI) in the absence of BR was significantly more frequent in patients with RHS than with BP (p<0.05). CONCLUSION: BR test results were a good prognostic indicator in patients with BP and RHS, as were ENoG value. Absence of BR was more frequently associated with severe residual palsy in RHS than in BP.

The effect of metabolic syndrome on Bell's palsy recovery rate.

OBJECTIVE: This study investigated the effects metabolic syndrome (MetS) and its factors such as diabetes mellitus (DM), hypertension (HTN), obesity, hypertriglyceridemia (high TG) and low high-density lipoprotein cholesterol (low HDL-C) on the recovery rate of patients with BP. METHODS: The medical records of 124 patients with BP were retrospectively reviewed. Patients were divided into a MetS group and a Non-MetS group according to the diagnostic criteria of MetS, and the demographic and clinical characteristics of the two groups at baseline and six months after BP onset were analyzed. RESULTS: Age was significantly higher in the MetS group than in the Non-MetS group (p < .05), but there were no significant differences in sex ratio, initial House-Brackmann (H-B) grade, initial electroneurography and initial electromyography (p > .05). The most common comorbidity of BP was high TG, followed by low HDL-C, HTN, obesity and DM. There were no differences in initial H-B grade in patients with and without each component of the MetS (p > .05). The recovery rate of BP was significantly lower in the MetS than in the Non-MetS group and was particularly affected by DM, obesity and high TG. CONCLUSIONS: Recovery rate op BP is lower in patients with than without MetS.

Expression of C-type lectin receptor mRNA in chronic otitis media with cholesteatoma.

CONCLUSIONS: The levels of expression of various C-type lectin receptors (CLRs) messenger ribo nucleic acids (mRNAs) were significantly higher in cholesteatomas than in normal skin, suggesting that these CLRs may be involved in the pathogenesis of cholesteatoma. OBJECTIVES: Altered expression of pattern recognition receptors may be associated with immune responses in patients with cholesteatoma. This study assessed the levels of expression of CLR mRNAs in normal skin and in cholesteatoma. METHODS: Cholesteatoma specimens were obtained from 38 patients with acquired cholesteatoma. The levels of expression of various CLR mRNAs were assessed quantitatively using real-time RT-PCR (Reverse transcription polymerase chain reaction) and correlated with age, sex, the presence of bacteria, hearing level, frequency of surgery, and degree of ossicle destruction. RESULTS: The levels of CD206 (cluster of differentiation 206), DEC-205 (Dendritic and epithelial cell-205), MGL (monoacylglycerol lipase), CLEC5A (C-type lectin domain family 5 member A), Dectin-2 (dendrite cell-associated C-type lectin-2), BDCA2 (Blood dendritic cell antigen 2), Mincle, DCIR (dendritic cell immunoreceptor), Dectin-1, MICL (Myeloid inhibitory C type-like lectin), and CLEC12B (C-type lectin domain family 12, member B) mRNAs were significantly higher in cholesteatoma than in control skin samples (p < 0.05). The levels of CLEC5A (C-type lectin domain family 5 member) and Dectin-1 mRNAs were significantly higher in cholesteatomas with ≥2 than ≤1 destroyed ossicles (p < 0.05), and the levels of MGL, Mincle, Dectin-1, and CLEC12B mRNAs were significantly higher in recurrent than initial cholesteatoma specimens (p < 0.05). The level of CLEC5A mRNAs was significantly higher in patients with severe than mild-to-moderate hearing loss (p < 0.05).

Comparison of Acyclovir and Famciclovir for Ramsay Hunt Syndrome.

OBJECTIVE: Although antiviral agents are widely used to treat Ramsay hunt syndrome (RHS), their relative effectiveness has not been assessed. This study retrospectively compared clinical outcomes in patients with RHS treated with the antiviral agents acyclovir and famciclovir. PATIENTS AND METHODS: This study involved 227 patients diagnosed with RHS from 2003 to 2015. Patients were treated with prednisolone plus acyclovir (n = 102) or famciclovir (n = 125). Patient outcomes were measured using the House-Brackmann scale according to age, initial severity of disease, electroneurography, and underlying disease. RESULTS: Based on complications (p = 0.019) and disease severity (p = 0.013), the overall complete recovery rate was significantly higher with famciclovir than with acyclovir, whereas rates of recovery in patients with severe (p = 0.111) and initially moderate (grades III-IV; p = 0.070) facial palsy were similar. Electroneurography also showed no difference in remission rate between the two groups (p = 0.692). Complete recovery rates in patients with hypertension and/or diabetes mellitus were similar in the two groups. However, the complete recovery rate of patients without hypertension and diabetes was significantly higher in patients treated with famciclovir than acyclovir (p = 0.018). CONCLUSION: Recovery rates in patients with RHS were higher following treatment with steroid plus famciclovir than with steroid plus acyclovir, especially in patients without hypertension and diabetes mellitus.

Ocular vestibular evoked myogenic potential testing for the prognosis of Bell's palsy.

CONCLUSION: oVEMP could be a useful tool for predicting the prognosis of Bell's palsy comparable to ENoG and H-B grade. OBJECTIVES: Several previous studies have reported cases of Bell's palsy with vestibular function disorder. The basic hypothesis behind this effect lies in the close proximity of the vestibular and facial nerves in the internal auditory canal (IAC). Therefore, the aim of this study was to investigate the correlation between Bell's palsy prognosis and ocular vestibular evoked myogenic potentials (oVEMPs). METHODS: Total 104 consecutive patients who were diagnosed with Bell?s palsy from January 2012 to December 2014 were enrolled. Patients were divided into complete recovery group and incomplete recovery group. All of patients underwent oVEMP recordings within 1 week after disease onset. For the evaluation of correlation between H-B grades, ENoG, oVEMP and Recovery of Bell?s palsy, logistic regression analysis was performed. RESULTS: The mean value of ocular vemp asymmetry was significantly higher in the incomplete recovery group than the complete recovery group (p < 0.05). No association was found between the ipsilesional PTA threshold, caloric test, and rate of abnormal EMG and recovery state. However, the initial state of ENoG, initial H-B grade, and oVEMP abnormal findings (Latency & Amplitude symmetry ratio) were significantly correlated with the rate of recovery (p = 0.025, p = 0.013, and p < 0.005, respectively).

Tinnitus Retraining Therapy in Unilateral Tinnitus Patients with Single Side Deafness.

OBJECTIVE: The purpose of this study was to evaluate the audiologic and clinical characteristics of the tinnitus in single-sided deafness (SSD) patients and to determine whether tinnitus retraining therapy (TRT) is beneficial to those patients who suffer from tinnitus with SSD. MATERIALS AND METHODS: Thirty-six tinnitus patients with unilateral sensorineural profound hearing loss were included in the SSD group, and 46 tinnitus patients with normal hearing were included in the normal hearing group (NH group). Tinnitus evaluation consisted of the Tinnitus Handicap Inventory (THI), and visual analog scales (VAS) were obtained at the initial interview and 6 months after TRT. The therapeutic response was analyzed and compared between the two groups. RESULTS: The subjective intensity of tinnitus and objective loudness were greater in the SSD group. According to the THI scores prior to TRT, the SSD group showed significantly higher values, except in the emotional subscale. The THI score was significantly improved after TRT in both groups. The total THI score and all the subscale scores were significantly reduced. The VAS average scores were reduced from 6.5 to 5.1 in the SSD group, without statistical significance, whereas in the NH group, the VAS average scores significantly decreased from 5.8 to 4.5 after TRT. CONCLUSION: TRT was effective in SSD patients with subjective tinnitus.

Comparison of acyclovir and famciclovir for the treatment of Bell's palsy.

The relative effectiveness of acyclovir and famciclovir in the treatment of Bell's palsy is unclear. This study therefore compared recovery outcomes in patients with Bell's palsy treated with acyclovir and famciclovir. The study cohort consisted of patients with facial palsy who visited the outpatient clinic between January 2006 and January 2014. Patients were treated with prednisolone plus either acyclovir (n = 457) or famciclovir (n = 245). Patient outcomes were measured using the House-Brackmann scale according to initial severity of disease and underlying disease. The overall recovery rate tended to be higher in the famciclovir than in the acyclovir group. The rate of recovery in patients with initially severe facial palsy (grades V and VI) was significantly higher in the famciclovir than in the acyclovir group (p = 0.01), whereas the rates of recovery in patients with initially moderate palsy (grade III-IV) were similar in the two groups. The overall recovery rates in patients without hypertension or diabetes mellitus were higher in the famciclovir than in the acyclovir group, but the difference was not statistically significant. Treatment with steroid plus famciclovir was more effective than treatment with steroid plus acyclovir in patients with severe facial palsy. Famciclovir may be the antiviral agent of choice in the treatment of patients with severe facial palsy.

Delayed facial nerve decompression for Bell's palsy.

Incomplete recovery of facial motor function continues to be long-term sequelae in some patients with Bell's palsy. The purpose of this study was to investigate the efficacy of transmastoid facial nerve decompression after steroid and antiviral treatment in patients with late stage Bell's palsy. Twelve patients underwent surgical decompression for Bell's palsy 21-70 days after onset, whereas 22 patients were followed up after steroid and antiviral therapy without decompression. Surgical criteria included greater than 90 % degeneration on electroneuronography and no voluntary electromyography potentials. This study was a retrospective study of electrodiagnostic data and medical chart review between 2006 and 2013. Recovery from facial palsy was assessed using the House-Brackmann grading system. Final recovery rate did not differ significantly in the two groups; however, all patients in the decompression group recovered to at least House-Brackmann grade III at final follow-up. Although postoperative hearing threshold was increased in both groups, there was no significant between group difference in hearing threshold. Transmastoid decompression of the facial nerve in patients with severe late stage Bell's palsy at risk for a poor facial nerve outcome reduced severe complications of facial palsy with minimal morbidity.

White matter integrity associated with clinical symptoms in tinnitus patients: A tract-based spatial statistics study.

OBJECTIVE: To assess the relationship between white matter (WM) integrity and clinical variables in tinnitus patients using diffusion tensor imaging (DTI). METHODS: Sixty-seven tinnitus patients and 39 healthy controls were enrolled in this study. The tinnitus duration, laterality, pitch and characteristics, and two psychological self-rating tests were used as independent variables. Differences between patients and controls in diffusion indices were evaluated using tract-based spatial statistics (TBSS), and multiple regression between DTI values in significant clusters and clinical variables was investigated. TBSS correlation analysis between the clinical variables and DTI indices was performed in tinnitus patients. RESULTS: The tinnitus group had higher mean diffusivity (MD) and axial diffusivity in WM under the auditory cortex and limbic system compared with control group. Depression symptom score (BDI) was the only significant variable affecting MD and axial diffusivity value in these clusters. TBSS correlation analysis with BDI in tinnitus patients showed BDI was associated with diffusion indices in widespread regions of WM. CONCLUSIONS: WM integrity in tinnitus was associated with depression symptoms in both inter- and intragroup analyses. Our results support the hypothesized implication of altered WM integrity in the physiopathology of emotional symptoms of tinnitus. KEY POINTS: • WM integrity of left auditory-limbic circuit in tinnitus is different in controls. • Depression symptoms are a significant clinical variable affecting DTI values. • DTI value is correlated with depression symptoms in tinnitus patients.

The prognostic value of electroneurography of Bell's palsy at the orbicularis oculi versus nasolabial fold.

OBJECTIVES/HYPOTHESIS: We compared the prognostic value of different placements measured by electroneurography (ENoG) in Bell's palsy, especially among patients with poor results on ENoG. STUDY DESIGN: Retrospective study using electrodiagnostic data and medical chart review from August 2006 to June 2013 was performed of patients who were diagnosed with Bell's palsy. METHODS: We included 81 patients treated from August 2006 to June 2013. Initial and final facial function was established clinically by the House-Brackmann scale. Final state of facial palsy was estimated after 6 months from onset of facial palsy. Patients with less than 10% of ENoG response (more than 90% degeneration) were divided into three groups according to ENoG response by electrode placement as follows: group A, ENoG for orbicularis oculi (oculi) ≥ 10% and ENoG for nasolabial fold (NLF) < 10%; group B, ENoG (oculi) < 10% and ENoG (NLF) ≥ 10%; and group C, ENoG (oculi) < 10% and ENoG (NLF) < 10%. RESULTS: There were no differences in demographic data among the three groups in terms of age, gender, initial paralysis, and days from the onset to ENoG. The complete/nearly complete recovery rates were the following: group A, 49.9%; group B, 75%; group C, 32%. The overall incomplete recovery rate in groups A and C was significantly worse than group B, and group C was the worst (P < 0.05). CONCLUSION: The results suggest that ENoG of the NLF has more prognostic value in the outcomes of Bell's palsy than ENoG of the oculi, with poorest results in patients with the NLF < 10%. LEVEL OF EVIDENCE: 4. Laryngoscope, 126:1644-1648, 2016.

Evaluation of tinnitus patients by audiometric configuration.

PURPOSE: Although tinnitus patients have different audiometric configuration, we evaluated them using the same approach. Thus we analyzed the clinical features of patients with subjective tinnitus classified according to audiometric configuration. MATERIALS AND METHODS: The study cohort consisted of 123 patients with subjective tinnitus who visited the tinnitus clinic from April 2013 to April 2014. Patients with a previous history of otologic disease or migrainous vertigo were excluded. Factors evaluated included pure tone audiometry, tinnitogram, auditory brainstem response (ABR), distortion product otoacoustic emissions (DPOAEs) and transient evoked otoacoustic emissions (TEOAEs). RESULTS: Tinnitus patients could be divided into three groups: Flat, high frequency gently sloping (HFGS) and high frequency steeply sloping (HFSS). HFGS showed female predominance and HFSS male predominance (p<0.05 each). THI score was higher in the HFGS than in the other groups (p<0.05). Tinnitus pitch and occupations varied, but showed specific tendencies in each group. On ABR, the HFSS group showed significant prolongation of wave I, III, and V latencies (p<0.05 each). On DPOAEs, the HFSS group showed significantly lower response rates at 3, 4, and 6 kHz (p<0.05 each). TEOAE normal rates were significantly higher in the Flat than in the HFGS and HFSS groups (p<0.05). CONCLUSIONS: Average pure tone thresholds were similar, but threshold values at high frequencies, ABR, DPOAEs, and TEOAEs differed among the groups. Therefore, different access to tinnitus patients could be required according to audiometric shape.

Comparison of clinical characteristics in patients with bilateral and unilateral tinnitus.

CONCLUSION: Discomfort from bilateral tinnitus was more frequent and severe than that from unilateral tinnitus. Also, patients with bilateral tinnitus were significantly older and tended to have a longer duration of tinnitus than those with unilateral tinnitus. Background and subjects: Although bilateral tinnitus differs from unilateral tinnitus, their treatment is identical. Clinical characteristics associated with tinnitus, including tinnitograms, were retrospectively examined in 105 patients with unilateral tinnitus and 102 with bilateral tinnitus evaluated in the center between January 2012 and January 2014. This study compared the two groups to assess the characteristics differentiating their treatment. RESULTS: Mean age was significantly higher in patients with bilateral than unilateral tinnitus (p = 0.04), but gender distribution and duration of tinnitus were similar in the two groups. Both tinnitus handicap index (THI) and Beck depression index (BDI) values were significantly higher in patients with bilateral than unilateral tinnitus (p < 0.05 each). Rates of hyperacusis (p = 0.23), ear fullness (p = 0.16), and vertigo (p = 0.31) did not differ significantly between the two groups. Also, audiology test results, including tinnitograms, showed no significant differences.

Clinical Differences in Types of Otalgia.

BACKGROUND AND OBJECTIVES: Although otalgia is usually associated with ear problems, it may also originate outside the ear. We therefore assessed the clinical characteristics of patients with otalgia. SUBJECTS AND METHODS: We analyzed 294 patients who presented with otalgia. We assessed differences in otalgia between adults and children, differences in otogenic vs. referred otalgia between adults and children, differences between men and women. RESULTS: Of the 294 patients, 208 (70.7%) had otogenic otalgia and 86 (29.3%) had referred otalgia. Hearing disturbance and otorrhea were significantly more common in otogenic otalgia, whereas rhinorrhea, sore throat, and postnasal drip were significantly more common in referred otalgia. Children were more likely to have otogenic otalgia than adults. The proportion of patients with referred otalgia was significantly higher in adults than in children (p<0.05). Otogenic otalgia was more common in men, whereas referred otalgia was more common in women. Among patients with referred otalgia, neuralgia was significantly more frequent in women than in men (p<0.05). CONCLUSIONS: Otogenic otalgia was more frequent in men than in women and in children than in adults, whereas referred otalgia was more frequent in women and adults, indicating that types of otalgia were dependent on age and gender.

Neurotological parameters and prognosis of Bell's palsy patients.

BACKGROUND: To investigate the relationship with prognosis, various neurotological examinations evaluating all four nerves within the internal auditory canal were performed in patients with Bell's palsy. METHODS: A total of 69 consecutive patients with Bell's palsy were included. They were treated uniformly with steroid and an antiviral agent and underwent neurotological examinations consisting of electronystagmography, pure-tone audiometry (PTA), electroneurography (ENoG), caloric test, rotatory chair test and cervical vestibular evoked myogenic potentials (cVEMP). According to the final recovery state, patients were divided into two groups: a complete recovery group and an incomplete recovery group. The incidence of abnormal findings in each test was compared between the two groups. RESULTS: Fifty-six patients recovered completely and 13 patients recovered incompletely. No association was observed between the rate of ipsilesional PTA threshold and the rate of abnormal caloric test, function tests and recovery state. However, the initial state of facial palsy, ENoG and the rate of abnormal cVEMP were significantly correlated with the rate of recovery. CONCLUSION: The results indicate that Bell's palsy may be more comparable to mononeuritis multiplex and that cVEMP could be a useful tool for predicting the prognosis of Bell's palsy.