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Purpose: Arterial stiffness, represented by estimated pulse wave velocity (ePWV), is the independent surrogate marker for cardiovascular event. The aim of the study was to investigate the significance of ePWV in the treatment outcome of idiopathic sudden sensorineural hearing loss (SSNHL). Methods: One hundred and ten patients with idiopathic SSNHL who hospitalized between April 2019 and March 2022 were evaluated. Arterial stiffness was calculated with formula for ePWV and other cardiovascular parameters of body mass index (BMI), and serum lipid level was determined. All patients received systemic high-dose steroid therapy and intratympanic steroid injections as a salvage management. Treatment outcome was assessed at 6 months after treatment, and classified as recovery and nonrecovery groups according to hearing recovery. Results: The initial pure-tone hearing threshold was 72.6 ± 23.8 dB and final hearing threshold was 52.63 ± 31.10 dB. After treatment, 60 (54.5%) patients included in recovery group and other 50 (45.5%) were classified as nonrecovery group. Age, days of onset to treatment, BMI, waist circumference, and ePWV were higher in the nonrecovery group compared to recovery group in univariate analysis (p = 0.039, p = 0.049, p = 0.003, p = 0.004, p = 0.007, respectively). In multivariate analysis, days of onset to treatment, BMI, and ePWV were associated with recovery (p = 0.030, p = 0.007, p = 0.022). Conclusion: Higher ePWV, a measure of arterial stiffness, was associated with a poor hearing recovery of SSNHL. [ABSTRACT FROM AUTHOR]

More people use the internet for medical information, especially YouTube. Nevertheless, no study has been conducted to analyze the quality of YouTube videos about tinnitus in Korea. This study aims to review the contents and quality of YouTube videos on tinnitus. The top 100 Korean YouTube videos on tinnitus were reviewed by a tinnitus expert. This study assessed video details: title, creator, length, and popularity indicators—subscribers, views, and likes. The contents of the video clips were analyzed to determine the relevance, understandability, actionability, and quality of information. Out of 100 tinnitus videos, 27 were created by otolaryngologists, 25 by traditional Korean medicine doctors, 25 by other medical professionals, and 3 by lay persons. Sensorineural tinnitus was frequently dealt, and hearing loss, stress, and noise were introduced as main causes of tinnitus. Otolaryngologists' videos covered verified treatments, but others suggested unproven therapies including herbal medicine or acupressure. Otolaryngologists' videos showed significantly higher understandability and quality of information compared to others (p < 0.001). This study found that tinnitus YouTube videos frequently present low-quality and incorrect material, which could have an adverse effect on patients. Results highlight the need for tinnitus specialists to provide accurate information. [ABSTRACT FROM AUTHOR]

Learning-based data structures, such as a learned Bloom filter and a learned functional Bloom filter (L-FBF), have recently been proposed to replace traditional structures. However, using these structures for dynamic data processing is difficult because a specific element cannot be deleted from a trained model. A counting Bloom filter with return values (rCBF) is a more efficient key–value structure than a functional Bloom filter (FBF) for repetitive insertions and deletions. In this study, we propose a learned rCBF (L-rCBF) comprising a model, a Bloom filter, and an rCBF and the deletion algorithm for the L-rCBF. To delete a specific element from the L-rCBF, two different operations are performed according to four different cases. In the experiments, the proposed L-rCBF is compared with a single rCBF and an L-FBF in terms of undeletables and search failures, and this comparison is conducted using two different models. In addition, we present a theoretical analysis of the rCBF with experimental results to demonstrate that a structure with an rCBF is more suitable for dynamic data than a structure with an FBF. [ABSTRACT FROM AUTHOR]

Most patients with stroke suffer from complications and these include dysphagia. Dysphagia can cause malnutrition, and malnutrition affects prognosis and recovery. However, there is a lack of accurate studies on the nutritional status of stroke patients with dysphagia and its associated factors in different phases of stroke. This study retrospectively investigated 620 stroke patients who underwent a videofluoroscopic swallowing study (VFSS) due to dysphagia, from March 2018 to February 2021. The study aimed to evaluate the nutritional state and associated factors of malnutrition in acute and subacute stroke patients with dysphagia. Serum albumin and percentage of current weight to ideal weight were used to determine nutritional status. Malnutrition was observed in 58.9 and 78.9% of acute and subacute stroke patients. Exact logistic regression analysis revealed that old age and high penetration–aspiration scale score were significantly associated factors for malnutrition in patients with acute stroke. Old age, stroke history, bilateral hemiplegia, high modified Rankin score, low Korean Mini-Mental State Examination, pneumonia, and high functional dysphagia score were significantly associated factors for malnutrition in patients with subacute stroke. Patients with these associated factors in each phase of stroke require active nutritional assessment and care to decrease the risk of malnutrition. [ABSTRACT FROM AUTHOR]

More people use the internet for medical information, especially YouTube. Nevertheless, no study has been conducted to analyze the quality of YouTube videos about tinnitus in Korea. This study aims to review the contents and quality of YouTube videos on tinnitus. The top 100 Korean YouTube videos on tinnitus were reviewed by a tinnitus expert. This study assessed video details: title, creator, length, and popularity indicators—subscribers, views, and likes. The contents of the video clips were analyzed to determine the relevance, understandability, actionability, and quality of information. Out of 100 tinnitus videos, 27 were created by otolaryngologists, 25 by traditional Korean medicine doctors, 25 by other medical professionals, and 3 by lay persons. Sensorineural tinnitus was frequently dealt, and hearing loss, stress, and noise were introduced as main causes of tinnitus. Otolaryngologists' videos covered verified treatments, but others suggested unproven therapies including herbal medicine or acupressure. Otolaryngologists' videos showed significantly higher understandability and quality of information compared to others (p < 0.001). This study found that tinnitus YouTube videos frequently present low-quality and incorrect material, which could have an adverse effect on patients. Results highlight the need for tinnitus specialists to provide accurate information. [ABSTRACT FROM AUTHOR]

Acute thoracic aortic dissection is a life-threatening disease, in which blood leaking from the damaged inner layer of the aorta causes dissection between the intimal and adventitial layers. The diagnosis of this disease is challenging. Chest x-rays are usually performed for initial screening or diagnosis, but the diagnostic accuracy of this method is not high. Recently, deep learning has been successfully applied in multiple medical image analysis tasks. In this paper, we attempt to increase the accuracy of diagnosis of acute thoracic aortic dissection based on chest x-rays by applying deep learning techniques. In aggregate, 3,331 images, comprising 716 positive images and 2615 negative images, were collected from 3,331 patients. Residual neural network 18 was used to detect acute thoracic aortic dissection. The diagnostic accuracy of the ResNet18 was observed to be 90.20% with a precision of 75.00%, recall of 94.44%, and F1-score of 83.61%. Further research is required to improve diagnostic accuracy based on aorta segmentation. [ABSTRACT FROM AUTHOR]

In this study, we investigated the effects of carbonated water concentration on swallowing function using surface electromyography (sEMG). Healthy subjects (n = 52, 26.77 ± 3.21 years old) were asked to perform two swallows each of noncarbonated water, low-concentration carbonated water, medium-concentration carbonated water, and high-concentration carbonated water. Onset time, the mean sEMG activity amplitude, and duration of muscle activity in each swallow were measured and analyzed for orbicularis oris, masseter, submental muscle complex and infrahyoid muscles. Onset time significantly decreased and mean sEMG activity amplitude significantly increased with carbonation concentration. Therefore, stimulation with carbonation can be effective for modulating a faster and stronger swallow in the oral and pharyngeal phases of swallowing, and its effect on amplitude was greater in the oral phase than in the pharyngeal phase.Clinical Trials Registration This study is registered with Clinical Research Information Service (KCT0005925). [ABSTRACT FROM AUTHOR]

A machine learning platform operated without coding knowledge (Teachable machine®) has been introduced. The aims of the present study were to assess the performance of the Teachable machine® for diagnosing tympanic membrane lesions. A total of 3024 tympanic membrane images were used to train and validate the diagnostic performance of the network. Tympanic membrane images were labeled as normal, otitis media with effusion (OME), chronic otitis media (COM), and cholesteatoma. According to the complexity of the categorization, Level I refers to normal versus abnormal tympanic membrane; Level II was defined as normal, OME, or COM + cholesteatoma; and Level III distinguishes between all four pathologies. In addition, eighty representative test images were used to assess the performance. Teachable machine® automatically creates a classification network and presents diagnostic performance when images are uploaded. The mean accuracy of the Teachable machine® for classifying tympanic membranes as normal or abnormal (Level I) was 90.1%. For Level II, the mean accuracy was 89.0% and for Level III it was 86.2%. The overall accuracy of the classification of the 80 representative tympanic membrane images was 78.75%, and the hit rates for normal, OME, COM, and cholesteatoma were 95.0%, 70.0%, 90.0%, and 60.0%, respectively. Teachable machine® could successfully generate the diagnostic network for classifying tympanic membrane. [ABSTRACT FROM AUTHOR]

Background: This study aimed to develop an algorithm for multilabel classification according to the distance from carina to endotracheal tube (ETT) tip (absence, shallow > 70 mm, 30 mm ≤ proper ≤ 70 mm, and deep position < 30 mm) with the application of automatic segmentation of the trachea and the ETT on chest radiographs using deep convolutional neural network (CNN). Methods: This study was a retrospective study using plain chest radiographs. We segmented the trachea and the ETT on images and labeled the classification of the ETT position. We proposed models for the classification of the ETT position using EfficientNet B0 with the application of automatic segmentation using Mask R-CNN and ResNet50. Primary outcomes were favorable performance for automatic segmentation and four-label classification through five-fold validation with segmented images and a test with non-segmented images. Results: Of 1985 images, 596 images were manually segmented and consisted of 298 absence, 97 shallow, 100 proper, and 101 deep images according to the ETT position. In five-fold validations with segmented images, Dice coefficients [mean (SD)] between segmented and predicted masks were 0.841 (0.063) for the trachea and 0.893 (0.078) for the ETT, and the accuracy for four-label classification was 0.945 (0.017). In the test for classification with 1389 non-segmented images, overall values were 0.922 for accuracy, 0.843 for precision, 0.843 for sensitivity, 0.922 for specificity, and 0.843 for F1-score. Conclusions: Automatic segmentation of the ETT and trachea images and classification of the ETT position using deep CNN with plain chest radiographs could achieve good performance and improve the physician's performance in deciding the appropriateness of ETT depth. [ABSTRACT FROM AUTHOR]

The Korean government started to cover part of the price of hearing aids ($200) for individuals with hearing disabilities in 1997, and the reimbursement for a hearing aid increased in 2005 ($300) and again in 2015 ($1000). The aim of this study was to evaluate the annual trend of newly-registered individuals with hearing disability according to the changes of the hearing aid provision scheme. Subjects with newly-registered hearing disabilities were assessed using Korean National Health Insurance Service (KNHIS) data from January 1, 2004, to December 31, 2018. A total of 271,742 individuals were newly registered during the index period. Records of hearing aid prescriptions and hearing aid subsidies were used to assess the adoption of hearing aids. This study also assessed the intervals between registration of hearing disability and the adoption of hearing aids, as well as the number of hearing aid subsidies provided. From 2004 to 2009 there was a slight increase in the number of individuals newly registered with hearing disabilities, and from 2011 to 2015, the number showed a tendency to decrease. Then, from 2015, the number of individuals with hearing disabilities increased abruptly, and the proportion of subjects receiving hearing aid subsidies also increased. Between 2004 and 2018, the time interval from hearing disability registration to hearing aid adoption showed a decreasing trend. We conclude that the annual number of individuals with newly-registered hearing disabilities is affected by the level of the hearing aid subsidy, and there is much unregistered or unaddressed hearing loss prior to the introduction of realistic hearing aid provision. [ABSTRACT FROM AUTHOR]

As a challenging attempt to replace a traditional data structure with a learned model, this paper proposes a learned functional Bloom filter (L-FBF) for a key–value storage. The learned model in the proposed L-FBF learns the characteristics and the distribution of given data and classifies each input. It is shown through theoretical analysis that the L-FBF provides a lower search failure rate than a single FBF in the same memory size, while providing the same semantic guarantees. For model training, character-level neural networks are used with pretrained embeddings. In experiments, four types of different character-level neural networks are trained: a single gated recurrent unit (GRU), two GRUs, a single long short-term memory (LSTM), and a single one-dimensional convolutional neural network (1D-CNN). Experimental results prove the validity of theoretical results, and show that the L-FBF reduces the search failures by 82.8% to 83.9% when compared with a single FBF under the same amount of memory used. [ABSTRACT FROM AUTHOR]

BACKGROUND: Obstructive sleep apnea (OSA) could influence peripheral vestibular function adversely via intermittent hypoxia and its consequences. OBJECTIVE: This study aimed to evaluate the risk of peripheral vestibular disorders in OSA using a nationwide population-based retrospective cohort study. METHODS: The National Health Insurance Service–National Sample Cohort represents the entire Korean population from 2002 to 2015. OSA was defined as individuals who had used medical services twice or more under a diagnosis of OSA(G47.33 in ICD-10). A comparison cohort consisted of socio-demographically matched non-OSA subjects in a ratio of 1:4. The incidences of benign paroxysmal positional vertigo(BPPV), Meniere's disease, and vestibular neuritis were evaluated in each cohort. RESULTS: A total of 2,082 individuals with OSA and 8,328 matched non-OSA subjects were identified. The incidence rates(IRs) of peripheral vertigo in OSA and non-OSA were 149.86 and 23.88 per 10,000 persons, respectively (Ratio of IR, IRR = 6.28, 95%CI 4.89 to 8.08). In multivariable analysis, the risk of peripheral vertigo was significantly higher in OSA(adjusted HR = 6.64, 95%CI 5.20 to 8.47), old age(adjusted HR = 1.03, 95%CI 1.02 to 1.04), female sex(adjusted HR = 1.92, 95%CI 1.48 to 2.50), and comorbidities(adjusted HR = 1.09, 95%CI 1.003 to 1.19). The IRRs of each vestibular disorder in the two groups were 7.32(95%CI 4.80 to 11.33) for BPPV, 3.61(95%CI 2.24 to 5.81) for Meniere's disease, and 9.51(95%CI 3.97 to 25.11) for vestibular neuritis. CONCLUSIONS: Subjects diagnosed with OSA had a higher incidence of peripheral vestibular disorders than those without OSA, according to national administrative claims data. It is recommended to take peripheral vertigo into account when counseling OSA. [ABSTRACT FROM AUTHOR]

This study aimed to develop a method for detection of femoral neck fracture (FNF) including displaced and non-displaced fractures using convolutional neural network (CNN) with plain X-ray and to validate its use across hospitals through internal and external validation sets. This is a retrospective study using hip and pelvic anteroposterior films for training and detecting femoral neck fracture through residual neural network (ResNet) 18 with convolutional block attention module (CBAM) + +. The study was performed at two tertiary hospitals between February and May 2020 and used data from January 2005 to December 2018. Our primary outcome was favorable performance for diagnosis of femoral neck fracture from negative studies in our dataset. We described the outcomes as area under the receiver operating characteristic curve (AUC), accuracy, Youden index, sensitivity, and specificity. A total of 4,189 images that contained 1,109 positive images (332 non-displaced and 777 displaced) and 3,080 negative images were collected from two hospitals. The test values after training with one hospital dataset were 0.999 AUC, 0.986 accuracy, 0.960 Youden index, and 0.966 sensitivity, and 0.993 specificity. Values of external validation with the other hospital dataset were 0.977, 0.971, 0.920, 0.939, and 0.982, respectively. Values of merged hospital datasets were 0.987, 0.983, 0.960, 0.973, and 0.987, respectively. A CNN algorithm for FNF detection in both displaced and non-displaced fractures using plain X-rays could be used in other hospitals to screen for FNF after training with images from the hospital of interest. [ABSTRACT FROM AUTHOR]

Imaging the Eustachian tube is challenging because of its complex anatomy and limited accessibility. This study fabricated a fiber-based optical coherence tomography (OCT) catheter and investigated its potential for assessing the Eustachian tube anatomy. A customized OCT system and an imaging catheter, termed the Eustachian OCT, were developed for visualizing the Eustachian tube. Three male swine cadaver heads were used to study OCT image acquisition and for subsequent histologic correlation. The imaging catheter was introduced through the nasopharyngeal opening and reached toward the middle ear. The OCT images were acquired from the superior to the nasopharyngeal opening before and after Eustachian tube balloon dilatation. The histological anatomy of the Eustachian tube was compared with corresponding OCT images, The new, Eustachian OCT catheter was successfully inserted in the tubal lumen without damage. Cross-sectional images of the tube were successfully obtained, and the margins of the anatomical structures including cartilage, mucosa lining, and fat could be successfully delineated. After balloon dilatation, the expansion of the cross-sectional area could be identified from the OCT images. Using the OCT technique to assess the Eustachian tube anatomy was shown to be feasible, and the fabricated OCT image catheter was determined to be suitable for Eustachian tube assessment. [ABSTRACT FROM AUTHOR]

Objectives: Foreign bodies (FBs) in external auditory canal (EAC) can occur at any age but are especially common in children and adolescents. The aims of the study were to evaluate the clinical characteristics of EAC FBs in children and adolescents and to discuss their proper management. Methods: A retrospective medical chart review was performed on patients who were treated for EAC FBs in a tertiary referral center from January 2007 to December 2017. We investigated the parameters of age, sex, type of FB, sedation method, complications, and removal strategy. Results: Of 284 patients, 176 (62.0%) were male. Peak incidences were noted at the ages of 3 to 6 years and 17 to 18 years. The frequently observed FBs were insects, followed by air-gun pellets, cotton balls, marbles, and earrings. Forty-one (14.4%) EAC FBs were removed with the naked eye, while 243 (85.6%) were removed under microscope in the otolaryngology department. Of these patients, 23 (9.5%) were administered sedatives and 1 (4.1%) needed general anesthesia. During or after the removal procedure, 4 (15.5%) patients had complications of EAC abrasion or laceration (42, 14.8%), and tympanic membrane perforation (2, 0.7%). Conclusions: External auditory canal FB showed a distinct characteristic of incidence regarding age, related to removal strategies. Characteristics of FB must be considered for safe removal. [ABSTRACT FROM AUTHOR]

Background: To compare long-term effects of antigravity treadmill (AGT) combined with conventional rehabilitation (CR) and CR after hip fracture in patients with sarcopenia.Methods: Forty-five patients were randomly allocated to AGT combined with CR (experimental group) or CR (control group) for 10 consecutive working days. Participants were evaluated prior to treatment, 3 weeks, 3 months, and 6 months after treatment. Outcome measurement included Koval walking ability scores functional ambulatory category (FAC), Berg Balance Scale (BBS), Korean version of Mini-Mental State Examination, Euro Quality of Life Questionnaire Five-Dimensional Classification, Korean version of modified Barthel index, and grip strength.Results: At 3 weeks and 3 months, the comparison of change scores in KOVAL between two groups revealed difference of 0.84 (95% CI: -1.19, -0.49; p for trend = .000) and 1.21 (95% CI: -2.05, -0.36; p for trend = .006), respectively. At 3 weeks, comparison of change score in FAC between two groups revealed a difference of 0.73 (95% CI: 0.28, 1.19; p for trend = .003). The comparison of change scores between two groups also showed a difference in the 6 months in KOVAL and in the 3 and 6 months in FAC. The comparison of changes in scores in BBS between two groups revealed difference of 11.63 (95% CI: 5.85, 17.40; p for trend = .001), 9.00 (95% CI: 2.28, 15.71; p for trend = .006), and 11.05 (95% CI: 3.62, 18.48; p for trend = .006), respectively, at each follow-up.Conclusions: Both groups were improved after intervention. As additional benefits were evident among those who carried out AGT, it may be appropriate for patients with sarcopenia after hip fracture surgery. [ABSTRACT FROM AUTHOR]

Key–value data structures have been extensively used in various applications. When a large amount of data needs to be compactly stored in a fixed memory size, a functional Bloom filter is a space-efficient key–value structure. In this letter, we propose a 2-stage functional Bloom filter structure composed of a primary functional Bloom filter and a secondary functional Bloom filter to resolve the indeterminables produced from the primary functional Bloom filter. We analytically present the memory ratio allocated for each of the two Bloom filters to achieve the lowest search failure rate. The analytical result is validated through experiments, thereby demonstrating that the optimal performance is realized when the secondary functional Bloom filter uses 3% of the total memory. [ABSTRACT FROM AUTHOR]

Hash-based data structures have been widely used in many applications. An intrinsic problem of hashing is collision, in which two or more elements are hashed to the same value. If a hash table is heavily loaded, more collisions would occur. Elements that could not be stored in a hash table because of the collision cause search failures. Many variant structures have been studied to reduce the number of collisions, but none of the structures completely solves the collision problem. In this paper, we claim that a functional Bloom filter (FBF) provides a lower search failure rate than hash tables, when a hash table is heavily loaded. In other words, a hash table can be replaced with an FBF because the FBF is more effective than hash tables in the search failure rate in storing a large amount of data to a limited size of memory. While hash tables require to store each input key in addition to its return value, a functional Bloom filter stores return values without input keys, because different index combinations according to each input key can be used to identify the input key. In search failure rates, we theoretically compare the FBF with hash-based data structures, such as multi-hash table, cuckoo hash table, and d-left hash table. We also provide simulation results to prove the validity of our theoretical results. The simulation results show that the search failure rates of hash tables are larger than that of the functional Bloom filter when the load factor is larger than 0.6. [ABSTRACT FROM AUTHOR]

Predicting hearing outcomes in idiopathic sudden sensorineural hearing loss (ISSNHL) is still challenging. We hypothesized that assessment of the semicircular canal (SCC) function via the video head impulse test (vHIT) might provide prognostic information. The medical records of patients diagnosed with ISSNHL from January 2015 to December 2018 were retrospectively reviewed. The prognostic values of the vHIT and other previously known factors in predicting hearing recovery were analyzed using a logistic regression model. A total of 148 patients with normal contra-lesional hearing were analyzed. Fifty-seven patients exhibited low gain (<0.7) on the vHIT in at least one SCC, more than the number of patients complaining of dizziness. Multivariable analysis revealed that non-recovery of normal hearing was associated with older age (OR 1.040), worse canal paresis on the caloric test (OR 1.023), worse initial hearing thresholds (OR 1.045) and abnormal vHIT result in the posterior SCC (OR 3.670). Low vHIT gain in the posterior SCC had specificity of 94.4% and positive predictive value of 85.7% in predicting non-recovery of normal hearing. In conclusion, abnormal vHIT gain in the posterior SCC appears to be a specific prognostic factor for incomplete hearing recovery in ISSNHL. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the clinical implications of diabetes for the management of idiopathic sudden sensorineural hearing loss (ISSNHL).Study Design: Retrospective study.Setting: Tertiary referral center.Subjects and Methods: ISSNHL patients (N = 403) who received inpatient management between January 2015 and December 2018 were analyzed. All were managed by a uniform treatment protocol of high-dose steroid therapy and salvage intratympanic steroid injections. Treatment results were evaluated according to the American Academy of Otolaryngology-Head and Neck Surgery's criteria 3 months after the start of treatment. We compared the clinical parameters and treatment outcomes of ISSNHL with and without diabetes. We also evaluated the influence of diabetes on the prognosis of ISSNHL by propensity score matching.Results: Overall, of the 403 ISSNHL patients, 94 (23.3%) had diabetes, and 11 were newly diagnosed with diabetes. The patients with diabetes were older than those without diabetes (P < .001), and their initial hearing threshold was significantly higher (P < .001). The diabetic patients were hospitalized for a longer period, and their hearing recovery rate was lower. However, when age, sex, and initial hearing level were adjusted by propensity score matching, the diabetic patients and matched controls yielded similar treatment results.Conclusions: ISSNHL with diabetes usually presents with severe hearing loss and requires longer hospitalization. However, diabetes itself may not influence the prognosis of ISSNHL. Proper management must be provided in ISSNHL with diabetes. [ABSTRACT FROM AUTHOR]

The Internet Protocol (IP) address lookup is one of the most challenging tasks for Internet routers, since it requires to perform packet forwarding at wire-speed for tens of millions of incomming packets per second. Efficient IP address lookup algorithms have been widely studied to satisfy this requirement. Among them, Bloom filter-based approach is attractive in providing high performance. This paper proposes a high-speed and flexible architecture based on a vectored-Bloom filter (VBF), which is a space-efficient data structure that can be stored in a fast on-chip memory. An off-chip hash table is infrequently accessed, only when the VBF fails to provide address lookup results. The proposed architecture has been evaluated through both a behavior simulation with C language and a timing simulation with Verilog. The hardware implementation result shows that the proposed architecture can achieve the throughput of 5 million packets per second in a field programmable gate array (FPGA) operated at 100 MHz. [ABSTRACT FROM AUTHOR]

Background: Vestibular schwannoma (VS) is a benign intracranial neoplasm originating in the Schwann cells of the vestibular nerve. Despite its origin, the most common symptom is sensorineural hearing loss which is presented in more than 90% of patients. The underlying pathophysiology of this hearing loss has not been fully understood.Objective: To assess the in vivo function of cochlear inner hair cells and spiral ganglion neurons in VS, cochlear dead regions (DRs) were evaluated via the threshold-equalizing noise (TEN) test in untreated VS patients.Method: Untreated patients diagnosed with sporadic unilateral VS and normal contralesional hearing were enrolled from July 2011 to June 2016. Audiometric evaluation including TEN tests were performed. Based on the magnetic resonance findings, characteristics of individual tumors were assessed.Results: The average pure-tone threshold (word recognition score [WRS]) of 23 enrolled patients was 42.7 dB (76.1%). Nineteen DRs (11.8% of 161 tested frequencies) were found in 8 patients (34.8% of enrolled cases). Among the intracanalicular (IAC) tumors, 6 out of 10 ears (60%) carried DRs, while 2 of 13 (15.4%) showed DRs among the cerebellopontine angle (CPA) lesions (p = 0.039). Pure-tone thresholds and WRS were not different between the two groups. Logistic regression analysis showed that the tumor location, IAC versus CPA, was significantly associated with DRs (p = 0.041, Nagelkerke R2 = 0.471), whereas age, sex, tumor size, distance from the tumor to the cochlea, T2-weighted hypointensity on the MRI and pure-tone thresholds showed no significance.Conclusions: Cochlear DRs are detected in hearing losses associated with unilateral sporadic VS using the TEN test. Individual DRs were detected variously in high, mid, or low frequencies. In our preliminary data, IAC tumors showed a higher number of DRs than CPA tumors despite similar average hearing thresholds. Further studies including longitudinal follow-up of hearing as well as change in DRs may provide useful information about VS patients. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the clinical significance of 4‐hour delayed‐enhanced 3.0 Tesla (3T) 3D‐fluid‐attenuated inversion recovery (FLAIR) MR imaging in sudden sensorineural hearing loss (SSNHL). Study design: Case series with comparisons. Setting: Tertiary referral centre. Participants: Eighty‐seven idiopathic SSNHL patients were enrolled between January 2015 and December 2016 and received high dose steroid therapy and intratympanic steroid injections as salvage treatment. Intervention: Pre‐contrast, 10‐minute and 4‐hour delayed‐enhanced 3D‐FLAIR MR images were obtained using double‐dose IV gadolinium. Main outcome measures: The results of treatment were evaluated according to Siegel's criteria 3 months after the start of treatment. Where possible lesion‐side laterality of the inner ear was identified based on the MR images, the associations between MR findings and other clinical parameters were analysed, and the relationships between hearing recovery and MR image findings were assessed. Results: Lesion‐side laterality was identified on MRI in 52 (59.7%), 18 (20.1%) and 8 (9.2%) patients, based on 4‐hour delayed, 10‐minute delayed, and pre‐contrast images, respectively. The hearing recovery rate was significantly lower in the patients with lesion‐side laterality on 4‐hour delayed images (P < 0.001). In a multivariate analysis, lesion‐side laterality on 4‐hour delayed images was associated with poor prognosis (OR = 5.6) after adjusting other prognostic factors including initial hearing level, lesion‐side laterality on 10‐min delayed images and presence of vertigo. In addition, as the extent of enhancement in the inner ear increased the probability of hearing recover decreased (P = 0.001). Conclusions: Contrast enhancement of inner ear structures can be seen on 4‐hour delayed‐enhanced 3T 3D‐FLAIR MR images in idiopathic SSNHL. Asymmetric lesion‐side enhancement of the inner ear may be associated with a poor prognosis. [ABSTRACT FROM AUTHOR]

Network traffic has increased rapidly in recent years, mainly associated with the massive growth of various applications on mobile devices. Named data networking (NDN) technology has been proposed as a future Internet architecture for effectively handling this ever-increasing network traffic. In order to realize the NDN, high-speed lookup algorithms for a forwarding information base (FIB) are crucial. This paper proposes a level-priority trie (LPT) and a 2-phase Bloom filter architecture implementing the LPT. The proposed Bloom filters are sufficiently small to be implemented with on-chip memories (less than 3 MB) for FIB tables with up to 100,000 name prefixes. Hence, the proposed structure enables high-speed FIB lookup. The performance evaluation result shows that FIB lookups for more than 99.99% of inputs are achieved without needing to access the database stored in an off-chip memory. [ABSTRACT FROM AUTHOR]

Objective: To investigate the clinical significance of 4-hour delayed-enhanced 3.0 Tesla three-dimensional (3D) fluid-attenuated inversion recovery (FLAIR) magnetic resonance (MR) imaging in acute vestibular neuritis.Study Design: A prospective observational study.Methods: Twenty-nine vestibular neuritis patients were enrolled between January 2017 and June 2017. Vestibular function tests, comprising the caloric and video head impulse tests and vestibular-evoked myogenic potential measurements, were performed. Precontrast, 10-minute, and 4-hour delayed-enhanced 3D-FLAIR MR images using double-dose IV gadolinium were obtained. After laterality and extent of inner ear enhancement were defined, the patients were divided into groups based on the patterns of enhancement, and clinical parameters were analyzed according to the groups.Results: Twenty patients (20 of 29, 69.0%) had obviously asymmetric enhancement of the affected inner ear structures on 4-hour delayed images, whereas only three patients (10.3%) had marked enhancement on 10-minute delayed images. The duration of spontaneous nystagmus (DurSN) was significantly longer in the patients with enhancement, especially with enhancement of the whole inner ear, including the vestibule and semicircular canals (P < 0.033). Spontaneous nystagmus resolved within 12 days in patients without laterality of enhancement, and within 16 days in ipsilesional enhancement confined to the inner auditory canal and fundus. Other results of vestibular function tests did not reveal any significant associations with MR enhancement.Conclusions: Contrast enhancement of the vestibular nerve and inner ear structures can be identified on 4-hour delayed-enhanced 3T 3D-FLAIR MR images in acute vestibular neuritis. The extent of inner ear enhancement may be associated with the DurSN.Level Of Evidence: 4. Laryngoscope, 1946-1951, 2018. [ABSTRACT FROM AUTHOR]

A counting Bloom filter (CBF) is commonly used in many applications for the membership queries of dynamic data since the CBF can provide delete operations. A CBF uses an array of $c$ -bit counters. The $c$ should be large enough to avoid overflows. In this letter, we propose an alternative to CBF, named ternary Bloom filter (TBF) for performance improvement. The proposed TBF allocates the minimum number of bits to each counter and includes more number of counters instead to reduce false positive probability. We present a mathematical analysis and experimental results for a set of performance measures. When the TBF consumes the same amount of memory as the CBF, the TBF provides much lower false positive rates than the CBF. [ABSTRACT FROM PUBLISHER]

Correction to: I Scientific Reports i https://doi.org/10.1038/s41598-022-26486-3, published online 19 December 2022 The original version of this Article contained an error in the spelling of the author Jin Hyuk Kim which was incorrectly given as Kim Jin Hyuk. These authors contributed equally: Dong Keon Lee, Jin Hyuk Kim, Jaehoon Oh and Tae Hyun Kim. [Extracted from the article]

This study evaluated the clinical effectiveness of wireless contralateral routing of offside signals hearing aids (CROS) in patients with severe to profound unilateral sensorineural hearing loss (USNHL). Twenty-one patients with USNHL were enrolled in this prospective study. The change of subjective satisfaction was evaluated using three questionnaires (K-HHIE, K-IOI-HA, K-SSQ). Changes in objective measurements were evaluated with sound localization test (SLT) and hearing in noise test (HINT). These tests were performed at pre-CROS fitting, 2 and 4 weeks after use of CROS. Subjects were grouped according to the age: young (<40 years) vs. old (≥40 years) group. The average K-HHIE and K-SSQ scores significantly improved with the use of CROS. SLT result revealed that hit rate and error degree improved in the young group and lateralization ability improved in both groups. In quiet environments, the reception threshold for speech also indicated a significant benefit in the young group. When the noise was presented to the normal ear, HINT revealed benefit of CROS, while loss of performance with CROS use was significant when noise was presented to the impaired ear. Wireless CROS provided increased satisfaction and overall improvement of localization and hearing. Although true binaural hearing cannot be obtained, CROS is a practical option for rehabilitation of USNHL. [ABSTRACT FROM AUTHOR]

Cochlear synaptopathy refers to a subclinical hearing pathology which could potentially explain hearing difficulties within the normal hearing threshold; it is also called "hidden hearing loss". We hypothesized that a temporary threshold shift in sudden sensorineural hearing loss (ISSNHL) also affects the function in the synapse. The aim of the study was to evaluate the presence of cochlear synaptopathy in patients who had completely recovered from unilateral SSNHL Nineteen patients who had completely recovered from ISSNHL from January 2018 to June 2021 were assessed. Complete recovery was established by pure tone audiometry (PTA) 3 months after treatment, according to the American Academy of Otolaryngology–Head and Neck Surgery criteria. Subjects completed the pure tone audiometry, speech audiometry and auditory brain stem response (ABR) test, and completed a questionnaire regarding hearing loss after hearing recovery. The ABR amplitudes of wave I and wave V, and the ratio of wave I/V of both ears (recovered side and healthy side) were assessed. A visual analog scale (VAS) and a hidden hearing loss questionnaire were used to evaluate subjective hearing difficulty. The ABR waves I of the recovered ears had a significantly lower amplitude (p = 0.002) than those of the healthy side, whereas there was no difference in wave V (p = 0.985) or in the ratio of wave I/V (p = 0.107). Some patients still felt mild hearing difficulty although their PTA results were normal, but there was no clear relationship between the VAS score, wave I amplitude and speech recognition scores. The present findings point to the possible existence of cochlear synaptopathy in ears that have completely recovered from unilateral sudden sensorineural hearing loss. We suggest that the causes of cochlear synaptopathy and of idiopathic sudden hearing loss may have something in common. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis To evaluate the prognostic and predictive value of electroneuronography (ENoG) in acute severe inflammatory facial paralysis, including Bell's palsy and Ramsay Hunt syndrome ( RHS). Study Design Prospective observational study. Methods Patients with acute severe facial paralysis of House-Brackmann (H-B) grade IV or worse and diagnosed with Bell's palsy or RHS were enrolled from August 2007 to July 2011. After treatment with oral corticosteroid, antiviral agent, and protective eye care, patients were followed up until recovery or 12 months from onset. Results Sixty-six patients with Bell's palsy and 22 with RHS were included. Multiple logistic regression analysis showed significant effect of ENoG value on recovery in both Bell's palsy and RHS. Values of ENoG were significantly worse in RHS than Bell's palsy. Chance of early recovery within 6 weeks after correction of ENoG effect was still significantly worse in RHS. Logistic regression analysis showed 90% chance of recovery within 6 months, expected with ENoG values of 69.2% degeneration (Bell's palsy) and 59.3% ( RHS). The receiver operating characteristics ( ROC) curves showed ENoG values of 82.5% (Bell's palsy) and 78.0% ( RHS) as a critical cutoff value of nonrecovery until 1 year, with the best sensitivity and specificity. Conclusions A higher chance of recovery was expected with better ENoG in Bell's palsy and RHS. Based on our data, nonrecovery is predicted in patients with ENoG value greater than 82.5% in Bell's palsy, and 78% in RHS. Level of Evidence 4. Laryngoscope, 123:2526-2532, 2013 [ABSTRACT FROM AUTHOR]

J Oral Pathol Med (2010) 39: 349–355 Objective: Defects in the mitotic checkpoint lead to aneuploidy and might facilitate tumorigenesis. However, the ploidy status in salivary duct carcinoma (SDC) has been reported to play limited role in prediction of prognosis. Thus, we need more reliable markers to reflect the rapid tumor progression in SDCs. We aimed here to investigate the expression of mitotic checkpoint proteins benzimidazole 1 homolog beta (BUB1B) and mitosis arrest-deficient 2 like 1 (MAD2L1) in SDCs and to determine their possible role as surrogate prognostic markers. Methods: We analyzed the clinical courses, pathologic findings and immunohistochemical profiles of mitotic checkpoint proteins (BUB1B and MAD2L1) in 27 pathologically confirmed SDCs. The expression status of BUB1B and MAD2L1 was compared with clinicopathologic factors and other molecular markers, such as TGF-beta, c-erb-B2, androgen receptor, vascular endothelial growth factor, and epidermal growth factor receptor, for prognostic significance. Results: High BUB1B expression was detected in 25.9% of subjects, and high MAD2L1 expression was in 55.6% of subjects. However, survival analysis revealed that mitotic checkpoint expression did not have prognostic significance in SDCs, nor did the other studied markers. Rather, the clinical variable of N classification at diagnosis (in N+ status, hazard ratio 5.19, 95% CI 1.26–21.32 for disease-free survival and hazard ratio 7.18, 95% CI 1.09–46.99 for overall survival) was strongly associated with survival and prognosis based on the Cox proportional hazard model. Conclusions: Mitotic checkpoint proteins appeared to play a limited role in predicting prognosis in SDCs. Further study is required to elucidate the exact role of mitotic checkpoint proteins in SDCs. [ABSTRACT FROM AUTHOR]

The present study aimed to develop a machine learning network to diagnose middle ear diseases with tympanic membrane images and to identify its assistive role in the diagnostic process. The medical records of subjects who underwent ear endoscopy tests were reviewed. From these records, 2272 diagnostic tympanic membranes images were appropriately labeled as normal, otitis media with effusion (OME), chronic otitis media (COM), or cholesteatoma and were used for training. We developed the "ResNet18 + Shuffle" network and validated the model performance. Seventy-one representative cases were selected to test the final accuracy of the network and resident physicians. We asked 10 resident physicians to make diagnoses from tympanic membrane images with and without the help of the machine learning network, and the change of the diagnostic performance of resident physicians with the aid of the answers from the machine learning network was assessed. The devised network showed a highest accuracy of 97.18%. A five-fold validation showed that the network successfully diagnosed ear diseases with an accuracy greater than 93%. All resident physicians were able to diagnose middle ear diseases more accurately with the help of the machine learning network. The increase in diagnostic accuracy was up to 18% (1.4% to 18.4%). The machine learning network successfully classified middle ear diseases and was assistive to clinicians in the interpretation of tympanic membrane images. [ABSTRACT FROM AUTHOR]

Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo, which results from dislodged vestibular otoliths. Because the otoliths are mainly composed of calcium carbonate, it has been suggested that BPPV may be associated with osteoporosis. We aimed to assess the incidence and recurrence of BPPV in osteoporosis patients using a nationwide population-based cohort study with matched control. We used the database of the National Health Insurance Service of Korea, a universal system covering all 50 million Koreans. Osteoporosis was defined as patients who underwent bone mineral density tests and visited a clinic three or more times between Jan 2004 and Dec 2006. A control cohort consisted of non-osteoporotic subjects socio-demographically matched in a ratio of 1:1. The incidence and recurrence of BPPV between Jan 2007 and Dec 2016 were evaluated. A total of 177,797 osteoporosis patients and the same number of matched controls were identified. The incidence rates (IR) of BPPV in the osteoporosis patients and controls were 31.58 and 18.09 per 1000 persons, respectively (ratio of IR, IRR = 1.75, 95% CI 1.67-1.83). The IRs of recurrent BPPV were 187.3/1000 in the osteoporosis, 163.5/1000 in the controls (IRR = 1.15, 95% CI 1.02-1.28). In multivariate analysis, osteoporosis, female gender (adjusted HR = 1.76), age <65 (adjusted HR = 0.8), living in a metropolis, earning more than the lowest income and hypertension were significantly associated with increased risk of BPPV development. For recurrence, osteoporosis was the only meaningful risk factor (adjusted HR = 1.12). In conclusion, the risks of BPPV development and recurrence are higher in osteoporosis. Physicians might consider informing osteoporosis patients of the risk of developing BPPV and related falls. [ABSTRACT FROM AUTHOR]

Objective: Analyze the outcomes of early surgical exploration in suspected traumatic perilymph fistulas (PLF). Method: Study Design: Retrospective case review. Setting: Tertiary otology referral center. Patients and Intervention: Nine patients (10 cases) that developed sudden sensorineural hearing loss and dizziness following head trauma underwent exploratory tympanotomy and PLF repair with the clinical impression of traumatic PLF. Outcome Measure: Postoperative hearing changes and control of dizziness. Results: All patients had sudden or progressive hearing loss and dizziness following head trauma; a car accident, slap injury, and barotraumas. Surgical exploration was performed 2 to 47 days after the trauma. Possible evidence of PLF was found in 9 cases and included: fibrous web around the oval window (OW) (n = 3), perilymph collection around the round window (RW) (n = 5), and bulging of the RW membrane (n = 1). After surgical repair, the mean hearing gain was 28dB (10~55dB); the hearing improved to serviceable levels in 6 out of 10 cases (60%). All patients had resolution of the vestibular symptoms after the surgery. Conclusion: Sudden or progressive sensorineural hearing loss accompanied by dizziness following head trauma should prompt the consideration of a traumatic PLF. Early surgical exploration is recommended to control dizziness and improve hearing outcomes. [ABSTRACT FROM AUTHOR]

Objective: Assess the efficacy and safety of ultrasound‐powered shears (Harmonic Scalpel) in free flap elevation for head and neck defects. Method: From January to August 2010, there were 15 patients enrolled, who underwent reconstructive surgery with free flap in our institution. Donor sites were radial forearm in 10, anterolateral thigh in 5, and fibula in 2. HS was used in harvesting the perforators and the vascular pedicles. Results: All the free flaps were successfully harvested within 50 to 70 min (from skin incision to pedicle ligation). Bleeding was minimal even without tourniquet application. All vascular pedicle dissections were performed without mechanical or thermal damages, and they were anastomosized to proper, recipient vessels. Conclusion: Based on our experiences, HS is a safe and efficient instrument in harvesting the free flaps, especially because of no increased risk of thermal damage to vascular pedicle. [ABSTRACT FROM AUTHOR]