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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., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

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.

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., (© 2023. Springer Nature Limited.)

Objective: To investigate long-term changes in femoral anteversion angle (FAA) in children with intoeing gait and to identify factors that affect FAA changes., Methods: We retrospectively analyzed three-dimensional computed tomography data from 2006 to 2022 of children with intoeing gait with ≥3 years of follow-up without active treatment. The study examined the mean changes in FAA, the effects of sex, age, and initial FAA on FAA change, and mean FAAs by age. Changes in FAA severity up to eight years of age were also observed and analyzed by sex., Results: A total of 126 lower limbs of 63 children (30 males, 33 females) with intoeing gait were included, with a mean age of 5.11±1.05 years and a mean follow-up period of 43.59±7.74 months. The initial FAA was 41.42°±8.29° and the follow-up FAA was 33.25°±9.19°, indicating a significant decrease (p<0.001). Significant correlations were observed between age and changes in FAA, as well as between initial FAA and changes in FAA (r=0.248, p=0.005; r=-0.333, p<0.001). At age 8 years, only 22 limbs were classified as having mild FAA severity., Conclusion: During the follow-up period, children with intoeing gait had a significant decreased in FAA. No significant difference in FAA change was found between sex, but younger children and those with greater initial FAA were more likely to have decreased FAA. However, most children retained moderate to severe severity of increased FAA. Further studies are required to validate these findings.

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., (© 2022. The Author(s).)

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)., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

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.

Background: Hearing loss is considered a potentially modifiable risk factor for dementia. However, the effect of use of a hearing aid on the development of dementia has not been clearly established. We aimed to assess the incidence of dementia in hearing-impaired individuals according to hearing aid use in a nationwide population-based cohort study with matched controls., Methods: This was a retrospective, longitudinal, cohort study of South Korean national claims data for individuals newly registered with hearing disabilities (better ear ≥40 dBHL with worse ear ≥80 dBHL, or better ear ≥60 dBHL) between 2004 and 2008. The hearing aid cohort comprised individuals who received hearing aid subsidies from the National Health Insurance within a year from disability registration. The comparison cohort comprised individuals without a record of a hearing aid claim during the study period after 1:1 matching for audiologic and sociodemographic factors with the hearing aid cohort. The occurrence of dementia was followed up until 2018., Results: Each cohort comprised 8780 individuals. Overall incidence of dementia in the hearing aid and comparison cohorts were 156.0 and 184.5 per 10,000 person-years, respectively (incidence rate ratio = 0.85, 95% confidence interval 0.79-0.91). In a multivariable analysis of the whole study populations, hearing aid use (hazard ratio = 0.75, 95% confidence interval 0.70-0.81) attenuated the risk of dementia., Conclusions: Dementia incidence in individuals with hearing disabilities was lower in hearing aid users than that in nonusers. Hearing rehabilitation with hearing aids should be encouraged for individuals with hearing loss., (Copyright © 2022 The Authors. Ear & Hearing is published on behalf of the American Auditory Society, by Wolters Kluwer Health, Inc.)

Background: To compare the incidence and severity of ipsilateral shoulder dysfunction and lymphedema of 2 groups of patients needing to undergo unilateral breast cancer surgery, one of which had only received printed education materials and the other group which had received educational materials plus preoperative education., Methods: We selected 61 patients who had been diagnosed with unilateral breast cancer and planned to undergo surgery. Before surgery, patients were randomly assigned, either to a control group that only received printed education materials about exercise for shoulder pain relief and lymphatic edema prevention following breast cancer surgery, or to an experimental group that received the printed education material with personal education. Participants were evaluated at 1, 3, 6, and 12 months after the surgery. To evaluate the impairment of shoulder function, we measured the passive shoulder range of motion (ROM), the degree of pain as visual analog scale (VAS), the short version of the disability of arm, shoulder, and hand (short DASH) scores, and the shoulder pain and disability index (SPADI). We checked arm circumferences to evaluate lymphedema., Results: There was no significant difference in demographic or clinical variables between the control and experimental groups. The experimental group showed significantly less limitation in abduction (P = .042) and forward flexion (P = .039) in the 6 months following surgery. Change in the VAS, short DASH, and SPADI scores were 1.633 (P < .001), 2.167 (P < .001), and 4.1 (P = .003) at 1 month following surgery, respectively. These then decreased with time. These changes started before shoulder ROM and arm circumference changes had occurred, which had started 3 months following surgery., Conclusions: Preoperative education might be helpful for the prevention of a shoulder ROM limitation, and we need to focus on pain and disability in patients immediately following breast cancer surgery, and then on ROM and lymphedema., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objectives: Diseases of the middle ear can interfere with normal sound transmission, which results in conductive hearing loss. Since video pneumatic otoscopy (VPO) findings reveal not only the presence of middle ear effusions but also dynamic movements of the tympanic membrane and part of the ossicles, analyzing VPO images was expected to be useful in predicting the presence of middle ear transmission problems. Using a convolutional neural network (CNN), a deep neural network implementing computer vision, this preliminary study aimed to create a deep learning model that detects the presence of an air-bone gap, conductive component of hearing loss, by analyzing VPO findings., Design: The medical records of adult patients who underwent VPO tests and pure-tone audiometry (PTA) on the same day were reviewed for enrollment. Conductive hearing loss was defined as an average air-bone gap of more than 10 dB at 0.5, 1, 2, and 4 kHz on PTA. Two significant images from the original VPO videos, at the most medial position on positive pressure and the most laterally displaced position on negative pressure, were used for the analysis. Applying multi-column CNN architectures with individual backbones of pretrained CNN versions, the performance of each model was evaluated and compared for Inception-v3, VGG-16 or ResNet-50. The diagnostic accuracy predicting the presence of conductive component of hearing loss of the selected deep learning algorithm used was compared with experienced otologists., Results: The conductive hearing loss group consisted of 57 cases (mean air-bone gap = 25 ± 8 dB): 21 ears with effusion, 14 ears with malleus-incus fixation, 15 ears with stapes fixation including otosclerosis, one ear with a loose incus-stapes joint, 3 cases with adhesive otitis media, and 3 ears with middle ear masses including congenital cholesteatoma. The control group consisted of 76 cases with normal hearing thresholds without air-bone gaps. A total of 1130 original images including repeated measurements were obtained for the analysis. Of the various network architectures designed, the best was to feed each of the images into the individual backbones of Inception-v3 (three-column architecture) and concatenate the feature maps after the last convolutional layer from each column. In the selected model, the average performance of 10-fold cross-validation in predicting conductive hearing loss was 0.972 mean areas under the curve (mAUC), 91.6% sensitivity, 96.0% specificity, 94.4% positive predictive value, 93.9% negative predictive value, and 94.1% accuracy, which was superior to that of experienced otologists, whose performance had 0.773 mAUC and 79.0% accuracy on average. The algorithm detected over 85% of cases with stapes fixations or ossicular chain problems other than malleus-incus fixations. Visualization of the region of interest in the deep learning model revealed that the algorithm made decisions generally based on findings in the malleus and nearby tympanic membrane., Conclusions: In this preliminary study, the deep learning algorithm created to analyze VPO images successfully detected the presence of conductive hearing losses caused by middle ear effusion, ossicular fixation, otosclerosis, and adhesive otitis media. Interpretation of VPO using the deep learning algorithm showed promise as a diagnostic tool to differentiate conductive hearing loss from sensorineural hearing loss, which would be especially useful for patients with poor cooperation., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 The Authors. Ear & Hearing is published on behalf of the American Auditory Society, by Wolters Kluwer Health, Inc.)

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.

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., (© 2022. The Author(s).)

Abstract: This study analyzed the changes in the number of outpatients and disease presentation during the entirety of 2020, the period of COVID-19 pandemic.The average annual number of outpatient visits between 2017 and 2019 (before COVID-19) and the total number of outpatient visits in 2020 (COVID-19 period) were compared. Diagnostic codes were identified during 2 periods to analyze changes in the number of outpatient visits according to disease and month.The average annual number of outpatient visits was 47,105 before, and 40,786 during the COVID-19 pandemic, with a decrease of 13.4%. The number of outpatient visits in internal medicine decreased by 10.2% during the COVID-19 pandemic and tended to rebound during the second half of the year. However, the number of outpatient visits in the pediatric department decreased by 37.5% overall throughout the COVID-19 period and continued to decline in the second half of the year. The number of outpatients with infectious diseases decreased significantly (35.9%) compared to noninfectious diseases (cancer, 5.0%; circulatory disease, 4.1%). In addition, the number of outpatient visits due to viral diseases continued to decline, while the incidence of bacterial diseases increased rapidly in the second half of the year.This study confirmed that the number of outpatient visits due to bacterial or viral infections decreased throughout the COVID-19 crisis. Therefore, expanding public health and telemedicine services is necessary to prevent secondary health problems caused by essential medical use restrictions., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.)

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.

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.

Objective: The aim of this study was to investigate patterns of semicircular canal (SCC) and otolith organ dysfunction by vestibular mapping, and to determine the clinical implications of treatment outcomes in idiopathic sudden sensorineural hearing loss (ISSNHL)., Methods: We retrospectively reviewed 135 consecutive patients diagnosed with ISSNHL from January 2016 to December 2020. Patients underwent video-head impulse tests (vHIT) for each SCC, cervical vestibular-evoked myogenic potential test for the saccules, ocular vestibular-evoked myogenic potential test for the utricles, and hearing tests. Hearing outcomes were evaluated according to the American Academy of Otolaryngology-Head and Neck Surgery criteria and factors associated with prognosis were assessed. We also conducted vestibular mapping assessments and hierarchical cluster analysis., Results: Overall, utricular impairment (76, 56.3%) was the most frequent diagnosis in the 135 ISSNHL patients, followed by saccular impairment (59, 43.7%) and posterior SCC impairment (30, 22.2%). The mean number of affected end organs was 1.37 ± 1.24, with higher numbers in the complete recovery group than in the partial/no recovery groups. In a multivariate analysis, higher initial hearing level and abnormal vHIT results in the posterior SCC were associated with poor prognosis in ISSNHL. In hierarchical cluster analysis, horizontal SCC and anterior SCC showed the highest similarity but were in different clusters than posterior SCC, and the saccule and utricle were in separate clusters from the three SCCs., Conclusions: The vestibular end organ showed various patterns of dysfunction in patients with ISSNHL. Of the five vestibular end organs, only abnormal posterior SCC was associated with poor prognosis for hearing recovery., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

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., (© 2021. Society for Imaging Informatics in Medicine.)

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.

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.

Objective: To retrospectively review the characteristics of preschool children with speech and language disorders to determine their clinical features and compares the average degrees of language delay based on hospital visit purposes, language developmental delay causes, and maternal language., Methods: One thousand one hundred two children (832 males, 270 females) with the chief complaint of language or speech problems who underwent language assessment for the first time were included. Their medical records, including demographic data, language environments, and family history of language problems and other developmental problems, were collected. Furthermore, the results of language and developmental assessments and hearing tests were collected., Results: Among the children enrolled in this study, 24% had parental problems and 9% were nurtured by their grandparents. The average degree of language delay did not differ regarding purposes of hospital visits. The average degree of language delay was greatest in children with autism spectrum disorders and least in children with mixed receptive-expressive language disorders. In children with mothers who do not speak Korean as their native language, social quotients in the social maturity scale were less than 70., Conclusion: Language environment is an essential factor that may cause speech and language disorders. Moreover, maternal language seems to affect the social quotient of the social maturity scale.

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.

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., (© The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Importance: The association between hypertension and epistaxis has long been a subject of debate., Objectives: To evaluate the risk of epistaxis in patients with hypertension using a nationwide population cohort and to assess the association of hypertension with the methods of managing cases of epistaxis., Design, Setting, and Participants: In this retrospective cohort study, a hypertension cohort and comparison cohort were built using the Korean National Health Insurance Service-National Sample Cohort that represents the entire population of the Republic of Korea from January 1, 2002, to December 31, 2015. The hypertension cohort comprised 35 749 patients with a record of 3 or more prescriptions of antihypertensive medication and a diagnosis of hypertension (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code I10). Patients with other diseases associated with epistaxis, such as sinonasal tumors, facial trauma, bleeding tendency, and coagulation disorder, as well as those taking anticoagulant medications, were excluded. A comparison cohort comprised 35 749 individuals without hypertension matched sociodemographically in a 1:1 ratio. Statistical analysis was performed from January 1, 2019, to March 31, 2020., Main Outcomes and Measures: The incidence and recurrence of epistaxis were evaluated in both cohorts. The risk factors for epistaxis and management strategies were also assessed., Results: Among the 35 749 patients in the hypertension cohort (20 579 men [57.6%]; median age, 52 years [interquartile range, 45-62 years]) the incidence rate (IR) of epistaxis was 32.97 per 10 000 persons (95% CI, 30.57-35.51 per 10 000 persons); among the 35 749 individuals in the comparison cohort (20 910 men [58.5%]; median age, 52 years [interquartile range, 45-62 years]), the IR of epistaxis was 22.76 per 10 000 persons (95% CI, 20.78-24.89 per 10 000 persons) (IR ratio, 1.45; 95% CI, 1.29-1.63; adjusted hazard ratio, 1.47; 95% CI, 1.30-1.66). The IR of recurrent epistaxis was 1.96 per 10 000 persons in the hypertension cohort and 1.59 per 10 000 persons in the nonhypertension cohort (IR ratio, 1.23; 95% CI, 0.77-2.00). Patients with hypertension who experienced epistaxis were more likely to use the emergency department (odds ratio, 2.69; 95% CI, 1.70-4.25; Cohen h effect size, 0.27; 95% CI, 0.16-0.39) and receive posterior nasal packing (odds ratio, 4.58; 95% CI, 1.03-20.38; Cohen h effect size, 0.15; 95% CI, 0.03-0.26) compared with the comparison cohort., Conclusions and Relevance: This study suggests that patients with hypertension had an increased risk of epistaxis requiring hospital visits. In addition, epistaxis in patients with hypertension appeared to need more emergency department visits and require more posterior nasal packing procedures compared with patients without hypertension. Medical counseling about epistaxis is advisable for individuals with hypertension, and the presence of hypertension should be considered in managing nasal bleedings.

Objectives: To report the effects of scrambler therapy in patients diagnosed with failed back surgery syndromes and to analyze the factors affecting pain before and after the therapy., Methods: This study included 26 patients (12 males and 14 females). The Oswestry Disability Index (ODI) and Brief Pain Inventory (BPI) before and after scrambler therapy, Beck Depression Inventory (BDI) score before therapy, and residual pain after therapy were assessed. The changes in the ODI, BPI, and residual pain before and after the therapy were analyzed using the Wilcoxon signed rank test. Spearman correlation analysis and Fisher's exact test were used to confirm the correlation between BDI and other factors. Multiple regression analysis was used to identify independent factors predicting residual pain, posttherapy ODI, and posttherapy BPI., Results: The ODI changed from 25.69 ± 7.98 to 21.80 ± 9.41 ( p < 0.05), and the BPI changed from 68.96 ± 18.00 to 61.62 ± 20.27 after scrambler therapy ( p < 0.05). In addition, residual pain changed from 100 to 76.15 ( p < 0.05). The BDI was negatively correlated with the duration of scrambler therapy and positively correlated with the initial OPD and BPI. In multiple regression analysis, residual pain was significantly correlated with the BDI ( p < 0.05)., Conclusion: Scrambler therapy can be used to change the total scores of the ODI and BPI after 5 sessions of treatment. Also, residual pain was significantly related to the BDI. Clinical significance of depression severity on pain should be further investigated via prospective studies., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 Hayoung Byun et al.)

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.

Background: To compare the muscle strength of patients with a hip fracture according to the presence of sarcopenia after surgery and the correlation of measured values between a Biodex and surface electromyography (sEMG) in postoperative measurement of muscle strength., Methods: Seventy-one patients who underwent hip fracture surgery were included in this study. Muscle mass was measured using dual energy X-ray absorptiometry and the grip strength was evaluated using a dynamometer. The diagnosis of sarcopenia followed the Asian Working Group for Sarcopenia criteria. We evaluated the Biodex to assess muscle strength according to the presence of sarcopenia and at the same time measured the sEMG to evaluate the correlation of muscle strength between Biodex and sEMG., Results: We assigned 34 patients with sarcopenia and 37 without sarcopenia to 2 groups. In the comparison of muscle strength using Biodex and sEMG between the 2 groups, it was confirmed that muscle strength of sarcopenia group was decreased compared with that of the non-sarcopenia group, although there was no statistical significance between the groups. However, Biodex and sEMG showed very close correlation with muscle strength in all variables., Conclusions: We suggest that using sEMG for the evaluation of muscle strength after hip fracture surgery may be an excellent tool alternative to isokinetic testing machines such as the Biodex., Competing Interests: Conflict of interest: No potential conflict of interest relevant to this article was reported., (Copyright © 2020 The Korean Society for Bone and Mineral Research.)

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.

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., (© 2019 John Wiley & Sons Ltd.)

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.

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., (© 2019 S. Karger AG, Basel.)

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., (© 2018 The American Laryngological, Rhinological and Otological Society, Inc.)

Age-related hearing impairment (ARHI) is a complex degenerative disease in the elderly. As multiple factors interact during the development of ARHI, it is important to elucidate the major influencing factors to understand and prevent ARHI. We aimed to identify risk factors associated with the development of ARHI with a retrospective cohort from 2001 to 2010. The records of the adult subjects over 40 years of age who consecutively underwent a comprehensive health checkup including pure-tone audiometry at the Health Promotion Center were reviewed. During this period, 1560 subjects who underwent pure-tone audiometry more than twice, had no other otologic diseases, and were followed-up more than 2 years were included. A pure-tone average (PTA: 0.5, 1, 2, 4 kHz) was calculated. Development of ARHI was defined as a PTA at follow-up more than 10 dB greater than the baseline PTA. Times to the first development of ARHI were investigated. Overall, 12.7% of subjects developed ARHI within the first 4 years. High blood ionized calcium (hazard ratio [HR] 0.084), albumin (HR 0.239), systolic blood pressure (HR 0.577), thyroid hormone (T3) (HR 0.593), and alpha fetoprotein levels (HR 0.883) were associated with decreased hazard for the development of ARHI. In contrast, high blood high-density lipoprotein (HR 2.105), uric acid (HR 1.684), total protein (HR 1.423), and total bilirubin levels (HR 1.220) were potential risk factors for the development of ARHI. Development of ARHI is common among the aged population, and a variety of factors may interact during this process. The results of this study can be used for counseling of adults at high-risk of developing ARHI with regard to regular audiological check-up.

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.

Objectives: The aim of this study was to assess the objective and subjective long-term binaural benefits of surgical correction in children with unilateral congenital aural atresia, using an open-set sentence test in noise and subjective questionnaires., Design: A prospective study was performed between August 2010 and February 2013. This study included pediatric patients who had unilateral conductive hearing loss (normal bone conduction hearing) on the atretic side but normal air conduction hearing on the normal side and were scheduled to undergo a primary canaloplasty. Pure-tone audiometry, the hearing in noise test (HINT), and questionnaires (Sound-Spatial-Qualities of Hearing Scale; Glasgow Benefit Inventory [GBI]) were administered preoperatively and at 6 and 12 months postoperatively., Results: Among 34 consecutive patients who initially met enrollment criteria, 26 subjects (23 boys and 3 girls) aged 10 to 16 years (mean 12.3 years) completed this study. Canaloplasty and hearing restoration procedures were performed uneventfully in all patients. The mean air conduction thresholds were significantly improved from 63.9 to 35.0 dB (6 months) and 39.4 dB (12 months) after surgery (p < 0.001). In HINT, speech understanding in noise that was presented toward the newly opened atretic ear significantly improved at 1 year postoperatively (p = 0.014). In noise toward the normal ear, speech understanding significantly improved after surgery, from -0.1 dB preoperatively to -2.0 dB at 6 months (p = 0.002) and -1.8 dB at 12 months (p = 0.005) (p for quadratic trend = 0.036). The composite score improved from -2.6 dB preoperatively to -3.4 dB at 6 months and -3.6 dB at 12 months (p = 0.045; p for linear trend = 0.005). The Sound-Spatial-Qualities of Hearing Scale scores in all domains significantly improved 1 year after surgery (p < 0.034). The mean GBI scores in each domain ranged from 14.2 to 49.4. Total GBI score was correlated with better signal to noise ratio in noise toward the atretic ear as measured by HINT at postoperative 1 year (Spearman ρ = 0.482, p = 0.013)., Conclusions: Teenaged patients with unilateral congenital aural atresia showed satisfactory hearing improvement after canaloplasty with hearing restoration surgery. In a serial long-term follow-up, speech understanding in noise measured by HINT improved over time. One year after surgery, teenaged children acquired binaural hearing (binaural squelch), as measured by the HINT with noise presented to the newly opened atretic ear. Subjective questionnaires also showed improvements in binaural hearing function and quality of life.

Objective: To investigate the changes in sound localization ability in the horizontal plane after canaloplasty in unilateral congenital aural atresia (CAA) patients., Study Design: Prospective interventional study., Setting: Tertiary referral center., Patients: Twenty-eight patients with unilateral CAA were enrolled. All patients had unilateral conductive hearing loss., Interventions: Canaloplasty., Main Outcome Measures: Pure tone audiometry, sound localization test, and the Speech, Spatial, and Quality questionnaire (SSQ) were administered preoperatively, 6 and 12 months postoperatively. For the sound localization test, 8 loudspeakers were positioned in a circle at 45-degree intervals, and patients were instructed to identify the speaker from which sound was coming. Mean correct response rate and mean error degree were calculated for each patient. The correct lateralization rate to the ipsilesional/contralesional stimuli was also calculated., Results: Mean hearing threshold decreased from preoperatively 63.8 to 39.4 dB 12 months after canaloplasty. Mean correct response rate and error degree at preoperative evaluation were 26.0% and 60.7 degrees, respectively, and these were respectively improved to 58.5% and 27.8 degrees postoperatively. Respective mean correct lateralization rate to ipsilesional stimuli after canaloplasty improved from 20.6% to 84.0%, and that to contralesional stimuli slightly improved from 93.8% to 98.8%. Patients with good postoperative hearing (<40 dBHL) showed better sound localization results. In addition, self-assessment scores of spatial domain in the SSQ questionnaire were significantly improved after the operation., Conclusion: Sound localization performance improved significantly after canaloplasty. Canaloplasty could provide better localization benefit and subjective improvement in spatial sensation to unilateral CAA patients.

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., (Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives: To investigate auditory perception, speech production, and language ability of prelingually deaf toddlers with cerebral palsy (CP) who were implanted within a sensitive period and who received proper speech therapy. Comparison of their outcomes with age- and sex-matched CI recipients without additional disabilities was also performed., Methods: We retrospectively reviewed a cohort of pediatric CI in Samsung Medical Center. Eight CP subjects who received CI before 3 years of age and age-sex matched control recipients who had no additional disabilities except idiopathic sensorineural hearing loss (SNHL) were included for the analysis. Preoperative evaluation included the Categories of Auditory Performance (CAP) score, Korean Version of the Ling's Stage (K-Ling), Sequenced Language Scale for Infants (SELSI), Bailey Scales of Infant Development II assessment, Social Maturity Scale test, and grading of CP severity using severity level and Gross Motor Function Classification System for CP (GMFCS). To measure the outcome, the CAP scores, K-Ling, and SELSI were performed at 3, 6, 12, and 24 months after implantation., Results: Four CP children with outstanding performances showed comparable achievement with matched control recipients. These patients had less severe motor disabilities (mild-moderate severity, GMFCS level 1-3), better social quotient, and better cognitive abilities. Although the others showed poor language abilities and hardly produced meaningful speech, their CAP scores reached 1 or 2 in 24 months after implantation., Conclusions: Deaf children with CP could have various ranges of benefits up to the levels of normal peers whose only disability was hearing loss, when CI was performed within a critical period. Especially, children with mild or moderate CP had a favorable outcome after CI, equivalent to that of normal peers., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Objectives: Treatment of traumatic perilymph fistula (PLF) remains controversial between surgical repair and conservative therapy. The aim of this study is to analyze the outcomes of early surgical exploration in suspected barotraumatic PLF., Methods: Nine patients (10 cases) who developed sudden sensorineural hearing loss and dizziness following barotrauma and underwent surgical exploration with the clinical impression of PLF were enrolled. Types of antecedent trauma, operative findings, control of dizziness after surgery, postoperative hearing outcomes, and relations to the time interval between traumatic event and surgery were assessed retrospectively., Results: All patients had sudden or progressive hearing loss and dizziness following trauma. Types of barotrauma were classified by the origin of the trauma: 4 external (car accident, slap injury) and 6 internal traumas (lifting, nasal blowing, straining). Surgical exploration was performed whenever PLF was suspected with the time interval of 2 to 47 days after the trauma. The possible evidence of PLF was found during surgery in 9 cases: a fibrous web around the oval window (n=3), fluid collection in the round window (RW; n=6) and bulging of the RW pseudomembrane (n=1). In every patient, vestibular symptoms disappeared immediately after surgery. The hearing was improved with a mean gain of 27.0±14.9 dB. When the surgical exploration was performed as early as less than 10 days after the trauma, serviceable hearing (≤40 dB) was obtained in 4 out of 7 cases (57.1%)., Conclusion: Sudden or progressive sensorineural hearing loss accompanied by dizziness following barotrauma should prompt consideration of PLF. Early surgical exploration is recommended to improve hearing and vestibular symptoms.

Objectives: Advances in reconstruction and conservative surgery and the importance of quality of life (QOL) encouraged this reevaluation of surgery-based treatments for oropharyngeal cancer. We tried to compare treatment outcome and QOL after surgery-based versus radiation-based treatment in oropharyngeal cancer., Methods: The 133 eligible patients were divided into surgery-based and radiotherapy (RT)-based treatment groups. Medical records were reviewed, and EORTC QLQ-C30 and HN65 questionnaires were completed for survivors. Three-year overall survivals, disease-free survivals, locoregional control rates, and QOL scores were compared between the two groups., Results: Demographic data and overall stages were not significantly different between the two groups, and all survival rates were non-significantly different, either. The scores for most QOL items were equivalent, however, for a few items, scores were significantly better in surgery-based group., Conclusion: The surgery-based group achieved equivalent treatment outcomes and slightly better QOL scores than the RT-based group. The results of this study suggest that surgery could still be considered as a first-line therapy for oropharyngeal cancer.

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.

Objectives: To analyze the error rate of ex vivo mapping and to evaluate in situ mapping of lymph node (LN) levels during neck dissection (ND) METHODS: We retrospectively reviewed the pathological data on metastatic LN levels in head and neck cancer patients that had ND and ex vivo mapping of LN levels. Among them, we included the data from 43 patients that had a high risk for metastatic nodes based on both the preoperative CT and PET/CT. We compared the metastatic node levels based on the radiological studies and surgical pathology. In addition, we prospectively evaluated the accuracy of in situ mapping (N = 20)., Results: With ex vivo mapping, the discrepancy between the radiological results and the pathological reports was 11.6% (5 out of 43); two side mismatches, two up down mismatches, and one faulty labeling, and in 7.0% (3 out of 43), the adjuvant treatment was redirected. However, in situ mapping of LN levels during ND resulted in no differences between the post-operative pathological and preoperative radiological findings., Conclusion: Ex vivo mapping of LN levels had an error rate of 11.6% in labeling of LN levels. In situ mapping of cervical LN levels during ND provided more accurate results about the status of LN metastasis.