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Tinnitus can be subclassified as either pulsatile or non-pulsatile based on the perceived quality of sound. Of them, pulsatile tinnitus (PT) is an auditory perception of heartbeat-synchronous sound, which is usually caused by vascular abnormalities. If PT is also audible by the examiner, it is also described as objective PT. Intracranial dural arteriovenous fistula (AVF) is one of the causes of PT. Dural AVF designates an abnormal direct connection between dural arteries and dural veins or a venous sinus, and accounts for approximately 10-15% of intracranial arteriovenous malformations. Dural AVFs are predominantly idiopathic, but a small percentage of patients have a history of previous craniotomy, trauma, or dural sinus thrombosis. The most common causes of traumatic AVFs are penetrating injuries to adjacent arteries and veins or iatrogenic sequelae of medical procedures. Diagnosis of traumatic AVFs are usually delayed for 2-6 months, because their clinical manifestations are quite variable and it takes time to be enlarged enough to emerge radiologically. Previous researchers have reported PT caused by traumatic AVF and its treatment. In most cases, tinnitus symptom occurred a few months after trauma, and there have been no reported cases of objective PT developed immediately after trauma by traumatic AVF. In the current study, we report a case of a traumatic AVF presenting as newly developed objective PT immediately after head Pulsatile Tinnitus due to Intracranial Dural Arteriovenous Fistula after Head Trauma by a Golf Ball

Multiple myeloma is a clonal B-cell tumor of slowly proliferating plasma cells within the bone marrow. It is a relatively well known disease, but temporal bone involvements have rarely been reported. It is not easy to diagnose multiple myeloma of the temporal bone in the early stage, since it presents with general, nonspecific otologic symptoms and pathologic confirma tion in the temporal bone is difficult. Multiple myeloma involving the temporal bone area is considered to be in its terminal stage, but the treatment strategy is the same as that for conventional multiple myeloma involving other organs. We experienced a case of facial palsy had suddenly developed and was later diagnosed with multiple myeloma after a pathologic review and systemic evaluation. Herein we report this rare case with a review of literature. � Korean J Otorhinolaryngol-Head Neck Surg 2011;54:73-6 Key WordsZZMultiple myeloma ㆍFacial paralysis ㆍTemporal bone.

Received July 1, 2011 Accepted July 30, 2011 Address for correspondence Ja-Won Koo, MD, PhD Departments of Otorhinolaryngology, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam 463-707, Korea Tel +82-31-787-7402 Fax +82-31-787-4057 E-mail jwkoo99@snu.ac.kr Posterior fossa meningioma located on the endolymphatic sac may present Meniere’s diseaselike symptoms possibly due to endolymphatic hydrops by tumor compression. A 70-yearold woman presented with recurrent vertigo and combined hearing loss that had lasted for 6 years. She had been diagnosed as left-sided posterior fossa meningioma with a maximum diameter of 20.3×7.7×12 mm about 10 years ago and had been followed up regularly. Since then she was found with a slightly increased tumor and thus referred to our department for the treatment of intractable recurrent vertigo accompanying Tumarkin attacks with secondary head trauma. Since pharmaceutical treatment was not effective, intratympanic gentamicin was repeatedly injected. After successful ablation of vestibular function, no further recurrence of vertigo or Tumarkin attack was reported. This case illustrates that posterior fossa meningioma can be intimately involved with endolymphatic sac and present symptoms and signs suggestive of endolymphatic hydrops. Korean J Otorhinolaryngol-Head Neck Surg 2011;54:722-6 Key WordsZZMeniere’s disease ᆞEndolymphatic hydrops ᆞMeningioma ᆞPosterior cranial Zfossa ᆞGentamicins.

Background and Objectives The purpose of this study was to analyze the survival rate treatment modalities and certain prognostic factors in patients with external auditory canal (EAC) cancer using the University of Pittsburgh TNM Staging System. Subjects and Method Medical records and radiological findings of 33 patients treated for EAC cancer between January 1995 and January 2009 were reviewed retrospectively. The median follow-up period was 65 months (range, 12-182 months). Results The most common histological type was squamous cell carcinoma (19 patients; 57.6%), followed by adenoid cystic carcinoma (9 patients; 27.3%), basal cell carcinoma (1 patient), adenocarcinoma (1 patient), rhabdomyosarcoma (1 patient), undifferentiated carcinoma (1 patient) and malignant small round cell tumor (1 patient). Seven of 33 patients died of EAC cancer and the overall survival rate was 70.6%. There was a significant difference in the survival rate with respect to TNM stages (p=.031). The 10 yr-survival rate of patients with stage I disease was 100.0%, whereas those of stages II, III and IV were 50.0, 80.0 and 58.3%, respectively. Five of 7 patients with recurrence had a history of initial positive resection margin. Conclusion Early detection and proper surgical treatment with sufficient resection margin are essential for disease-specific survival and prevention of recurrence in patients with EAC cancer.

Background and Objectives Several treatment options have been introduced to control Meniere’s disease (MD). Among them, intratympanic injection of gentamicin (ITGM) is now accepted as a standard treatment method for intractable vertigo in patients with hearing impaired MD. The purpose of this study was to analyze the clinical course and treatment flow in patients with MD and to analyze the efficacy and problems after ITGM. Subjects and Method A retrospective study was performed on 458 patients who were diagnosed as definite MD from May 2003 to October 2007 and were followed up at least 1 year. The authors investigated the course of disease and the results in our patients according to the treatment options. Several clinical parameters including frequency of vertigo, audiometry, caloric and rotation test were reviewed and analyzed according to the guideline of the AAO-HNS (1995), if necessary. Efficacy and problems after ITGM were reviewed. Results Among 458 patients, vertigo was resolved or improved in 399 patients (87.1%) with medical management. Fifty-nine patients needed further treatment (endolymphatic sac decompression: 4, Meniette: 2, ITGM: 53). Among 53 patients who got ITGM, 40 patients were followed up for more than 1 year after injection. Thirty-six patients (87.5%) showed successful control of vertigo. The average pure-tone threshold was changed from 54.1 dB to 56.9 dB after treatment. Three patients (7.5%) revealed more than 20 dB aggravation. Conclusion Vertigo was controlled by supportive treatments or medication in 87% of definite MD patients. And ITGM could effectively and reasonably control vertigo for intractable MD patients.

Background and Objectives Malleus fixation is one of the important causes of persistent conductive hearing loss. This study was designed to evaluate the clinical manifestation and the treatment outcome of malleus fixation. Subjects and Method This study was a retrospective review of medical records between 1989 and 2008. Patients diagnosed as malleus fixation by intraoperative findings at the Department of Otorhinolaryngology, Seoul National University Hospital were included. Those cases with chronic otitis media and congenital ossicular anomaly involving the incus or stapes were excluded. A total of 13 patients were included (M : F=4 : 9, Mean age: 24.4 years old). Results All patients (100%) complained of hearing loss. Preoperative mean air-bone conduction gap was 34.4 dB and 5 (83.3%) out of 6 patients had A-type in impedence audiometry and 3 (75%) out of 4 patients had negative results in Gelle test. In the temporal bone computed tomography (TBCT) findings, we could identify bony spicules (2 cases), sclerosis of ligament (3 cases) and epitympanic contraction (2 cases). According to the different causes of conductive hearing loss, corrective surgery was performed: the release of bony ankylosis (2 cases), lysis of ligament (6 cases) and ossiculoplasty (5 cases) were performed. There was a statistically significant improvement in air-bone conduction gap (34.4 dB vs. 20.3 dB, p=0.009) after surgery. Conclusion Considering the improvement of air-bone conduction gap after the corrective surgery, clinical suspicion of malleus fixation is important in cases of unknown conductive hearing loss.