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Recent advances in neuroscience and precise electric stimulation have enabled us to deliver complex signals to the central nervous system. But most of the successful electric stimulation devices such as cochlear implant and deep brain stimulation require surgery. Considering that most of the patients with hearing loss have a significant residual hearing, it is not feasible to open up the round window and insert an electrode in a functional cochlea. The concept of non-invasive electric stimulation of the auditory system may have a role in the future to overcome this unmet need in the clinic. Until now, many researchers have tried to delivery speech signal to the brain by means of non-invasive electric stimulation. Trans-cranial electric stimulation have most extensively been studied and interesting outcomes have recently been published. Some studied were able to prove that the envelope of the speech can be delivered by non-invasive electric stimulation. This new technology is called speech entrainment. By inducing speech entrainment, researchers were able to enhance the speech recognition score in noisy environments. But there are also some limitations in this approach. For instance, the time delay of the auditory sound and brain entrainment must be matched which is quite challenging. Although some limitation needs to be resolved, recent advancements in this new field is very interesting. More developments will follow in the next few years that can help patients with hearing loss in the near future.

OBJECTIVES From our previous study about the weak expressions of potassium-chloride (KCC2) and sodium-potassium-2 chloride (NKCC1) co-transporters in the lateral superior olive (LSO) in circling mice, we hypothesized that partially damaged cochlea of circling mice might be a cause of the weak expressions of KCC2 or NKCC1. To test this possibility, we reproduced the altered expressions of KCC2 and NKCC1 in the LSO of rats, whose cochleae were partially destroyed with kanamycin. METHODS Rat pups were treated with kanamycin from postnatal (P)3 to P8 (700 mg/kg, subcutaneous injection, twice a day) and sacrificed for immunohistochemical analysis, scanning electron microscope (SEM) and auditory brain stem response. RESULTS The SEM study revealed partially missing hair cells in P9 rats treated with kanamycin, and the hearing threshold was elevated to 63.8±2.5 dB SPL (4 ears) at P16. Both KCC2 and NKCC1 immunoreactivities were more prominent in control rats on P16. On 9 paired slices, the mean densities of NKCC1 immunoreactivities were 118.0±1.0 (control) and 112.2±1.2 (kanamycin treated), whereas those of KCC2 were 115.7±1.5 (control) and 112.0±0.8 (kanamycin treated). CONCLUSION We concluded that weak expressions of KCC2 and NKCC1 in circling mice were due to partial destruction of cochleae.

OBJECTIVES: This study was undertaken to confirm the clinical characteristics of recurrent pleomorphic adenoma (RPA), and to identify those factors that affect the development of malignant transformation (MT) from RPA. METHODS: The medical records of 270 patients, who were operated upon for parotid PA, were retrospectively reviewed. The pathologic specimens of a selected series of 23 patients were reviewed for histologic subtype and microscopic multi-nodularity. RESULTS: Mean age of initial operation in RPA without MT (RPA(-MT)) group was significantly lower than that of primary PA group. Mean age of the revision operation in RPA with MT (RPA(+MT)) group was significantly greater than that of RPA(-MT) group. Mean interval from operation to recurrence shortened after each revision operation. The risk of MT and additional recurrence increased significantly with recurrence. In RPA(-MT) group tumor recurrence occurred in 21.4% of patients despite a clear resection margin. CONCLUSION: The risk factors for MT may be an age of over 45 yr and multiple recurrences. However, younger patients are more at risk of recurrence. A clear resection margin cannot guarantee a cure in RPA, and it seems that parotid pleomorphic adenomas slowly gain malignant characteristics after repeated recurrences.

Objectives. The objective of this study was to compare the long-term auditory performance and language skill depending on the age of cochlear implantation in the Korean population. We especially tried to separate the effect of maturation/ development from that of the age at implantation. Methods. Eighty-six pre-lingual children with profound hearing loss who underwent a cochlear implantation before the age of six and had been followed for more than 3 yr were included in this study prospectively. Categories of Auditory Performance (CAP) and Korean Picture Vocabulary Test (K-PVT) were serially followed up. In order to separate the age at implantation effect, K-PVT results were readjusted to the child’s chronological age in the normal hearing population. Results. When the CAP and K-PVT scores were directly compared without chronological readjustment, we failed to show a significant difference for improvements according to the age at implantation. Early cochlear implantation was associated with better language development, only when the K-PVT scores were readjusted to percentile scores of their chronological age. Conclusion. Early cochlear implantation was associated with better language development even within the critical period. This advantage may be recognized only when the effect of the age at implantation is separated from the effect of maturation/development.

Objectives Tympanic membrane perforations are common, but there have been few studies of the factors determining the extent of the resulting conductive hearing loss. The aims of this study were to determine whether the size of tympanic membrane perforation, pneumatization of middle ear & mastoid cavity, and location of perforation were correlated with air-bone gap (ABG) of patients. Methods Forty-two patients who underwent tympanoplasty type I or myringoplasty were included and preoperative audiometry were analyzed. Digital image processing was applied in computed tomography for the estimation of middle ear & mastoid pneumatization volume and tympanic membrane photograph for the evaluation of perforation size and location. Results Preoperative mean ABG increased with perforation size (P=0.018), and correlated inversely with the middle ear & mastoid volume (P=0.005). However, perforations in anterior versus posterior locations showed no significant differences in mean ABG (P=0.924). Conclusion The degree of conductive hearing loss resulting from a tympanic membrane perforation would be expected with the size of perforation and pneumatization of middle ear and mastoid.

Received June 1, 2015 Revised July 27, 2015 Accepted July 27, 2015 Address for correspondence Myung-Whan Suh, MD, PhD Department of OtorhinolaryngologyHead and Neck Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel +82-2-2072-2448 Fax +82-2-2072-2447 E-mail drmung@naver.com Background and ObjectivesZZThere exist few studies about relationship between tinnitus and sleep disturbance. Furthermore, the currently available studies have some limitations of confounding factors. This study evaluated correlation between tinnitus and sleep quality, especially by controlling depression and anxiety factors. Subjects and MethodZZThe present study was planned as a cross sectional study using questionnaires. Using 46 patients with tinnitus, sleep quality was investigated by Pittsburgh Sleep Quality Index (PSQI) score, anxiety by State-Trait Anxiety Inventory (STAI, axis1 and axis2), depression by Beck Depression Inventory (BDI), and tinnitus induced distress by Tinnitus Handicap Inventory (THI). The final analysis method was multiple regression analysis. THI and PSQI were regarded as dependent and independent variables, respectively. BDI and STAI were regarded as confounding factors. ResultsZZEach factor (PSQI, two STAI, and BDI) revealed significant correlation with THI score. Considering four factors together with regression analysis, PSQI score was the most influencing factor on THI score (p=0.002). ConclusionZZAlthough depression and anxiety were both influencing factors on tinnitus-induced distress as known previously, sleep quality influenced tinnitus-induced distress came out as the most significant factor in the multivariable analysis. Korean J Otorhinolaryngol-Head Neck Surg 2015;58(11):754-8

인공와우 이식이 양측성 심고도 감각신경성 난청의 안전하 고 효과적인 치료 방법이라는 의견은 이미 알려진 사실이다. 그럼에도 드물게는 이식된 장치가 피부를 뚫고 돌출하거나 장 치 주위에 감염이 발생하여 장치를 제거하거나 재이식 해야 하 는 심각한 부작용이 발생한다. 이전의 보고에 따르면 이러한 이유로 소아에서 인공와우 재이식률은 약 5.6~14%이고 성인 에서는 약 5.4~7.0%로 알려져 있다. 특히 소아에서 재이식의 빈도가 더 높은 이유는 두부손상 후 이식물이 피부 밖으로 돌 출하거나 이식물 감염을 일으키는 중이염의 발생률이 높기 때 문이다. 또 두개골의 성장과 같은 다양한 요인들로 인해 전극 위치이동의 위험도 더 높은 것으로 추정되고 있다. 최근에 는 수술 기술과, 이식 장치의 제조기술이 향상되어 재이식의 빈도는 점차 감소하고 있다. 그러나 아직까지도 장치 돌출이 나 감염으로 인하여 재이식을 시행해야 하는 경우가 드물지 않게 발생한다. 이식 장치가 피부 밖으로 돌출하거나 감염이 발생하는 경우 감염원, 감염의 정도, 생체막(biofilm) 존재의 가능성, 항생제 치료에 대한 반응에 따라 인공와우 장치를 제거, 혹은 장치를 그대로 둔 상태에서 감염 조직만 치료하는 방법을 선택할 수 있다. 기존 인공와우 장치를 유지하면서 감염 조직만 제거하 는 경우 수신기/자극기(receiver/stimulator)의 위치를 조금씩 조정할 수 있지만, 이때 와우 내에 삽입된 전극이 빠지거나 이 동하지 않도록 주의해야 한다. 일반적으로는 수신기/자극기와 와우내 전극 사이 거리가 멀고 전극 길이에 여유가 있기 때문 에 수신기/자극기의 위치가 조금 바뀌더라도 와우내 전극이 빠지는 경우는 발생하지 않는다. 그러나 수신기/자극기의 위치 가 많이 이동하거나, 위치 이동 후 전극에 인장력이 작용하는 경우 전극이 빠질 우려가 있다. 아직까지 위치를 얼마나 많이 Case Report Korean J Otorhinolaryngol-Head Neck Surg 2013;56:105-9 / pISSN 2092-5859 / eISSN 2092-6529 http://dx.doi.org/10.3342/kjorl-hns.2013.56.2.105

Received July 3, 2013 Revised September 12, 2013 Accepted September 13, 2013 Address for correspondence Seung-Ha Oh, MD, PhD Department of Otorhinolaryngology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea Tel +82-2-2072-3649 Fax +82-2-745-2387 E-mail shaoh@snu.ac.kr Background and ObjectivesZZEosinophilic otitis media (EOM) is characterized by the presence of a highly viscous effusion containing eosinophils. It mainly occurs in patients with bronchial asthma, nasal polyps and is resistant to conventional treatments for otitis media. In these patients, steroid is very effective in controlling the disease. However, the major complication is sensorineural hearing loss, especially at high frequencies, which may occur despite steroid therapy. Subjects and MethodZZHere we report 10 cases of EOM at Seoul National University Hospital. Clinical courses and characteristics of the patients were analyzed. We compared the hearing deterioration and other clinical variables between EOM patients and age-matched non-EOM chronic otitis media patients. ResultsZZAll cases had viscous effusion and 9 cases were associated with asthma and nasal polyps. All patients had a decreased hearing in high frequency range compared to the age matched controls. The average bone conduction threshold difference at 2 kHz, 4 kHz was 22.4 dB HL and 42.5 dB HL, respectively. Among the patients, one showed profound sensorineural hearing loss bilaterally after the onset of EOM and received cochlear implantation. The open set sentence score was 82% 6 months after cochlear implantation. Most of the cases were resistant to conventional treatments for otitis media, such as administration of antibiotic agents, ventilation tube insertion or mastoidectomy. However, cases that were given steroid treatment had improvement in ear symptoms. ConclusionZZSince EOM patients show deterioration of hearing, it is important to properly diagnose EOM, start adequate treatment and explain to patients that the disease may last for a long period and progressive hearing loss may occur. Korean J Otorhinolaryngol-Head Neck Surg 2013;56:692-9

Background and ObjectivesZZActive noise cancelling (ANC) is a technology that can reduce external noise by producing a signal that is similar to noise but different in that it has an opposite phase to noise. Nowadays ANC has become an important technology in the field of hearing aids, but many studies have not focused on the effect of ANC of earphones when listening to portable music players. In this study, we aimed to evaluate whether ANC earphones can effectively reduce external noise and lower the preferred listening level. Subjects and MethodZZThree different earphones (Ear-canal, On-the-ear, Covering-theear) were tested in three different noise environments. Nine participants were tested in 10 experiments. First, through the real ear measurement (REM) system, we evaluated the differences in sound pressure level when the ANC was either turned on or off. Second, we evaluated the effects of ANC on Preferred Listening Level (PLL) for participants listening to the same song with different earphones. Through the REM system, we evaluate the level of sound pressure level when participants controlled the volume and felt most comfortable with the volume level.

Received January 25, 2012 Revised April 27, 2012 Accepted May 22, 2012 Address for correspondence Myung-Whan Suh, MD, PhD Department of OtolaryngologyHead & Neck Surgery, Dankook University College of Medicine, 201 Manghyang-ro, Dongnam-gu, Cheonan 330-715, Korea Tel +82-41-550-6469 Fax +82-41-556-1090 E-mail drmung@naver.com Sildenafil is an effective oral medication for male erectile disorder. Due to potential vasodilating effects, silenafil is known to have side effects such as headache, flushing, dyspepsia, and nasal congestion. Recently, we experienced a case of acute unilateral vestibular weakness that occurred in a 39-year-old man after ingesting sildenafil. The symptom lasted for 2 weeks and then was resolved partially. To the best of our knowledge, this is the second case report of sildenafil induced vestubular weakness in the literature. Thus, we report a case of a rare side effect of sildenafil. Korean J Otorhinolaryngol-Head Neck Surg 2012;55:513-7 Key WordsZZDizziness ᆞSide effect ᆞSildenafil ᆞVestibulopathy.

Myung-Whan Suh, Hyun-Ju Lee, June Sic Kim, Il-Yong Park, Jae Yun Jung and Seung-Ha Oh Department of Otorhinolaryngology-Head & Neck Surgery, Dankook University Hospital, Cheonan; and Seoul National University College of Medicine, Magnetoencephalography Center, Seoul; and Department of Medical and Biological Engineering, Dankook University College of Medicine, Cheonan; and Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul; and Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, Korea

We present a 66-year old woman complaining of dizziness and vomiting for the previous three days. Her symptoms were quite similar to vestibular neuritis except for mild headache. Spontaneous nystagmus recording, head shake test, and slow harmonic acceleration results were also similar to vestibular neuritis. But the caloric test was not consistent with the chair test results. During the neurologic examination, ptosis, mydriasis, and the diplopia in the left eye were detected, which was indicative of central organic pathology. Bilateral posterior communicating artery aneurysm that was compressing the left oculomotor nerve was detected by CT angiography. A careful and precise neurologic examination should never be neglected when examining a dizzy patient. It was also noticeable that, acute third nerve palsy may present as intermittent saccades which mimic spontaneous nystagmus in vestibular neuritis. Korean J Otorhinolaryngol-Head Neck Surg 2009;52:784-8 Key WordsZZOculomotor nerve·Aneurysm·Posterior communicating artery aneurysm.

Background and ObjectivesZZThe purpose of this study was to verify if high vestibulo-ocular reflex (VOR) gain in slow harmonic acceleration (SHA) test can be considered as a hallmark of a distinct disease entity. We hypothesized that patients with high VOR gain in the SHA test can be classified as a distinct disease group and looked for evidence that can support this hypothesis. Subjects and MethodZZFor this study, 306 patients who had undergone a rotation chair test were enrolled. We checked other VOR measurements (caloric test and step velocity) and clinical manifestation of the patients with high gain in SHA (HG group). The data were compared to those of the migraine associated vertigo (MAV), benign recurrent vertigo (BRV) and psychogenic dizziness (PsyD). ResultsZZAn abnormally long time constant and a large response to the caloric test were found more frequently in the patient group with high gain in SHA. The incidence of high gain in SHA was significantly higher in MAV, BRV and PsyD. The clinical manifestation of HG group was not distinguishable from the effects of BRV and PsyD. But MAV was different from HG group. ConclusionZZWe failed to find any evidence that the patients with high gain in the SHA could be classified as a distinct disease group. It seems that high gain is not merely a non-specific or incidental finding but a reproducible finding that reflects an aspect of the subject’s vestibular function. Also, the high gain in SHA is more suggestive of BRV or PsyD than MAV. Korean J Otorhinolaryngol-Head Neck Surg 2009;52:874-9 Key WordsZZHigh gain·Vestibulo-ocular reflex·Rotation chair test·Sinusoidal harmonic acceleration test.

Background and Objectives Diagnosis and treatment of dizziness after motor vehicle accident (MVA) is not challenging. Psychological factors may be important and patient’s quality of life can be underestimated due to nonspecific vague symptoms. The aim of this study is to reveal the clinical characteristics of dizziness after motor vehicle accident. Subjects and Method Of the patients who have visited Dankook University hospital for traumatic dizziness from Jan. 1994 through Jan. 2008, we enrolled 51 patients who had history of motor vehicle accident and performed vestibular function test (VFT). Patients were divided into groups according to VFT findings. Patients who had unilateral hypo-function in VFT were classified as Group A. Patients who showed typical nystagmus for benign paroxismal positional vertigo (BPPV) were classified as Group B. And the others were classified as Group C who showed fair VFT results. Results Group C was found with unidentified dizziness, a tendency of late onset and long term recovery. Also they complained different distributions of their symptoms, that is, the rate of patients with headache and visual symptoms were higher in Group C. Conclusion There were no remarkable characteristics in unidentified dizziness after MVA. Although the objective test results were non-specific, their clinical progress was not favorable. They complained of headache and visual symptoms more than other groups.