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Background and Objectives Surgery for bilateral chronic otitis media (COM) is usually performed sequentially, not simultaneously. The main reason is to prevent iatrogenic bilateral conductive hearing loss during recovery period. However, with asymmetric hearing loss, the difference in patient inconvenience between sequential and simultaneous surgery may be the same. This study evaluates the efficacy of simultaneous COM surgery in patients with asymmetric hearing.Subjects Materials and Method From 2012 to 2018, 9 patients underwent simultaneous bilateral COM surgery. The period of patients’ hospital stay, the success rate of tympanoplasty, tolerability for operation, and hearing thresholds were analyzed statistically.Results For the 8 same-day surgery patients, the mean hospital period was 4.4±0.7 days, which was much shorter than that of sequential surgery (8 days). Tympanoplasty was successful in all patients without complications. In the better side, the preoperative/postoperative mean air conduction thresholds (AC) were 62.97±12.89 dB/47.81±19.07 dB (p=0.017), the bone conduction thresholds (BC) were 46.72±10.31 dB/37.66±16.99 dB (p=0.161) and the air-bone gaps (ABG) were 16.25±8.81 dB/10.16±7.78 dB (p=0.176). In the worse side, the preoperative/ postoperative mean AC were 86.56±18.22 dB/72.18±29.43 dB (p=0.035), BC were 53.28± 11.10 dB/48.13±18.41 dB (p=0.173), and ABG were 33.28±11.22 dB/24.06±14.80 dB (p=0.500). In both ear, the postoperative AC and BC were better than or equivocal to those of the preoperative value, and the result was similar with each of the unilateral ear audiological results.Conclusion Despite the fact that there is no complete consensus to date, simultaneous bilateral COM surgery can be an option when patients have asymmetric hearing loss. Simultaneous bilateral COM surgery could save time, cost, and lead to similar results with sequential surgery, so it could be a considerable surgical option for patients with bilateral COM.

The study of cognitive impairment associated with hearing loss has recently garnered considerable interest. Epidemiological data have demonstrated that hearing loss is a risk factor for cognitive decline as a result of aging. However, no previous study has examined the effect of hearing loss in patients with cognitive problems such as Alzheimer’s disease. Therefore, we investigated the effect of conductive hearing loss in an Alzheimer’s mouse model. Positron emission tomography (PET) and magnetic resonance imaging (MRI) were used to evaluate changes in glucose metabolism and gray matter concentrations in the 5xFAD Alzheimer’s Disease (AD) transgenic mouse model with and without conductive hearing loss (HL). Conductive hearing loss was induced using chronic perforation of the tympanic membrane. Behavioral data from the Y-maze and passive avoidance tests revealed greater memory deficits in the AD with HL (AD-HL) group than in the AD group. Following induction of hearing loss, lower cerebral glucose metabolism in the frontal association cortex was observed in the AD-HL group than in the AD group. Although lower glucose metabolism in the hippocampus and cerebellum was found in the AD-HL group than in the AD group at 3 months, the gray matter concentrations in these regions were not significantly different between the groups. Furthermore, the gray matter concentrations in the simple lobule, cingulate/retrosplenial cortex, substantia nigra, retrosigmoid nucleus, medial geniculate nucleus, and anterior pretectal nucleus at 7 months were significantly lower in the AD-HL group than in the AD group. Taken together, these results indicate that even partial hearing loss can aggravate memory impairment in Alzheimer’s disease.

Objective The aims of this multicenter study were to prospectively evaluate the prevalence of dead regions (DRs) in sudden sensorineural hearing loss (SSNHL) and compare the clinical characteristics and hearing outcomes of SSNHL according to the presence of DRs. Study design Prospective study. Setting Multicenter study. Patients and methods The threshold-equalizing noise (TEN) test was prospectively performed on a total of 130 patients diagnosed with SSNHL. All patients received systemic steroid therapy and/or intratympanic steroid injection within 1 month after onset. Pure-tone audiograms and the TEN test were conducted before and after steroid treatment. Age, sex, side of affected ear, recurrence, onset of symptoms, presence of dizziness, and comorbid diseases were also collected. The prevalence of DRs in SSNHL and clinical factors related to the DRs were assessed. Hearing outcomes for SSNHL according to DRs were evaluated in 68 patients who followed a pure-tone audiogram. Results The overall prevalence of one or more DRs in SSNHL evaluated using the TEN test was 20.8% (27/130 subjects) and the overall frequency-specific prevalence of DR was 6.7% (61/910 DRs). Although the DRs (+)and DR (-) groups had similar initial pure-tone thresholds, the DRs (+) group had significantly worse initial WRS compared to the DRs (-) group (p = 0.015). The presence of DRs was not associated with hearing recovery in a multivariate logistic regression model, but it was significantly associated with the degree of hearing gain in a multivariate linear regression model (p = 0.018). Conclusions The presence of DRs can be considered one of the poor prognostic factors for SSNHL and the TEN test may contribute to assess the prognosis of SSNHL in clinical settings.

Objectives To analyze the clinical characteristics of cochlear fistulas (CFs) and propose a new fistula classification system with regard to the cochlea. Materials and methods A retrospective chart review was conducted between January 2008 and December 2015 to identify patients who had undergone surgery for cholesteatoma with an associated CF. The following data were collected: preoperative symptoms, findings of temporal bone computed tomography (TBCT), fistula stage, cholesteatoma classification, surgical technique, and pre- and postoperative pure-tone audiometry. Results We analyzed a total of 159 patients, out of which 9 (5.7%) were diagnosed with a CF. The average duration of the chronic otitis media was 19.8 years. Cholesteatomas that induced CF rarely existed in the nonaggressive state; recurrent otorrhea was observed in all but one of our subjects. All the patients with CF had a distinct origin of cholesteatoma that developed from the retraction of posterior pars tensa; further, 88.9% cholesteatomas extended to and filled the sinus tympani. Preoperative audiometry revealed total hearing loss in 4 (44.4%) patients. Further, five patients with residual hearing before surgery had stage I fistulas, and the bone conduction thresholds remained stable after surgery. Conclusion Cochlear fistulas were often detected in patients with (1) a history of chronic otitis media (exceeding 10 years), (2) frequently recurring otorrhea, and (3) pars tensa cholesteatomas that extended to the posterior mesotympanum and filled the sinus tympani. Such patients can suffer from potentially severe and irreparable sensorineural hearing loss.

Objectives/hypothesis To evaluate the long-term effects of intralesional steroid injections (ILSIs) in patients with otohematoma and to suggest the clinical implications, especially with regard to the duration of otohematoma. Study design Retrospective analysis. Methods Fifty-six patients were enrolled and classified into short-term otohematoma (n = 30) and long-term otohematoma (n = 26) groups according to the period of time after auricular trauma. After the first ILSI, all patients underwent weekly examinations during the 21-day observational period to determine the treatment outcomes and were then followed up for reevaluation for a maximum of 36 months. We considered ILSIs to be ineffective if the otohematoma persisted after the third ILSI, and we opted to perform surgical treatment in such cases. In addition, we evaluated early recurrence, late recurrence, and ILSI-related complications. Results After up to three ILSIs, 29 out of 30 cases (96.7%) with short-term otohematoma and 20 out of 26 cases (76.9%) with long-standing otohematoma were treated without complications. Three patients with long-term otohematoma, however, experienced late recurrences at 4, 15, and 18 months, respectively. Seven patients who showed no response after ILSIs underwent surgical treatment. The duration of otohematoma (P = .043) and a higher initial aspirated fluid volume (P = .014) were shown to significantly increase the risk of treatment failure after ILSIs. Conclusions Multiple and immediate ILSIs in patients with otohematoma appear to be an effective treatment approach with no complications. Patients with short-term otohematoma showed better outcomes following ILSIs. The treatment approach may be optimized based on the duration and degree of otohematoma. Level of evidence 4 Laryngoscope, 129:459-465, 2019.

Objective Although many studies have investigated sudden sensorineural hearing loss (SSNHL) in adults, there were few studies on SSNHL in the pediatric population; especially research on treatment and prognosis of pediatric SSNHL was limited. The aim of this study was to evaluate clinical characteristics, treatment outcomes and prognostic factors in children and adolescents with SSNHL. Methods A retrospective review of medical records of 67 pediatric patients (67 ears) who had diagnosed with SSNHL at our hospitals was performed to analyze patients’ clinical manifestations and audiograms. All patients were treated with high-dose systemic prednisolone (1 mg/kg), and 17 of them underwent intratympanic steroid injection therapy. Audiological evaluation was carried out before and after treatment, and hearing recovery was defined as complete recovery and partial recovery according to Siegel’s criteria. Patients were divided into two groups: childhood group (ages between 4 and 12 years old) and adolescence group (age > 12 years), and clinical characteristics and treatment outcomes were investigated. In addition, patients were divided into two groups according to degree of hearing recovery, and evaluation was made regarding possible prognostic factors. Results The recovery rate in total 67 patients was 55.2%. The recovery rate of the childhood group was significantly lower than that of the adolescence group ( p = 0.038). While the presence of vertigo did not significantly correlate with prognosis ( p = 0.219), the presence of tinnitus was significantly associated with hearing recovery ( p = 0.005). Audiological assessment revealed that a low initial hearing threshold, high speech discrimination score, and descending type of audiogram were positively associated with hearing recovery ( p = 0.002, p = 0.003, and p = 0.029, respectively). Conclusion The childhood group had worse treatment outcomes than the adolescence group. High initial hearing threshold and absence of tinnitus were poor prognostic factors of hearing recovery. Active treatment is required for patients with these poor prognostic factors and childhood patients with SSNHL.

Purpose: Although some studies argue that it is worthy for cochlear implant (CI) users to have frequency information above 3,000 Hz for consonant recognition, it is not clear whether CI patients make use of this information, especially in Korean. In this experiment, we tested whether consonant recognition in CI patients depended on the utilization of information from 3,000 to 8,000 Hz. Methods: We conducted consonant recognition tests in Korean [3 syllable structures: vowel-consonant-vowel (VCV), consonant-vowel (CV), and vowelconsonant (VC)] pronounced by one male and one female speakers for 3 normal hearing (NH) and 3 CI adults with 9 low-pass filtering frequency conditions. Results: Both groups showed decreased correction scores as cut-off frequency getting lower. CI subjects scored twice errors to NH subjects across frequency conditions. The cut-off frequency of 1,500 Hz brought a significant decrease of consonant recognition. Consonants in VCV syllable recognized better than VC and CV syllable in both groups. Fricatives and affricates in the manner of articulation and alveolar and palatal in the place of articulation are the ones that benefit from high frequency coding. Alveolar plosive sounds were most difficult sounds in both groups and this confirms previous studies of consonant recognition in Korean. Conclusion: NH and CI groups demonstrated poorer consonant recognition as cut-off frequency decreased with relatively large decrements of CI group. The information above 3,000 Hz conveys little information for consonant recognition in the normal and CI subjects while some CI subjects utilized information up to 6,000 Hz. There were large individual differences, particularly in CI group.

Objective This study aimed to determine the radiation dose of temporal bone computed tomography (TBCT) to detect pediatric congenital cholesteatoma (CC), and suggests strategy for lowering perioperative radiation dose. Methods Fifty-three CC patients followed up for more than 12 months after surgery. Perioperative clinical findings and the effective radiation dose (ERD) of TBCT were investigated. Patients’ mean age at initial TBCT was 60 months; the mean follow-up period was 43 months. Results In 33 (62.3%) of 53 patients, only one TBCT was performed postoperatively. Postoperative CT imaging was performed to evaluate before second-stage ossiculoplasty, due to suspicion of CC recurrence on examinations, or as part of follow-up. When TBCT was performed on more than two occasions after surgery as a part of follow-up, there was no difference in the distribution of stage or type of CC compared to patients subjected to TBCT on less than three occasions ( p = 0.093 and p = 0.744, respectively). During the most-recent follow-up of these 53 cases, there was no CC recurrence. The mean ERD of a single TBCT was 1.2 mSv, and the mean cumulative ERD of TBCT was 2 mSv per patient. Conclusion Mean and cumulative ERD of TBCT performed in CC cases was not too high to consider radiation hazard. However, efforts to minimize the number of CT scans should be taken basically.

Deafness induces many plastic changes in the auditory neural system. For instance, dendritic changes cause synaptic changes in neural cells. SMI-32, a monoclonal antibody reveals auditory areas and recognizes non-phosphorylated epitopes on medium- and high-molecular-weight subunits of neurofilament proteins in cortical pyramidal neuron dendrites. We investigated SMI-32-immunoreactive (-ir) protein levels in the auditory cortices of rats with induced unilateral and bilateral deafness. Adult male Sprague-Dawley rats were divided into unilateral deafness (UD), bilateral deafness (BD), and control groups. Deafness was induced by cochlear ablation. All rats were sacrificed, and the auditory cortices were harvested for real-time quantitative polymerase chain reaction (RT-qPCR) and western blot analyses at 2, 4, 6, and 12 weeks after deafness was induced. Immunohistochemical staining was performed to evaluate the location of SMI-32-ir neurons. Neurofilament heavy chain (NEFH) mRNA expression and SMI-32-ir protein levels were increased in the BD group. In particular, SMI-32-ir protein levels increased significantly 6 and 12 weeks after deafness was induced. In contrast, no significant changes in protein level were detected in the right or left auditory cortices at any time point in the UD group. NEFH mRNA level decreased at 4 weeks after deafness was induced in the UD group, but recovered thereafter. Taken together, BD induced plastic changes in the auditory cortex, whereas UD did not affect the auditory neural system sufficiently to show plastic changes, as measured by neurofilament protein level.

Neural plasticity is a characteristic of the brain that helps it adapt to changes in sensory input. We hypothesize that auditory deafferentation may induce plastic changes in the cytoskeleton of the neurons in the inferior colliculus (IC). In this study, we evaluated the dynamic status of neurofilament (NF) phosphorylation in the IC after hearing loss. We induced auditory deafferentation via unilateral or bilateral cochlear ablation in rats, aged 4 weeks. To evaluate cytoskeletal changes in neurons, we evaluated mRNA fold changes in NF heavy chain expression, non-phosphorylated NF protein fold changes using SMI-32 antibody, and the ratio of SMI-32 immunoreactive (SMI-32-ir) neurons to the total neuronal population in the IC at 4 and 12 weeks after deafness. In the bilateral deafness (BD) group, the ratios of SMI-32-ir neurons significantly increased at 4 weeks after ablation in the right and left IC (6.1 ± 4.4%, 5.0 ± 3.4%, respectively), compared with age-matched controls (P 0.01, P 0.01). At 12 weeks after ablation, the ratio of SMI-32 positive neurons was higher (right, 3.4 ± 2.0%; left, 3.2 ± 2.3%) than that in the age-matched control group, albeit not significant in the right and left side (P = 0.38, P = 0.24, respectively). Consistent with the results of the ratio of SMI-32-ir neurons, SMI-32-ir protein expression was increased at 4 weeks after BD, and the changes at 12 weeks after bilateral ablation were not significant in the right or left IC. The age-matched control fold changes of NF mRNA expression after bilateral deafness were not significant at 4 and 12 weeks after deafness in right and left IC. Unilateral deafness did not induce significant change of NF mRNA expression, SMI-32-ir protein expression, and the ratio of SMI-32-ir neurons in the IC at 4 and 12 weeks after hearing loss. Bilateral auditory deafferentation induces structural changes in the neuronal cytoskeleton within the IC, which is prominent at 4 weeks after BD. The structural remodeling of neurons stabilized at 12 weeks after BD. Unlike BD, unilateral auditory deafferentation did not affect the dynamic status of NFs in the IC.

Objective This study analyzed the characteristics of tinnitus identified in anemia patients with cohort- and population-based studies in a single institute and suggests a management algorithm. Methods Fifty patients who were treated for anemia and referred for tinnitus treatment were included in a single institute retrospective study. Characteristics of tinnitus were investigated in a correlation analysis with demographic and audiologic parameters. For the population-based study, data from the Korea National Health and Nutrition Examination Survey collected between 2010 and 2011 were analyzed. The study population consisted of 11,402 individuals aged 20–97 years with complete tinnitus-related data. The prevalence of tinnitus in anemia patients was investigated using the questionnaire, and associations between tinnitus and blood/urine parameters were evaluated by binary logistic regression analysis. Results In a single-institute study, patients with non-pulsatile tinnitus were significantly older and their initial hemoglobin was higher than those with pulsatile tinnitus (p = 0.001, 0.008, respectively). In pulsatile tinnitus, age and difference between initial and post-treatment hemoglobin were significantly associated with a subjective improvement in tinnitus (p = 0.002, 0.016, respectively). There were no significant audiologic or hematologic parameters associated with the improvement of non-pulsatile tinnitus. In the population-based study, there was no significant correlation between anemia and tinnitus (p = 0.064). In a multivariate analysis, age was the only parameter associated with tinnitus in participants with anemia. Conclusion The therapeutic strategy and prognosis of tinnitus in anemia patients differ according to the characteristics of tinnitus and the severity of anemia.

The present study aimed to evaluate the effects of systemic lipoic acid on hearing preservation after cochlear implantation. Twelve Dunkin-Hartley guinea pigs were randomly divided into two groups: the control group and the lipoic acid group. Animals in the lipoic acid group received lipoic acid intraperitoneally for 4 weeks. A sterilised silicone electrode-dummy was inserted through the round window to a depth of approximately 5 mm. The hearing level was measured using auditory brainstem responses (ABRs) prior to electrode-dummy insertion, and at 4 days and 1, 2, 3 and 4 weeks after electrode-dummy insertion. The threshold shift was defined as the difference between the pre-operative threshold and each of the post-operative thresholds. The cochleae were examined histologically 4 weeks after electrode-dummy insertion. Threshold shifts changed with frequency but not time. At 2kHz, ABR threshold shifts were statistically significantly lower in the lipoic acid group than the control group. At 8, 16 and 32kHz, there was no significant difference in the ABR threshold shift between the two groups. Histologic review revealed less intracochlear fibrosis along the electrode-dummy insertion site in the lipoic acid group than in the control group. The spiral ganglion cell densities of the basal, middle and apical turns were significantly higher in the lipoic acid group compared with the control group. Therefore, systemic lipoic acid administration appears to effectively preserve hearing at low frequencies in patients undergoing cochlear implantation. These effects may be attributed to the protection of spiral ganglion cells and prevention of intracochlear fibrosis.

Objectives/Hypothesis: Herniation of the temporomandibular joint (TMJ) into the external auditory canal (EAC) is a very rare condition, and it mostly occurs in patients with bony wall defects in the anterior EAC. The purpose of this study was to evaluate the clinical and radiological findings and the treatment results of TMJ herniation into the EAC by reviewing a large sample of temporal bone computed tomography (CT) scans. Study Design: A retrospective study. Methods: We reviewed 985 adult temporal bone CT scans and evaluated the presence of defects, the size and location of defects, and TMJ herniation. We enrolled 23 cases with anterior EAC wall defects. Results: Twenty-three (2.3%) patients from the 985 temporal bone CT cases revealed an anterior wall defect involving the EAC. We identified the causes for the defects, such as canal cholesteatoma and trauma, in eight of the 23 cases. We observed 15 (1.5%) patients with patent foramen of Huschke. The mean defect size was 3.06 × 2.69 mm. Among the patients with these lesions, six had a TMJ herniation into the EAC. Four of the six cases were surgically reconstructed using a titanium mesh via a preauricular approach, whereas the remaining two cases were managed with endaural removal and skin graft. Conclusions: TMJ herniation into the EAC is very rare and may not occur even if an anterior wall defect of the EAC is present. Lesions can be successfully managed with surgical reconstruction of the TMJ via a preauricular approach, whereas small lesions can be managed using an endaural approach. Laryngoscope, 2010

Several previous studies have demonstrated that comorbidities, secondary causes, physical inactivity, and osteoporosis may cause recurrence of benign paroxysmal positional vertigo (BPPV). However, there has also been some controversy over the clinical course(s) and cause(s) of recurrent BPPV (rBPPV). We identified clinical features and associated factors, including decreased bone mineral density, in the recurrence of BPPV.In total, 198 patients with idiopathic BPPV, diagnosed at the otolaryngology clinics of Seoul National University Boramae Medical Center, were enrolled. The medical data of these patients were reviewed retrospectively. Recurrent BPPV was defined as the recurrence of BPPV after at least 1 month of a symptom-free interval following previous successful treatment.Of the BPPV patients, 67 (33.8%) were classified as rBPPV. Among them, about 16% showed changes in the involved semicircular canals and about 6% showed multiple semicircular canal involvement. rBPPV was more common in patients with comorbidities (P0.001). Involved semicircular canals showed no statistically significant difference according to the recurrence of BPPV. The mean symptom-free interval of the rBPPV group varied from 1 to 50.2 (mean, 11.6) months; however, 90% of BPPV recurrence occurred within 24 months. Bone mineral density in dual-energy X-ray absorptiometry (DEXA) was markedly decreased in BPPV patients versus normal controls, but there were no significant differences according to BPPV recurrence.The incidence of rBPPV in idiopathic BPPV patients was 33.8% in the present study. The mean period of recurrence after a symptom-free interval was about 11.6 months; most patients showed recurrence within 2 years after the first attack of BPPV. Furthermore, about 16% of patients suffered from rBPPV at a different kind or type of canal from the semicircular canal of the initial BPPV attack. Comorbidities, but not age, gender, or the involved semicircular canal, might be correlated with BPPV recurrence. Decreased bone mineral density did not show significant association with BPPV recurrence, but showed a significant relation with BPPV occurrence.

Objectives: This study was conducted to examine improvements of cognitive abilities after cochlear implantation in deaf children. We also examined the psychosocial factors that predict good outcomes of cochlear implantation. Design: A neuropsychological test battery was administered to 17 deaf children (mean age, 7 yr 2 mo) before receiving the cochlear implant, and they were reassessed with the same test at 6-mo follow-up. Their parents completed questionnaires concerning their medical and educational history, parenting style, and parental emotional problems. Results: Deaf children showed marked improvement in speedy and delicate motor coordination and visual organization abilities. Their cognitive functions of comprehension, concentration, and sequential processing, as measured by nonverbal tests, were found to have improved from the levels of borderline to mild mental retardation to that of near-normal range. However, their performances on Information, Comprehension and Similarity, and Mathematics subtests requiring verbal abilities did not show significant changes. Deaf children's working memory improved significantly after cochlear implantation. However, they showed more omission errors in the visual attention test at follow-up than before cochlear implantation. Such inattentiveness for visual stimuli in children post-implantation could be attributed to distractibility of these children toward external noise. Mothers' depression was negatively correlated with scores of acquired knowledge of deaf children. Conclusion: At the 6-mo follow-up after cochlear implant, deaf children showed marked improvement in nonverbal cognitive functions and working memory. Conversely, their verbal abilities did not significantly change. Maternal factors were found to be important for predicting the prognosis of cochlear implantation. The absence of a control group precludes the possibility of drawing any firm conclusions because the effect of the implant cannot be teased apart from the effects of maturation and training. Future studies should address this question with the use of appropriate control groups.

This study was designed to determine if hearing status monitoring during intravenous infusion of EA reduces individual variability and to evaluate the correlation between EA dose and Bwt.Twenty-five cats with the mean age of 24 ± 3.7 weeks (range = 20.6-28.3) and a mean weight of 3.21 ± 0.84 kg (range = 1.9-5.1) were administered a subcutaneous injection of KM (300 mg/kg) followed by an intravenous infusion of EA (1 mg/min). Click-evoked auditory brainstem responses (ABRs) were recorded to monitor hearing during the infusion. When ABR thresholds exceeded a 90 dB sound pressure level, the infusion of EA was terminated. Histopathology forapex, middle, and base sections of the cochlea were examined after 6 months.The dose of EA was optimized for deafening through simultaneous ABR measurements. Bwt was positively correlated with EA dose (mg) (p 0.001, R(2) = 0.548), which was different from a study previously reported. Cochlear histopathology assessments revealed an absence of organ of Corti in the majority of cochleae.Co-administration of kanamycin (KM) and ethacrynic acid (EA) was an easy and effective method for deafening procedures in adult animals. Body weight (Bwt) was positively correlated with EA dose (mg) and an optimal EA dose can be calculated.

Objectives This study was aimed to assess the relationship between the type of temporal bone area involved and conductive hearing loss. Methods We enrolled 97 patients who visited the otolaryngology clinics of Seoul National University Hospital or Boramae Medical Center, Seoul Metropolitan Government-Seoul National University with temporal bone fracture between January 2004 and January 2014. Audiometric parameters, including initial and improved air-bone (AB) conduction gap values, were reviewed in accordance with the temporal bone computed tomography (external auditory canal [EAC], middle ear [ME], mastoid [M], and ossicle [O]). Results Patients with ossicular chain involvement exhibited a larger AB gap compared to those with no ossicular chain involvement at 250, 1,000, 2,000, and 4,000 Hz. Among the groups without ossicular chain involvement, the initial AB gap was largest in patients with EAC+ME+M involvement, followed by the ME+M and M-only involvement groups. The greatest improvement in the AB gap was observed in the EAC+ME+M group followed by the ME+M and M-only groups, irrespective of ossicular chain involvement. Improvements in AB gap values were smallest at 2,000 Hz. Conclusion Conductive hearing loss pattern differed according to the temporal bone area involved. Therefore, areas such as the hematoma and hemotympanum, as well as the fracture line of the temporal bone area, must be evaluated to predict audiologic patterns with otic capsule preserving temporal bone fracture.

Superficial siderosis (SS) of the central nervous system has been thought to be a rare condition that generates progressive hearing loss, ataxia, pyramidal signs, and dementia. The main cause of hearing loss by SS is thought to be neuronal. Because there is no histopathologic report of the human temporal bone in SS, there is a debate about the possibility of cochlear involvement. We present a 25-year-old man who was investigated for bilateral progressive sensorineural hearing loss and vestibular failure after head trauma. On brain MRI, SS of the central nervous system was detected. Distortion product otoacoustic emission (DPOAE) and auditory brainstem response (ABR) showed no response on both sides. However, integrity of the eighth nerve was proved by the electrical ABR test on the right side and the patient benefited significantly from cochlear implantation. The sensorineural hearing loss in SS seems to be related to cochlear damage as well as neuronal damage. So, cochlear implantation would be a hearing rehabilitation modality for the sensorineural hearing loss caused by SS.

Although autologous rib cartilage is a preferred source of graft material in rhinoplasty, rib cartilage for dorsal augmentation has been continuously criticized for its tendency to warp and for high donor-site morbidities. However, no meta-analysis or systemic review on complications associated with autologous rib cartilage use in rhinoplasty has been conducted.To carry out a systematic review and a meta-analysis of available literature to evaluate complications regarding autologous rib cartilage in rhinoplasty.The studies reporting complications associated with the autologous rib cartilage use in rhinoplasty were systematically reviewed by searching the MEDLINE, PubMed, and Embase databases for sources published from 1946 through June 2013.The selected articles included clinical studies conducted with at least 10 patients and at least 1 postoperative long-term complication or donor-site morbidity in rhinoplasty. Excluded were nonhuman studies; review articles; case reports; abstracts; and reports of nasal reconstruction as indication for surgery, use of homologous rib cartilage, and diced or laminated methods.Two investigators independently reviewed all studies and extracted the data using a standardized form. A meta-analysis was performed using a random-effects model.Number of patients; follow-up duration; and rates of complication, donor-site morbidity, and revision surgery. Also noted were study authors and year of publication.Ten studies involving a total 491 patients were identified. Mean follow-up across all studies was 33.3 months. In meta-analysis, the combined rates were 3.08% (95% confidence interval [CI], 0%-10.15%) for warping, 0.22% (95% CI, 0%-1.25%) for resorption, 0.56% (95% CI, 0%-2.61%) for infection, 0.39% (95% CI, 0%-1.97%) for displacement, 5.45% (95% CI, 0.68%-13.24%) for hypertrophic chest scarring, 0% (95% CI, 0%-0.32%) for pneumothorax, and 14.07% (95% CI, 6.19%-24.20%) for revision surgery.The overall long-term complications and donor-site morbidity rates associated with autologous rib cartilage use in rhinoplasty were low. Warping and hypertrophic chest scarring showed relatively higher rates, warranting a surgeon's attention. Because a limited number of studies and patients were eligible, and consistent definitions of complications were lacking in this meta-analysis, future studies with a larger series of patients and objective outcome measurements are needed to obtain more reliable results.4.

BACKGROUND: Asthmatic nasal polyps primarily exhibit eosinophilic infiltration. However, the identities of the immune cells that infiltrate non-asthmatic nasal polyps remain unclear. Thus, we thought to investigate the distribution of innate immune cells and its clinical relevance in non-asthmatic chronic rhinosinusitis (CRS) in Korea. METHODS: Tissues from uncinate process (UP) were obtained from controls (n = 18) and CRS without nasal polyps (CRSsNP, n = 45). Nasal polyps (NP) and UP were obtained from CRS with nasal polyps (CRSwNP, n = 56). The innate immune cells was evaluated by immunohistochemistry such as, eosinophil major basic protein (MBP), tryptase, CD68, CD163, CD11c, 2D7, human neutrophil elastase (HNE) and its distribution was analyzed according to clinical parameters. RESULTS: In comparisons between UP from each group, CRSwNP had a higher number of MPB(+), CD68(+), and CD11c(+) cells relative to CRSsNP. Comparisons between UP and NP from CRSwNP indicated that NP have a higher infiltrate of MBP(+), CD163(+), CD11c(+), 2D7(+) and HNE(+) cells, whereas fewer CD68(+) cells were found in NP. In addition, MBP(+) and CD11c(+) cells were increased from UP of CRSsNP, to UP of CRSwNP, and to NP of CRSwNP. Moreover, in UP from CRSwNP, the number of MBP(+) and CD11c(+) cells positively correlated with CT scores. In the analysis of CRSwNP phenotype, allergic eosinophilic polyps had a higher number of MBP(+), tryptase(+), CD11c(+), 2D7(+) cells than others, whereas allergic non-eosinophilic polyps showed mainly infiltration of HNE(+) and 2D7(+) cells. CONCLUSIONS: The infiltration of MBP(+) and CD11c(+) innate immune cells show a significant association with phenotype and disease extent of CRS and allergic status also may influences cellular phenotype in non-asthmatic CRSwNP in Korea.

This study was conducted to investigate long-term neurocognitive outcomes and to determine associated risk factors in a cohort of Korean survivors of childhood acute lymphoblastic leukemia (ALL). Forty-two survivors of ALL were compared with 42 healthy controls on measures of a neurocognitive test battery. We analysed potential risk factors (cranial irradiation, sex, age at diagnosis, elapsed time from diagnosis, and ALL risk group) on neurocognitive outcomes. ALL patients had lower, but non-significant full-scale intelligence quotient (FSIQ, 107.2±12.2 vs. 111.7±10.2), verbal intelligence quotient (VIQ, 107.7±13.6 vs. 112.2±11.4), and performance intelligence quotient (PIQ, 106.3±14.2 vs. 110.1±10.7) scores than healthy controls. However, patients treated with cranial irradiation performed significantly lower on FSIQ (102.2±8.1), VIQ (103.3±11.7), and PIQ (101.4±13.2) compared to non-irradiated patients and healthy controls. ALL patients also had poor attention, concentration, and executive functions. Among ALL survivors, cranial irradiation was a risk factor for poor FSIQ, being male was a risk factor for poor PIQ, and younger age was a risk factor for poor attention. Therefore, the delayed cognitive effects of ALL treatment and its impact on quality of life require continuing monitoring and management. Graphical Abstract

Temporal modulation detection ability matures over many years after birth and may be particularly sensitive to experience during this period. Profound hearing loss during early childhood might result in greater perceptual deficits than a similar loss beginning in adulthood. We tested this idea by measuring performance in temporal modulation detection in profoundly deaf children and adults fitted with cochlear implants (CIs). At least two independent variables could constrain temporal modulation detection performance in children with CIs: altered encoding of modulation information due to the CI-auditory nerve interface, and atypical development of central processing of sound information provided by CIs. The effect of altered encoding was investigated by testing subjects with one of two different hearing mechanisms (normal hearing vs. CI) and the effect of atypical development was studied by testing two different age groups. All subjects were tested for their ability to detect acoustic temporal modulations of sound amplitude. A comparison of the slope, or cutoff frequency, of the temporal modulation transfer functions (TMTFs) among the four subject groups revealed that temporal resolution was mainly constrained by hearing mechanism: normal-hearing listeners could detect smaller amplitude modulations at high modulation frequencies than CI users. In contrast, a comparison of the height of the TMTFs revealed a significant interaction between hearing mechanism and age group on overall sensitivity to temporal modulation: sensitivity was significantly poorer in children with CIs, relative to the other three groups. Results suggest that there is an age-specific vulnerability of intensity discrimination or non-sensory factors, which subsequently affects sensitivity to temporal modulation in prelingually deaf children who use CIs.

We aim to evaluate the incidence and clinical manifestations of sensorineural hearing loss (SNHL) in adult patients with acute otitis media (AOM). Seventy-five patients (age > 18 years; 83 ears) diagnosed with AOM between January 2008 and March 2011 at our clinic were enroled and retrospectively reviewed. We detected audiometrically confirmed SNHL during the course of AOM in eight patients. The clinical course, treatment, and audiometric final outcome of each case were reviewed. SNHL was associated with AOM in 8 out of 83 ears (9.3 %). The mean age of patients was 57.5 years, and the mean follow-up period was 21.1 months (range 0.6–46.3 months). The most common symptom was tinnitus. Mean bone conduction hearing threshold was 39.5 dB in pure tone audiometry. All patients showed high-frequency HL, and three showed pan-frequency HL. All patients were treated with oral antibiotics at the initial visit. Seven ears were treated with a combination of oral steroids. Myringotomy was also performed. Seven of eight patients showed improvement; however, 8 kHz thresholds were not improved. This suggested that the inflammation spread through the round window. The mean duration of recovery was 18.6 days. SNHL associated with AOM in adult patients occurs during the early phases of the disease course. High-frequency hearing was commonly affected and was well treated with oral antibiotics, myringotomy, and steroid therapy. Audiometry can be helpful for treating adult patients with AOM. Active treatment, including myringotomy, should be performed during the early phase, if SNHL is suspected.

Functional changes of mitochondrial respiratory chain (MRC) and hearing threshold shifts were observed after noise exposure and the pattern was different depending on the extent of the noise damage.The aim of this study was to reveal any functional changes of the MRC enzyme in outer hair cells after noise damage.Sprague-Dawley rats were used and divided into three groups including normal control group and noise exposure for 1 h and 5 h. White band noise was used with 120 dB SPL. We measured hearing threshold and activity of succinate dehydrogenase (SDH) before noise exposure, and immediately and 1, 3, 7, and 14 days after noise exposure in each group. Immunostaining using monoclonal anti-MRC complex V subunit α was performed. Transmission electron microscopy (TEM) was carried out.The hearing threshold level changed depending on the exposure time in both the noise-exposed groups. In the 1 h group, hearing was improved after 1 day, and in the 5 h group, hearing was measured after 7 days. Changes in SDH activity were observed at the third day in the 1 h group and at the seventh day in the 5 h group. The expression level of MRC complex V was increased after noise exposure. TEM showed mitochondrial damage.

The objective of the study was to determine the therapeutic efficacy of early combined treatment with intratympanic steroid injection (ITSI) in patients with severe to profound sudden sensorineural hearing loss (SSNHL), who did not respond to initial systemic steroid treatment (SST). The study design included historical controlled trials (retrospective analysis for the SST group). Patients (n = 73; 38 women and 35 men) diagnosed with severe to profound SSNHL at the time of their first visit in tertiary referral centers were recruited. Among these 73 patients, 30 patients who showed no early response within a week after the start of initial SST were prospectively included as the ITSI group. ITSI was performed twice a week for two consecutive weeks. In contrast, 43 patients with the same condition who did not receive ITSI were retrospectively included as the SST group. For each group, pure-tone audiogram (PTA) and speech discrimination score (SDS) tests were performed before SST and more than 2 months after termination of treatment in each group. After termination of each treatment, the final average gain on PTA showed no significant difference between the two groups; however, the final average gain of SDS demonstrated a significantly better recovery in the ITSI group. ITSI as part of an early combined therapy represents an effective treatment in terms of the improvement of SDS in severe to profound SSNHL showing no early response to initial SST.

Although much is known about the cerebral neural plasticity that occurs after deafness, it is unclear how much time is required for its development or what other cortical changes may consequently occur. This study provides a longitudinal assessment of cerebral cortical neural plasticity, as manifested in adult deafened cats. A total of 5 male cats were subjected to whole cortex analysis of glucose metabolic activity via 2-deoxy-2[(18)F] fluoro-D-glucose (FDG) micro-positron emission tomography (PET). The imaging was performed at the baseline state of normal hearing and then at 4, 9, 24, and 33 months after the induction of deafness. We compared glucose metabolism between the normal hearing state and each deafened state by using voxel-based statistical analysis (P

This study was performed to evaluate the usefulness of Hounsfield unit (HU) to better distinguish cholesteatoma from other inflammatory conditions in the mastoid ad antrum before primary mastoid surgery.We enrolled 82 patients who underwent tympanomastoidectomy for treatment of chronic otitis. Forty-one patients were pathologically diagnosed with cholesteatoma, whereas the others were diagnosed with inflammatory granulation. These lesions were confirmed, and HU was measured in preoperative computed tomography. The difference in HU between cholesteatoma and non-cholesteatoma tissues was analyzed, and the improvement in the diagnosis of cholesteatoma after inclusion of HU data was calculated.The HU was calculated as 42.68 ± 24.42 in the cholesteatoma group and 86.07 ± 26.50 in the non-cholesteatoma group. The differences between the 2 groups were statistically different (Student t test, P.01). By applying the HU, the sensitivity (51.2%-80.5%), specificity (80.5%-87.8%), positive predictive value (72.4%-86.8%), and negative predictive value (62.3%-81.8%) to diagnose cholesteatoma improved.The HU density was found to be statistically different between cholesteatoma and inflammatory granulation tissue in mastoid antrum. An improved diagnosis of cholesteatoma was achieved after adjusting for the HU.

외이의 기형은 외이의 형성부전(anotia)부터 경도의 외이기 형까지 다양한 정도를 보인다. 외이의 기형은 상당이 흔한 편 이다. Tanzer는 외이 기형의 유병률이 5% 이상 될 것으로 추 정하였다. 경도의 외이 기형에는 돌출귀(prominent ear), 매몰 귀(cryptotia), 경도의 수축귀(constricted ear) 등이 포함된다. 외이의 기형은 형태학적인 이상 외에도 전음성 청력 감소 등 의 기능적 문제 및 사회적 위축, 따돌림과 같은 심리적인 문 제가 같이 동반된다. 이비인후과 의사의 입장에서는 전통적으로 외이도 형성부 전으로 인한 전음성 난청이 문제가 되었으며, 이의 교정을 위 해서 외이도 성형술(canaloplasty)을 시행해 왔다. 사실 이비 인후과 의사의 입장에서 외이의 기형에 의한 난청을 전통적 으로 중요시해 왔으며 그 이외 외이 기형을 교정하기 위한 수 술에 대해서는 등안시해 왔던 것이 사실이다. 하지만 외이가 손상을 받았을 때 이의 재건과 교정은 이비인후과의 역할이 었다. 한발 더 나아가 최근에는 경도의 외이 기형의 교정에 대 한 관심도 높아지고 있으며 실제로 시행되면서 좋은 결과들 을 보여주고 있다. 여기에서는 외이 기형 중에서 경도에 속하면서 가장 유병률 이 높은 돌출귀에 대해서 기술하고 이의 수술적 교정에 대해 서 이야기하고자 한다.

The incidence of ipsilesional beating vibration induced nystagmus (VIN) is significantly higher in Meniere's disease (MD) with lower canal paresis (CP) group on caloric test and the intensity of VIN shows significant positive correlation with CP. Considering previous reports showing predominant loss of type II hair cells in MD and discrepancy of the results between caloric test and head thrust test in MD patients, VIN may provide valuable information regarding the functional reservoir of vestibular type II hair cells in MD.Clinical presentation of MD is dynamic and nystagmus changes phase to phase, which is attributed to the recovery process in addition to central compensation after active vertigo attack of MD. VIN has been shown to reflect the side difference of peripheral vestibular excitability and is well correlated with the severity of caloric weakness in vestibular neuritis. Aim of this study was to compare the intensity and the direction of VIN with CP in unilateral MD.52 patients with unilateral definite MD on AAO-HNS guideline (1995) were included. Auditory and vestibular function tests including caloric test, post-head shaking nystagmus (HSN) and VIN were evaluated during symptom free period and cases with spontaneous nystagmus were excluded. Vibratory stimuli (100 Hz) were applied to either mastoid alternatively. Eye movement was recorded using video nystagmography system. The horizontal component of VIN was compared with HSN and caloric test.37 patients (71%) showed VIN. VIN to ipsilesional side was in 10 and to contralesional side in 27. In patients with CP over 43% (N =23), 2 beated to ipsilesional side, 17 to contralesional side and 4 showed no VIN. In patients with CP of less than 43% (N =29), 8 beated to ipsilesional side, 10 to contralesional side and 11 showed no VIN (p0.05). 33 patients (63%) showed HSN and 24 patients of them (72%) showed contralesional nystagmus. The intensity of VIN shows significant positive correlation with the degree of CP on caloric test (Spearman's rho =0.340, p0.05).

This study compared long-term speech performance after cochlear implantation (CI) between surgical strategies in patients with chronic otitis media (COM). Thirty patients with available open-set sentence scores measured more than 2 yr postoperatively were included: 17 who received one-stage surgeries (One-stage group), and the other 13 underwent two-stage surgeries (Two-stage group). Preoperative inflammatory status, intraoperative procedures, postoperative outcomes were compared. Among 17 patients in One-stage group, 12 underwent CI accompanied with the eradication of inflammation; CI without eradicating inflammation was performed on 3 patients; 2 underwent CIs via the transcanal approach. Thirteen patients in Two-stage group received the complete eradication of inflammation as first-stage surgery, and CI was performed as second-stage surgery after a mean interval of 8.2 months. Additional control of inflammation was performed in 2 patients at second-stage surgery for cavity problem and cholesteatoma, respectively. There were 2 cases of electrode exposure as postoperative complication in the two-stage group; new electrode arrays were inserted and covered by local flaps. The open-set sentence scores of Two-stage group were not significantly higher than those of One-stage group at 1, 2, 3, and 5 yr postoperatively. Postoperative long-term speech performance is equivalent when either of two surgical strategies is used to treat appropriately selected candidates. Graphical Abstract Keywords: Cochlear Implantation, Otitis Media, Tympanomastoidectomy, Speech Performance INTRODUCTION Profound sensorineural hearing loss (SNHL) can occur in patients with chronic otitis media (COM) as a secondary effect of labyrinthitis, a labyrinthine fistula, or iatrogenic injury during surgery. Cochlear implantation (CI) has become the mainstay of auditory rehabilitation in patients with profound SNHL. However, CI was initially contraindicated in COM patients, because insertion of foreign material through a contaminated field into a space featuring potential intracranial communication was thought to be inappropriate (1). As the audiological benefits afforded by CI became better understood, and as surgical skills and radiological techniques improved, CIs have been increasingly performed in patients with COM. Recently, many reports on CI in patients with COM have appeared, addressing several issues, including candidate selection, choice of surgical strategy, and postoperative complications (2, 3, 4, 5, 6, 7, 8, 9, 10). In patients with COM, complete eradication of infected foci in the middle ear cleft prior to CI is essential to avoid development of serious complications and subsequent explantation (8). Therefore, it is essential to consider disease activity status when planning the surgical strategy; either one- or two-stage surgery may be appropriate. Postoperative findings after CI in patients with COM have been evaluated in those treated with one- or two-stage procedures, but among-study differences in results are apparent (2, 3, 7, 9). Hearing rehabilitation is the most important goal of CI, so the evaluation of postoperative speech performance is essential. However, such performance after CI in COM patients has been evaluated in only a few reports (4, 10) and comparisons of speech performance after application of various surgical strategies have not been performed. Hence, in the present study, we analyzed the postoperative complication and post-CI long-term speech performance of patients with COM treated via one- or two-stage surgery.

Received July 2, 2011 Accepted September 5, 2011 Address for correspondence Min-Hyun Park, MD Department of Otorhinolaryngology, Boramae Medical Center, Seoul National University-Seoul Metropolitan Government, 20 Boramae-ro 5-gil, Dongjak-gu, Seoul 156-707, Korea Tel +82-2-870-2443 Fax +82-2-831-0714 E-mail drpark@snu.ac.kr The auditory system recognized sound waves. The sound waves are longitudinal waves in the air, where the pressure varies in time. It is distinguished as the rapid pressure changes, referred to as ‘fine structure’, and slower overall changes of amplitude fluctuations, as ‘envelope’. The auditory system has a limited ability to follow the time-varying envelope, and this ability is known as ‘temporal resolution’. Our auditory system analyzes sound waves in frequency, intensity, and time domain. The understanding about frequency and intensity domain is relatively easy compare to time domain. Hearing threshold is measured by sound intensity in frequency domain. However the speech discrimination and understanding of the sentence in quiet and noise are associated with temporal resolution. So for the comprehensive understanding about the auditory system and hearing ability, we must extend our knowledge to the temporal ability of the auditory system. Korean J Otorhinolaryngol-Head Neck Surg 2011;54:585-91

Objectives. The objective of this study was to determine the various factors that affect the extrusion rate of ventilation tubes (VTs), including the nature of the middle ear effusion. Methods. A retrospective chart review of 82 pediatric patients (177 ears) who received VT insertion surgery under general anesthesia was carried out to evaluate the relationship between various factors and the VT extrusion rate. The factors we analyzed included age, gender, the adenoid size, the amount and content of the middle ear effusion after myringotomy, bleeding events, associated adenoidectomy and the findings of the tympanic membrane status, the tympanometry and the audiometry of the air bone gap. Results. The mean extrusion time was 254 days (range, 11 to 809 days). The patients with no history of previous VT insertion had a longer extrusion time (mean, 279 days) than did the patients who had undergone previous VT insertion (mean, 203 days). The patients with serous effusion had the shortest extrusion time (mean, 190 days) as compared to those patients with glue (273 days) and pus (295 days) effusions. Other factors had no statistical significant relationship with the extrusion time. Conclusion. The mean VT extrusion time was 254 days. The VT extrusion time was significantly related to the characteristics of the middle ear effusion and a history of previous VT insertion. Thus, the nature of middle ear effusion can provide a clinical clue to predict the VT extrusion time.

Background and Objectives : Co-administration of kanamycin (KM) with the loop diuretic ethacrynic acid (EA) has been known to produce a rapid and profound hearing loss in adult animals. The objective of this study was to see if monitoring the hearing status during intravenous infusion of EA could minimalize individual variability and to evaluate the correlation between the dose of EA and the body weight (wt). Materials and Method : Twenty cats with the mean age of 24 weeks3.7 (range, 20.6-28.3 weeks) and the mean weight of 3.27 kg0.75 (range 2.4-4.75 kg) received a subcutaneous injection of KM (300 mg/kg) followed by an intravenous infusion of EA (1 mg/min). Click evoked auditory brainstem responses (ABRs) were recorded to monitor the hearing during the infusion. When the ABR thresholds rose to levels in excess of 90 dB SPL, the infusion of EA was stopped. The histopathologies for sections of apex, middle, base of cochlea were examined after 6 months. Results : There was a significant positive correlation (p=.583) between the EA dose and body weight. Cochlear histopathology showed an absence of organ of Corti and decrease of spiral ganglion cells in the majority of cochleas, especially in the basal turn. The extent of loss of spiral ganglion cells was dependent on their distance from the round window. Conclusion : Monitoring the animal's hearing status during the procedure ensured that the dose of EA was optimized for individual animals. Thus, the positive correlation between the EA dose and body weight should be considered should in designing the animal models of controlled high frequency hearing loss.

Intracochlear schwannoma is a rare tumor arising from Schwann cells limited to the cochlea. Most of the cases have been found incidentally at autopsies or during surgeries. Today, gadoliniumenhanced magnetic resonance imaging (MRI) has made the diagnosis possible before surgical intervention. Intracochlear schwannoma presents unilateral progressive hearing loss, tinnitus or vague unsteadiness, all of which are common otologic symptoms seen in the outpatient department. Therefore, a high index of suspicion to detect this tumor is needed. We report two cases of intracochlear schwannoma: one case was diagnosed at gadolinium-enhanced MRI and removed by modified transotic approach preserving external auditory canal; the other case was followed up closely without the intervention of surgery. Korean J Otorhinolaryngol-Head Neck Surg 2009;52:996-1000 Key WordsZZSchwannoma·Cochlea.