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Basic sciences imaging studies surgical issues patient selection and other issues pediatric cochlear implant brainstem implant rehabilitation speech processing and different languages.

Profound hearing loss can be accompanied by or be a result of chronic otitis media. Cochlear implantation in patients with chronic otitis media is often resisted because of possible problems associated with the introduction of foreign material into a septic space, which is a potential pathway to the intracranial space. However, the well-established benefits of cochlear implants and improved surgical techniques have encouraged discussions on the feasibility of cochlear implantation in the presence of chronic otitis media. Generally, special surgical techniques, in addition to implantation, are necessary to eradicate the infection and to protect the electrode array in the radical cavity. In this study, we describe our experience of cochlear implantation in patients with chronic ear disease, and propose management principles.

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

Jihye Rhee, Juyong Chung, Shin Hye Kim, Myung-Whan Seo, Ja-Won Koo, Jun Ho Lee, Seung Ha Oh and Sun O Chang Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul; and Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea

=0.961, 0.945, 0.923, respectively; p＜0.01, ＜0.01, ＜0.01, respectively). ConclusionZZKCID sentences can be used as a speech performance test material and might serve as a compatible test material for selection of the cochlear implant candidacy. � Korean J Otorhinolaryngol-Head Neck Surg 2012;55:85-9 Key WordsZZSpeech perception ㆍCochlear implants ㆍHINT ㆍCID.

Congenital aural atresia is a relatively common anomaly in otology. It requires an early assessment of hearing status and an early evaluation of the degree of atresia. Its surgical management is aimed at obtaining hearing gain and at establishing appropriate auditory canal status for the application of hearing aids. The authors analyzed the preoperative otologic findings, surgical findings, postoperative complications, and postoperative hearing results of 25 ears in 21 patients with congenital aural atresia. From January 1987 to February 1992, 24 of these ears were surgically corrected by anterior approach; the remaining 1 was corrected by transmastoid approach. Postoperative audiologic follow-up ranged from 8 months to 4 years (N = 21). A new modification of anterior approach is introduced. The final average air-bone gap was 30 dB, in contrast to preoperative 53 dB (N = 21). The final air-bone gap was improved to a level within 30 dB in 52% of the patients. Meatal stenosis was the most frequent postoperative complication and was seen in 12 patients in primary operation (N = 25). There was no postoperative facial nerve palsy and no sensorineural hearing loss. There was little difference in postoperative hearing among the various types of congenital aural atresia and the type of tympanoplasty that had been performed.

Cochlear implantation (CI) has been regarded as a safe and effective treatment for patients with severe to profound sensorineural hearing loss. The increase of experience in CI thus has had the effect of leading more children with inner ear anomaly to be considered as cochlear implant candidates. For patients with inner ear anomaly, auditory rehabilitation has been reported to be improved after CI; however, there are several factors such as cerebrospinal flu id leakage, facial nerve injury and abnormal positioning of electrode during surgery and uncertainty of auditory rehabilitation and possibility of the recurrent meningitis after CI that should be considered. Several studies proved that the incidence of otogenic meningitis is higher in patients with inner ear anomaly than in patients with normal inner ear anatomy. We experienced a case of recurrent meningitis due to an unusual cause after cochlear implantation in a patient with inner ear anomaly. � Korean J Otorhinolaryngol-Head Neck Surg 2011;54:166-9 Key WordsZZCochlear implantation ㆍMeningitis ㆍInner ear anomaly.

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 : Bone anchored hearing aid (BAHA) is an alternative method applicable to patients with chronic draining ear, congenital aural atresia and single sided deafness, who cannot benefit from conventional air conduction hearing aids. The objective of this study was to evaluate the experience of 14 patients who underwent BAHA surgery. Subjects and Method : We retrospectively reviewed the medical records of 14 patients who underwent BAHA surgery. Preoperative pure tone air and bone conduction thresholds and air-bone gap, postoperative BAHA-aided thresholds were measured. Hearing improvement as a result of implantation and complications related to implant were evaluated. Results : The most common indication for BAHA was congenital aural atresia (8 patients) and the rest consisted of chronic otitis media (3 patients) and unilateral sensorineural hearing loss (3 patients). The average threshold improvement with BAHA was 40 dB and 34 dB in patients with congenital aural atresia and chronic otitis media, respectively. Patients with unilateral hearing loss had a postoperative aided threshold of 25 dB. Complications were limited to the periabutment skin problem in two patients. One patient received revision surgery replacing the diseased skin with split-thickness skin graft from a thigh and the other patient received surgery to remove the abutment and the wound was closed with rotation flap, leaving the fixture underneath the skin. Conclusion : BAHA could be one of the safe and reliable treatment options available for auditory rehabilitation. Systematic evaluation for candidate selection might be needed to increase hearing gain and decrease co-morbidity.

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.

Labyrinthine fistula caused by cholesteatoma can make various complications according to the site of the lesion. The lateral canal, superior canal ampulla, posterior canal and promontory of the cochlea are the common areas of fistulization. However, invasion into the cochlea or internal auditory canal (IAC) is very rare. We have experienced a case of cholesteatoma extending into the cochlea and IAC, which was successfully treated via the transotic approach. Herein we report this case with a review of literature. (Korean J Otorhinolaryngol-Head Neck Surg 2009;52:468-70)

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.

Auditory evoked responses were collected in male zebra finches (Poephila guttata) to objectively determine differential frequency selectivity. First, the mating call of the animal was recorded and analyzed for its frequency components through the customized program. Then, auditory brainstem responses and cortical responses of each anesthetized animal were routinely recorded in response to tone bursts of 1–8 kHz derived from the corresponding mating call spectrum. From the results, most mating calls showed relatively consistent spectral structures. The upper limit of the spectrum was well under 10 kHz. The peak energy bands were concentrated in the region less than 5 kHz. The assessment of auditory brainstem responses and cortical evoked potentials showed differential selectivity with a series of characteristic scales. This system appears to be an excellent model to investigate complex sound processing and related language behaviors. These data could also be used in designing effective signal processing st...

Investigations evaluating the protective effect of Ginkgo biloba extract (EGb) on gentamicin (GM) ototoxicity were undertaken. Guinea pigs treated with 5 mg/kg gentamicin sulfate on the round window niche (RWN) showed acute changes on electrocochleogram and hair cell or microvilli damage on scanning electron microscopy (SEM). There was accumulation of GM in the whole cochlea, especially in the organ of Corti, stria vascularis, and type III fibrocyte on immunohistochemical study. However, the guinea pigs pretreated with local or systemic EGb revealed no significant changes by local GM installation. From these results, we concluded that EGb has a protective effect on the development of GM ototoxicity in the cochlea.