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Aim: To develop a bilateral vestibulopathy animal model induced by gentamicin using RS rat and to see the effect of LLLT on this bilateral vestibulopathy model. Method: RS rats were divided into 3 groups, control group (C), laser group (L), and histology group (H). All animals in the 3 groups received gentamicin (GM) 110 mg/kg, intravenously once daily for 3 days. The animals underwent sinusoidal oscillation about a vertical axis before the GM injection, 1, 3, and 7 days post injections. Transcanal low level laser therapy (LLLT) was irradiated to left ear canal for 7 days, starting 1 day post the GM injection. The H group animals were irradiated into the left ear of L group for 3 days, starting 1 day post GM injections for 3 days. C and L groups were sacrifice on 9 th day and H group was sacrificed on 7 th day. Results: The gain of the C group was significantly decreased in 3 and 7 days. The gain of the right ear of L group was decreased significantly in 3 and 7 days. The gain of left ear of L group was decreased in 3 days post LLLT but the decreased gain was improved significantly comparing to the level of 7 days gain of right ear and it was much closer to the pre-GM level. The average number of cells in cupula of H group after laser treatment for 3 days was significantly lower in non laser treated right ear comparing to the laser treated left ear and ears of the normal rats. Conclusion: The present study demonstrated that LLLT restores vestibular function and vestibular hair cells in rats post gentamicin induced ototoxic damage. LLLT may have clinical implications in the treatment of various vestibular dysfunction. Further studies are essential to verify the exact mechanisms and the most effective application of LLLT to rescue vestibular dysfunction.

The aim of this study was to find out the effect of low-level laser therapy (LLLT) on salicylate-induced tinnitus in the rat model. Fourteen Sprague-Dawley rats (8 weeks; 240–280 gm) were divided into 2 groups (study group, control group). Rats of both groups were treated with 400 mg/kg/day of sodium salicylate for 8 consecutive days. Tinnitus was monitored using GPIAS (Gap Prepulse Inhibition of Acoustic Startle) 2 h after first salicylate treatment, and every 24 h during 9 days of treatment. Rats in laser group were irradiated to each ear with wavelength of 830 nm diode laser (165 mW/cm2) for 30 min daily for 8 days. During salicylate treatment, rats of study group irradiated with low level laser showed significantly higher GPIAS values throughout the experiment. Therapeutic effect of LLLT is demonstrated in animal tinnitus model by means of GPIAS. Further experimental studies are needed to find possible mechanisms and better methods to improve LLLT efficacy.

Objectives The purpose of this study was to evaluate the therapeutic effect of three different types of sounds on tinnitus patients undergoing tinnitus retraining therapy (TRT). Methods This is a single-institution retrospective study, performed in one tertiary otological referral center. Thirty-eight adults with subjective idiopathic tinnitus who were followed for at least 9 weeks were enrolled. Sound therapy was delivered in 3 different ways: narrowband noise TRT (nTRT); mixed band noise TRT (mTRT); broadband noise TRT (bTRT). Treatment response was measured through validated psychometric questionnaires: Tinnitus Handicap Inventory (THI), visual analog scale (VAS) on annoyance, and numerical description of hours of tinnitus perception (awareness hours). Results A total of 38 patients were followed for at least 9 weeks. In nTRT group, all outcome measures including THI, VAS, and the awareness hours, decreased over 9 weeks with no statistical significance. In mTRT group, all outcome measures except for awareness hours significantly improved 9 weeks after the beginning of the treatment. In bTRT group, all outcome measures decreased significantly in 9 weeks. When therapeutic success is defined as improvement in THI 7 or more, bTRT group (77.8%) showed a higher success rate than other groups for 38 patients with the minimum follow-up of 9 weeks. Conclusion All three sounds can provide relief in patients with annoying tinnitus after TRT. However, there is difference in the therapeutic effect according to sound types. Broadband sound seems to be better than narrowband sound or mixed sound in relieving the patients from tinnitus. Therefore, sound therapy with broadband noise may be more appropriate during TRT, but further evidence is needed for precise conclusion.

OBJECTIVES Rectified vestibular evoked myogenic potential (rVEMP) is new method that simultaneously measures the muscle contraction power during VEMP recordings. Although there are a few studies that have evaluated the effect of the rVEMP, there is no study that has evaluated the capacity of rVEMP during asymmetrical muscle contraction. METHODS Thirty VEMP measurements were performed among 20 normal subjects (mean age, 28.2±2.1 years; male, 16). VEMP was measured in the supine position. The head was turned to the right side by 0°, 15°, 30°, and 45° and the VEMPs were recorded in each position. The interaural amplitude difference (IAD) ratio was calculated by the conventional non-rectified VEMP (nVEMP) and rVEMP. RESULTS The nVEMP IAD increased significantly according to increasing neck rotation. The IAD in rVEMP was almost similar from 0° to 30°. However, the IAD was significantly larger than the other positions when the neck was rotated 45°. When IAD during 0° was set as a standard, the IAD of the rVEMP was significantly smaller that the nVEMP only during the 30°rotaion. CONCLUSION Rectified VEMP is capable of correcting asymmetrical muscle contraction power. In contrast, it cannot correct the asymmetry if muscle contraction power asymmetry is 44.8% or larger. Also, it is not necessary if muscle contraction power asymmetry is 22.5% or smaller.

We investigated the effect of low-level laser radiation on rescuing hair cells of the cochlea after acute acoustic trauma and hearing loss. Nine rats were exposed to noise. Starting the following day, the left ears (NL ears) of the rats were irradiated at an energy output of 100 to 165 mW / cm2 for 60 min for 12 days in a row. The right ears (N ears) were considered as the control group. Frequency-specific hearing levels were measured before the noise exposure and also after the 1st, 3rd to 5th, 8th to 10th and 12th irradiations. After the 12th treatment, hair cells were observed using a scanning electron microscope. Compared to initial hearing levels at all frequencies, thresholds increased markedly after noise exposure. After the 12th irradiation, hearing threshold was significantly lower for the NL ears compared to the N ears. When observed using an electron microscope, the number of hair cells in the middle turn of the NL ears was significantly larger than that of the N ears. Our findings suggest that low-level laser irradiation promotes recovery of hearing thresholds after acute acoustic trauma.

Objective The objective of this study was to examine whether any clinical difference existed with respect to the characteristics of dizziness in vestibular neuritis (VN) and sudden sensorineural hearing loss with vertigo (SHLV). Study design Retrospective review. Setting Tertiary referral center. Patients Included in this study were 22 SHLV patients and 32 VN patients who had been confirmed of unilateral caloric weakness. Sudden sensorineural hearing loss accompanied sudden attack of rotatory vertigo. Main outcome measures Clinical features such as comorbidity, duration of vertigo, duration of spontaneous nystagmus, and others were compared between the 2 groups. Medical records related to the vestibular function test were also reviewed. Results When comparing comorbid diseases and symptoms, there was no significant difference between the 2 groups. There were also no differences in the duration of spontaneous nystagmus and vertigo symptoms. However, the proportion of patients with abnormal vestibular evoked myogenic potential response was significantly smaller in the VN group compared with the SHLV group. Conclusion Patients with SHLV are much more likely to have saccule/inferior vestibular nerve involvement than patients with VN.

To determine whether the vestibular nuclei are affected by inflammation of temporomandibular joint (TMJ) region, we studied vestibular nucleus neural activity using two experimental groups: (1) normal saline 0.1 cm 3 injection at right TMJ region, (2) 10% formalin 0.1 cm 3 injection at right TMJ region. Neural activity after 24 hours was assessed by immunohistochemical staining with free-floating section at the level of interaural −1.30 mm to −2.00 mm for c-Fos. In inflammation group, formalin injection produced a bilateral increase in c-Fos at vestibular nucleus with ipsilesional side higher activity. In control group, expression of c-Fos protein was also observed in the vestibular nucleus (VN), especially MVN. But stain intensity of Fos-positive neurons was much weaker and mean number of c-Fos positive cells was fewer than inflammation group. This result suggests that there is a close neural connection between TMJ and vestibular nucleus, especially in case of inflammation.

The transcanal LLLT was found to recover noise induced hearing loss (NIHL) but the LLLT was performed immediately after the induction of NIHL. The aim of this study was to find an optimal window time to treat and recover a NIHL with LLLT. Bilateral ears of 6SD rats (12ears) were exposed to noise. Left ears of the rats were irradiated with a LLLT (830 nm, 594 J/cm2 per day) for 12 days, starting 3 days and 7 days post exposure to noise. Right ears were used as control ears. The hearing levels were measured at each frequency of 4, 8, 12, 16, and 32 kHz before and after the noise exposure and post 12th irradiations. The initial hearing levels in all frequencies before and after the noise exposure were 26.5, 24.5, 24.0, 24.0 and 24.5 dB SPL and 63.5, 64, 71.5, 73.5 and 67.5 dB SPL in 4, 8, 12, 16 and 32 kHz, respectively in 6 ears. After 12th irradiation, the thresholds of the LLLT treated left ears of the 3-day group recovered significantly compared to those of the untreated right. However, for the 7 day group, the recovery of the LLLT treated left ears was not significantly improved compared to that of the untreated right. The results of this study suggest that the optimal window time to treat NIHL with LLLT was within 3 days from the exposure to noise but the hearing failed to recover if the LLLT was started 7 days post exposure to noise.

Aim: To see the effect of LLLT on noise-induced hearing loss. Methods: Eleven rats were exposed to noise (120 dB, 16 kHz, 6 h) and left ears were irradiated at 60J/cm 2 , 830 nm laser for 12 days. Right ears were control. Hearing levels were measured at frequencies of 4, 8, 12, 16, 32 kHz before noise exposure and after 12th irradiations. Results: The initial hearing levels were 26.5±4.7, 24.5±5.0, 24.0±5.2, 24.0±3.2, 24.5±5.5 dB SPL. After noise exposure, thresholds were 63.5±15.1, 64±16.8, 71.5±11.3, 73.5±15.6, 67.5±14.4 dB SPL in 4, 8, 12, 16, 32 kHz. After 12th irradiation, thresholds of treated ears recovered significantly 21±4.2, 20±3.5, 24±11.9, 24±12.9, 21±2.2 dB SPL and that of the untreated right ears measured 36.3±22.9, 45±15.8, 66.3±22.9, 50±16.8, 43.8±21.4 dB SPL. Conclusion: LLLT may promote recovery of hearing after noiseinduced hearing loss.

The aim of this study was to evaluate the antibacterial effects of photodynamic therapy (PDT) on common bacteria causing otitis media with effusion (OME).An in vitro study was carried out using a hematoporphyrin derivative sensitizer (Photogem; Lemonosov Institute of Fine Chemical, Moscow, Russia) and a 632-nm diode laser on Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae. The presence of colony-forming units of the bacteria was examined, the microscopic structures of the bacteria were examined by transmission electron microscopy (TEM), and flow cytometry of the bacteria was performed. An in vivo PDT study was performed using gerbils. S. pneumoniae or H. influenzae were injected into bullae. The Photogem was injected into the bullae 2 days later when OME developed, and transcanal irradiation with the 632-nm diode laser (90 J) was performed. Middle ear and bulla were washed with Dulbecco's phosphate buffered saline (DPBS) and the washed DPBS was cultured. The presence of bacterial colonies was examined.The PDT was effective in killing all three kinds of bacteria. TEM showed damaged bacterial cell membranes and cytoplasmic structures, and the flow cytometry showed a lower number of viable bacteria in the PDT group compared to the control group. PDT was effective in killing S. pneumoniae in 87% of the infected bullae with OME, whereas it was effective in eradicating H. influenzae in 50% of the infected bullae with OME.The results of these studies demonstrated that PDT may be effective to treat otitis media. PDT may have clinical implications in the treatment of otitis media that is resistant to antibiotic therapy.

Speechreading is a visual communicative skill for perceiving speech. In this study, we tested the effects of speech experience and deafness on the speechreading neural network in normal hearing controls and in two groups of deaf patients who became deaf either before (prelingual deafness) or after (postlingual deafness) auditory language acquisition. Magnetic signals from the cerebral cortex were recorded using a 306-channel magnetoencephalographic system. During magnetoencephalographic measurements, subjects were asked to perform a speechreading task from video clips of a female speaker either pronouncing syllables (speechreading condition) or showing closed-mouth movement. The sources of the evoked fields were modelled using equivalent current dipoles, the origins of which were fitted to the intracranial space based on magnetic resonance imaging findings. During the speechreading condition, the latency of auditory cortex activation was shorter in the postlingual deafness group than in the normal hearing control group. This parameter negatively correlated with speechreading scores measured clinically. Furthermore, as the duration of deafness increased, the latency of auditory cortex activation decreased exponentially. However, no such correlation was found in the prelingual deafness group which differed significantly from the two other groups in this respect. The latency of auditory cortex activation was significantly longer in the prelingual deafness group than in the two other groups. Thus, auditory experience may be crucial for the development of a normal neural network for speechreading. The pre-existing speechreading network in the postlingual deafness group is made more efficient by speeding up the neural response.

Objectives: The objective of this study was to evaluate the merits of a blood pressure (BP) manometry feedback method for measurement of vestibular evoked myogenic potentials. Methods: Sixty ears of 30 normal volunteers were prospectively investigated. The vestibular evoked myogenic potentials were recorded under 3 different conditions: In the feedback-negative (FB–) condition, ie, in a sitting position without feedback; in the feedback-positive (FB+) condition, ie, in a sitting position with self-monitored BP feedback (using a BP cuff); and in a supine condition, ie, in a supine position without feedback. The interaural amplitude difference (IAD) ratios and interaural latency differences were analyzed. Results: The mean IAD ratio was smaller in the FB+ condition than in the FB– and supine conditions, but the difference was without statistical significance. The upper limits of the normal range of the IAD ratios were 39.5%, 18.3%, and 25.9% for the FB–, FB+, and supine conditions, respectively. The interaural latency difference of p13 was significantly smaller in the supine condition than in the FB– and FB+ conditions. Conclusions: Although the reduction of the mean IAD ratio did not reach statistical significance by feedback monitoring in our study, feedback using a BP manometer may have some clinical significance, in that a more stable IAD ratio may be obtained with a narrower normal range and a smaller variation.

Background and Objectives:The purpose of this study was to investigate the effects of low level laser for the prevention and treatment of aminoglycoside-induced vestibular ototoxicity. Materials and Method:An organotypic culture of 2 to 4 days old rat utricular maculae was established. Rats were divided into 6 groups according to the treadtment of the utricles:G (gentamicin- treated), L (laser-irradiated), LG (laser-irradiated and gentamicin-treated), GL (gentamicin-treated and laser-irradiated), LGL (gentamicin-treated during laser-irradiated) and C (control). After organotypic culture, the utricles of 6 groups were examined by confocal laser scanning electron microscope and scanning electron microscope. The results of each group were compared with each other by statistical methods. Results:The number of vestibular hair cells of the group G was smaller compared to that of the group C. The group L had no difference compared with the group C. The groups LG and GL showed more vestibular hair cells compared with the group G. The group LG showed more vestibular hair cells than the group GL. The group LGL showed most vestibular hair cells compared to that of the groups G, LG, and GL. Conclusion:The most effective treatment of aminoglycoside- induced vestibular otoxicity is the irradiation of low level laser before and after the insult of the aminoglycoside. Further clinical studies using low level laser were needed to prevent aminoglycoside-induced ototoxicity and to promote the regeneration of ves- tibular hair cells. (Korean J Otorhinolaryngol-Head Neck Surg 2009;52:19-28)

The internal nasal valve (INV) angle in Asians is 21.6 degrees +/-4.5 degrees and it is significantly larger than that of Caucasians. The reconstructed CT method has better reproducibility than the endoscopic method in measuring the INV angle.The INV is an area of interest for nasal surgeons due to its functional significance in rhinoplasty and septoplasty. This study was designed to evaluate the size of the INV angle in an Asian population by measuring the angle through reconstructed CT scans and nasal endoscopy.Thirty-eight ostiomeatal unit CTs and 24 endoscopic photos of patients who had minimal or no sinonasal problems were analyzed. CT images that had been reconstructed perpendicular to the acoustic axis and endoscopic photos were used to measure the INV angle. Each method was verified as to reproducibility and the angles measured by the two methods were compared.The INV angle of the Asians measured by CT scan was 21.6 degrees +/-4.5 degrees . This value was significantly larger than that of the Caucasians, which has been reported to be 11.4 degrees +/-2.6 degrees (p0.001). The INV angle measured endoscopically was 19.3 degrees +/-3.6 degrees . Reproducibility of the reconstructed CT method was good (p0.001), while the reproducibility of the endoscopic method was poor (p=0.093). The correlation between the two methods was also poor (p=0.107).

Unlike mammals, avian cochlear hair cells can regenerate after acoustic overstimulation. The WDR1 gene is one of the genes suspected to play an important role in this difference. In an earlier study, we found that the WDR1 gene is over-expressed in the chick cochlea after acoustic overstimulation. The aim of this study was to compare the expression of WDR1 before and after acoustic overstimulation in the chick vestibule. Seven-day-old chicks were divided into three groups: normal group, damage group, and regeneration group. The damage and regeneration group was exposed to 120 dB SPL white noise for 5–6 hours. The damage group was euthanized shortly after the impulse, but the regeneration group was allowed to recover for 2 days. The utricle, saccule, and the three ampullae of each semicircular canal were dissected and immunohistochemically stained with anti-WD40 repeat protein 1 antibody. For quantitative analysis, immunoreactive densities were measured and quantitative real-time RT PCR was performed. WD40 repeat protein 1 expression was elevated in all the semicircular canals and utricle, two days after an acoustic overstimulation (P = 0.001). WDR1 mRNA expression was 1.34 times higher in the regeneration group compared to the normal group, but it was not statistically significant. Exceptionally, WD40 repeat protein 1 expression did not increase in the saccule of the regeneration group. Elevated WDR1 expression in the avian vestibule may have a role in the hair cell regenerating ability as in the avian cochlea. A similar mechanism of hair cell regeneration may exist in the avian cochlea and vestibule.

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.

In the article titled "Determinants of Conductive Hearing Loss in Tympanic Membrane Perforation," published in the June 2015 issue of Clinics in Experimental Otorhinolaryngology (2015;8:92-96; http://dx.doi.org/10.3342/ceo.2015.8.2.92), an error occurred in the byline. The sixth author's name should have been given as Myung-Whan Suh.

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

The primary cause of hearing loss includes damage to cochlear hair cells. Low-level laser therapy (LLLT) has become a popular treatment for damaged nervous systems. Based on the idea that cochlea hair cells and neural cells are from same developmental origin, the effect of LLLT on hearing loss in animal models is evaluated. Hearing loss animal models were established, and the animals were irradiated by 830-nm diode laser once a day for 10 days. Power density of the laser treatment was 900 mW/cm(2), and the fluence was 162 to 194 J. The tympanic membrane was evaluated after LLLT. Thresholds of auditory brainstem responses were evaluated before treatment, after gentamicin, and after 10 days of LLLT. Quantitative scanning electron microscopic (SEM) observations were done by counting remaining hair cells. Tympanic membranes were intact at the end of the experiment. No adverse tissue reaction was found. On SEM images, LLLT significantly increased the number of hair cells in middle and basal turns. Hearing was significantly improved by laser irradiation. After LLLT treatment, both the hearing threshold and hair-cell count significantly improved.

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 Objectives: Although the adverse effect of long term steroid usage is well known, the adverse effect of short term high dose steroid usage has not been studied thor- oughly. The purpose of this study was to identify the characteristics of the adverse effects when using a high dose steroid for a short term. We also compared the adverse effect of steroid be- tween in- and out-patients. Subjects and Methods: The medical record of 500 patients, who were treated with methylprednisolone 48 mg/day for 1-2 weeks, was retrospectively reviewed. Steroid was prescribed due to SSNHL, Bell's palsy, Ramsay-Hunt syndrome and herpes zoster oticus. The incidence of each adverse effect was analyzed, and also the time point of detection was analyzed. The 500 patients were composed of 250 in-patients and 250 out-patients. The adverse effect was compared between these two groups, as well. Results: Adverse effect of steroid was found in 33.0% of the patients. Among these adverse effects, abdominal discom- fort (26.8%) was most common, followed by skin rash (14.7%), swelling (13.4%), and hot flush (6.9%). Abdominal discomfort and hot flush was mostly detected on the first week. Meanwhile, the skin rash was usually detected on the third week. The incidence of adverse effect was sig- nificantly higher in the out-patient group. Conclusions: The incidence of high dose short term steroid treatment may be very high. The patients should be warned about these adverse ef- fects. Monitoring should be performed until 3-4 week, since some adverse effects may not be detected until this time point. Korean J Audiol 2012;16:65-70

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

Biofilm formation has been demonstrated for many mucosal pathogens such as Haemophilus influenzae . The presence of mucosal biofilms with chronic otitis media with effusion (COME) suggests that bacteria do not clear by antibiotics. Aim: To test the effect of photodynamic therapy (PDT) on H. influenzae induced biofilm in vivo. Methods: Gerbils were divided into control (C), HI group, Laser (L), PS, PDT A, and PDT B groups. The C group received no treatment. HI group was injected with 20μl (10 8 CFU/ml) of H. influenzae into the bullae and formation of biofilms in the bullae was obtained by 5 days. For L group, 120 J/cm 2 (100 mw × 20 min) of 632 nm LD laser was irradiated by a fiber inserted into the bullae 5 days after the H. influenzae injection. For PS group, photofrin 40μl (1mg/ml) were injected into the bullae 5 days after the H. influenzae injection. PDT A group received photofrin 1 mg/ml and LD laser 120 J/cm 2 that were administered into the bullae 5 days after the H. influenzae injection. PDT B group received photofrin 2 mg/ml and laser 150 J/cm 2 5 days after the H. influenzae injection. The mucosal tissues in bullae were examined by H/E staining, and SEM. Results: The C group showed normal mucosa of bullae. The HI, L, and PS groups have shown well formed biofilm. Twenty five percent of the PDT A group and 50 % of the PDT B group have shown completely or partially resolved biofilm. Conclusion: The results of this study demonstrated that PDT appears to be effective to treat experimental H. influenzae induced biofilms in vivo. Clinical implication: PDT may be an alternative to antibiotic treatment on otitis media with biofilm formation.

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.