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Background and Objectives Tinnitus retraining therapy (TRT) is one of the most effective treatment methods for tinnitus. This study aimed to evaluate the treatment response to TRT in tinnitus patients with hearing loss and to analyze an additive treatment effect of an hearing aid.Subjects and Method In this retrospective observational case-control study, we reviewed the medical records of the 80 patients who were diagnosed with sensorineural tinnitus with mild to moderate hearing loss and managed by TRT. The changes of tinnitus after TRT with or without hearing aids were measured by the questionnaire of visual analog scale (VAS) and the Tinnitus Handicap Inventory (THI) at 3, 6, 12, and 24 months after the treatment. Subjects were divided into two groups according to patients’ hearing aided condition: non-hearing aided TRT group (NHAG, n=40) and hearing aided TRT group (HAG, n=40). Treatment responses to TRT from both groups were also compared.Results All VAS scores of loudness, awareness, annoyance and effect on life of tinnitus, and THI scores were significantly decreased in both groups at 1-year follow-up period (p

Background and Objectives: The digits-in-noise (DIN) test was developed as a simple and time-efficient hearing-in-noise test worldwide. The Korean version of the DIN (K-DIN) test was previously validated for both normal-hearing and hearing-impaired listeners. This study aimed to explore the factors influencing the outcomes of the K-DIN test further by analyzing the threshold (representing detection ability) and slope (representing test difficulty) parameters for the psychometric curve fit.Subjects and Methods: In total, 35 young adults with normal hearing participated in the K-DIN test under the following four experimental conditions: 1) background noise (digit-shaped vs. pink noise); 2) gender of the speaker (male vs. female); 3) ear side (right vs. left); and 4) digit presentation levels (55, 65, 75, and 85 dB). The digits were presented using the method of constant stimuli procedure. Participant responses to the stimulus trials were used to fit a psychometric function, and the threshold and slope parameters were estimated according to pre-determined criteria. The accuracy of fit performance was determined using the root-mean-square error calculation.Results: The listener’s digit detection ability (threshold) was slightly better with pink noise than with digit-shaped noise, with similar test difficulties (slopes) across the digits. Gender and the tested ear side influenced neither the detection ability nor the task difficulty. Additionally, lower presentation levels (55 and 65 dB) elicited better thresholds than the higher presentation levels (75 and 85 dB); however, the test difficulty varied slightly across the presentation levels.Conclusions: The K-DIN test can be influenced by stimulus factors. Continued research is warranted to understand the accuracy and reliability of the test better, especially for its use as a promising clinical measure.

Background and Objectives The canal wall down mastoidectomy brings changes in the anatomy of the external auditory canal (EAC), causing potential problems, such as accumulated crust, vertigo attacks, and difficulties in wearing hearing aids (HAs). The objective of this study is to evaluate the safety and efficacy of mastoidoplasty using the demineralized bone matrix (DBM) to obliterate the mastoidectomized cavity and reconstruct EAC.Subjects and Method Medical records of patients with chronic otitis media with or without cholesteatoma who received mastoidoplasty using DBM by a single surgeon at Seoul St. Mary’s hospital between 2014 and 2021 were reviewed retrospectively.Results A total of 27 patients were included in this study. None of the patients showed any recurrence of cavity problem, wound infection, or any other complications during their followup period of 13.07±37 months. The average air and bone conduction hearing level of pure tone audiometry showed no significant change after surgery (p=0.50, p=0.54, respectively). Five patients indicated for hearing rehabilitation could adopt canal type HAs after surgery; six patients used completely-in-the canal type HAs, and one patient used in-the-canal type HAs. None of the patients using HAs complained of acoustic feedback or any other problem in wearing HAs.Conclusion Mastoidoplasty using DBM seems to be a very safe and effective surgical procedure that shows functionally acceptable EAC for hearing rehabilitation with canal type HAs and demonstrates no specific complication.

Subtype-specific alpha-antagonists are medications commonly prescribed for lower urinary-tract symptoms, benign prostatic hyperplasia in older populations. Our study aims to investigate the association between subtype-specific alpha-antagonists and fall risk.A total of 4,202,739 men aged 60-75 years eligible for Korean Health Insurance Review and Assessment Service (HIRA) during 2017-2018 were enrolled retrospectively. After propensity score matching, 53,303 people in the exposed and unexposed groups were considered in the final study analysis.The subtype-specific alpha-antagonists significantly increased the risk of fall in the exposed cohort compared to the unexposed cohort (odds ratio [OR] 1.80; 95% confidence interval [CI] 1.62-2.00). Low income increased the fall risk only in the unexposed cohort (OR 1.34; 95% CI 1.04-1.73). A seasonal difference appeared only in the exposed cohort, with a significantly higher risk of fall in summer (OR 1.23; 95% CI 1.03-1.47). A total of 968 events occurred in the exposed group, and 455 of these falls occurred on the first day of medication (47%).Subtype-specific alpha-antagonists significantly increased the risk of falls, especially on the first day of drug initiation and during the summer season. Education on orthostatic hypotension and fall prevention should be implemented when prescribing subtype-specific alpha-antagonists.

Background and Objectives The objective of this study was to investigate the effect of an active transcutaneous bone conduction implant (BCI) of Bonebridge (MED-EL) on tinnitus patients with asymmetric hearing loss (AHL) or single-sided deafness (SSD).Subjects and Method Medical records and tinnitus questionnaires were reviewed retrospectively of patients with AHL or SSD, who received Bonebridge by a single surgeon at Seoul St. Mary’s Hospital from 2017 to 2021. Audiologic evaluation and tinnitus questionnaires were conducted before and after surgery.Results Of the 17 patients, 8 patients had SSD and 9 patients had AHL, and 13 patients (76.47%) had tinnitus before surgery while 4 patients did not. No patient showed newly developed tinnitus after surgery. After implantation, three patients (23.08%) showed a complete resolution of tinnitus. All patients showed significant improvement in hearing level after surgery. The mean tinnitus handicap inventory (THI) score and visual analogue scale (VAS) score for effect on life showed a significant decrease after surgery, from 43.1±28.2 to 29.7±25.7 (pppp

Background and Objectives The newly introduced upright head roll test (UHRT), which exploits head rotations in the roll plane with the patient in the upright sitting position, is a diagnostic maneuver for horizontal canal-benign paroxysmal positional vertigo (HC-BPPV). This study is designed to determine whether UHRT, compared to supine head roll test (SHRT), can more accurately diagnose HC-BPPV and determine the subtype of HC-BPPV.Subjects and Method A total of 455 video nystagmus tests performed between April 2019 to June 2021 were retrospectively reviewed, and 63 patients with direction-changing positional nystagmus at UHRT or SHRT were enrolled in this study. UHRT result was classified as negative (if no nystagmus was observed), positive incomplete (if nystagmus was detected in one side), and positive complete (if nystagmus was evoked in both side). The frequency of nystagmus is also included in our assessment. In addition, the results of 4 patients with bow and lean test (BLT) records on videonystagmography were also analysed.Results The concordance rate between UHRT and SHRT was 97.8%, and the positive concordance rate was 91.38%. UHRT and SHRT provided identical subtype diagnosis in 98.1% (52 of 53 cases). In one case, UHRT and SHRT showed opposite results. Evaluating the affected side with bow and lean records, the SHRT, UHRT and BLT showed consistent results. The mean frequency of nystagmus was faster in SHRT than in UHRT.Conclusion UHRT showed equivalent results to SHRT in distinguishing subtype of HC-BPPV. UHRT is a useful method in diagnosing HC-BPPV simply in a sitting position.

BACKGROUND Hearing loss is a growing health concern worldwide. Hearing aids (HAs) are the treatment of choice for hearing rehabilitation in most cases of mild to moderate hearing loss. However, many patients with hearing loss do not use HAs due to their high cost, stigma, and inaccessibility. Since smartphones are widely used, many applications that mimic the amplification function of HAs have been introduced. Smartphone-based HA apps (SHAAs) are affordable and easy to access. However, the audiological benefit of SHAAs has not been determined. OBJECTIVE We compared the audiological performance between a SHAA and a conventional HA in a prospective, randomized, and controlled multicenter study. METHODS Patients with mild to moderate hearing loss were prospectively enrolled from two tertiary hospitals and randomly assigned to either a SHAA (Petralex, IT4YOU Corp. LLC, Saveni, Romania,) or a conventional HA (Siya 1 miniRITE, Oticon, Smorum, Denmark). For the cross-over study design, participants used the alternate device and repeated the same 2-month trial. Audiological measurements were obtained using hearing tests, real ear measurements (REMs), and hearing-in-noise tests (HINTs). Subjective satisfaction was evaluated using the Abbreviated Profile of Hearing Aid Benefit (APHAB) and the International Outcome Inventory for Hearing Aids (IOI-HA). RESULTS In total, 63 participants were screened and 38 participants completed the study. In sound field audiometry testing, the SHAA showed a 20–60 dB gain in the low to high frequencies of the hearing threshold level. The HA provided adequate gain in the middle to high frequencies (55, 65, and 75 dB in REMs), which is the sound level for most speaking volumes. However, the SHAA could not improve word recognition at 50 dB. The HA showed better audiological performance than the SHAA in both quiet and noisy conditions in HINTs. The IOI-HA scores were significantly improved by both the HA and SHAA versus unaided conditions. Among the SHAA users, 37%, 42%, 24%, and 32% showed improvement in APHAB scores for ease of communication, reverberation, background noise, and aversiveness of sounds, respectively. There were no differences in adverse events between the two study groups. CONCLUSIONS The HA showed better performance than the SHAA in word recognition and HINTs. However, the SHAA was significantly better than unaided hearing in terms of amplification. The SHAA may be a useful hearing assistance device for patients with mild to moderate hearing loss when listening to soft sounds in quiet conditions. The SHAA demonstrated poor performance when compared to the HA in the mid- to high-frequency sounds that are important for word recognition, sound quality, and hearing in noisy conditions. Further development of the signal technology of SHAA is needed to improve the sound quality of mid- to high-frequency sounds and to overcome noisy environments.

Objectives. Despite sufficient hearing gains, many patients with hearing loss have difficulty using hearing aids due to poor word recognition ability. This study was performed to introduce our hearing rehabilitation therapy (HRT) program for hearing aid users and to evaluate its effect on hearing improvement.Methods. In this prospective randomized case-control study, 37 participants with moderate or moderate-severe sensorineural hearing loss who had used bilateral hearing aids for more than 3 months with sufficient functional hearing gain were enrolled in this study. Nineteen participants were randomly assigned to the control group (CG) and 18 patients were assigned to participate in our HRT program once a week for 8 consecutive weeks (hearing rehabilitation therapy group [HRTG]). Their hearing results and questionnaire scores for hearing handicap and hearing aid outcomes were prospectively collected and compared between the two groups.Results. After completing 8 weeks of the HRT program, the HRTG showed a significantly greater improvement in scores for consonant-only and consonant-vowel sound perception than the CG (P

Background and Objectives: The purpose of the present study was to validate the performance and diagnostic efficacy of the Korean digits-in-noise (K-DIN) test in comparison to the Korean speech perception-in-noise (K-SPIN) test, which is the representative speech-in-noise test in clinical practice.Subjects and Methods: Twenty-seven subjects (15 normal-hearing and 12 hearing-impaired listeners) participated. The recorded Korean 0-9 digits were used to form quasirandom digit triplets; 50 target digit triplets were presented at the most comfortable level of each subject while presenting speech-shaped background noise at various levels of signal-to-noise ratios (-12.5, -10, -5, or +5 dB). Subjects were then instructed to listen to both target and noise masker unilaterally and bilaterally through a headphone. K-SPIN test was also conducted using the same procedure as the K-DIN. After calculating their percent correct responses, K-DIN and K-SPIN results were compared using a Pearson-correlation test.Results: Results showed a statistically significant correlation between K-DIN and K-SPIN in all hearing conditions (left: r=0.814, p

This study was performed to evaluate the effectiveness of our novel group vestibular rehabilitation therapy (G-VRT) and to analyze the factors affecting outcomes.Retrospective case series.Tertiary referral center.Patients with chronic dizziness who received G-VRT between December 2019 and July 2020.The G-VRT program consisted of a 1-hour physical therapy session by an otologist in a small group setting.Dizziness Handicap Inventory, visual analog scale, functional level scales, and video head impulse test, as well as the compliance to the program, were evaluated.All scores of dizziness questionnaires were significantly improved after G-VRT ( p0.001). The overall vestibule-ocular reflex gain calculated by video head impulse test increased compared to the initial scores, whereas the average PR scores of all three semicircular canals significantly decreased from the initial scores, indicating enhanced vestibular compensation ( p0.05). Enrolled patients showed high compliance to the program.G-VRT program is a cost-effective and efficient way to provide relief for chronic dizzy patients. Further case-control studies in a larger group, as well as comparative studies with generic or customized vestibular exercise, will be needed to validate the clinical value of G-VRT.

Background and Objectives Ototoxic sensorineural hearing loss causes permanent hearing loss in most cases. Recently there have been many reports describing cell base therapy with stem cells that has some effect on hearing recovery. We evaluated the efficacy of clinical grade, pre-made, human bone marrow derived mesenchymal stem cells (BM-MSCs) in ototoxic deaf animal model.Materials and Method BM-MSCs were cultured in a clinical grade laboratory. The animals were divided into 2 groups as follows: a saline injected control group and a stem cell injected group (MSC-group). Cultured MSCs were transplanted into the brachial vein of the deaf mice model. We recorded auditory brainstem response (ABR) and conducted immunohistochemistry at 1, 3, and 5 weeks.Results After the transplantation of MSC, a significant improvement in the hearing threshold of ABR was observed in the MSC transplanted group. Five weeks after transplantation of MSCs, hair cell regeneration was confirmed from the basal to the apex of the cochlea in fluorescent dyed image under the microscope compared to the control group.Conclusion BM-MSCs were effective in an acute ototoxic deaf animal model. These results show that stem cell transplantation mediate inner ear regeneration.

Objectives The objective of this study was to investigate current perception and expected price of personal sound amplification products (PSAPs) and to analyze influencing factors through multi-center hospital-based surveys of outpatients, caregivers, and hearing experts. Methods A multi-center exploratory cross-sectional study was conducted in two groups of respondents with two separate surveys: 1) a perception survey of patients and caregivers who visited an otorhinolaryngology outpatient clinic in 5 general hospitals and 2) an opinion survey of hearing specialists about the expected price of PSAPs. A total of 197 outpatient visitors responded to the perception survey, and 42 hearing specialists responded to the opinion survey. Results Overall perception score (18 questions) was 3.04 (95% CI, 3.00–3.09). When 5 categories of perception (knowledge, needs, cost, expectation, and information categories) were analyzed, cost and expectation showed the highest scores of 3.33 (95% CI, 3.21–3.44) and 3.33 (95% CI, 3.27–3.40), respectively, and needs showed the lowest score of 2.23 (95% CI, 1.97–2.49). The ≥ 60-year-old group showed significantly higher perception of PSAPs (P = 0.002), and the individuals with greater severity of subjective hearing loss showed significantly higher perception of PSAPs (P = 0.002). The expected price of PSAPs of the outpatient visitors was 933.9 USD (95% CI, 811.9–1056.0) per ear. Mean expected price of PSAPs of hearing specialists was 291.3 USD (95% CI, 238.2–344.3) per ear. Conclusion The perception rate of PSAPs was very low, and there was a discrepancy in the expected price of PSAPs between patients/caregivers and hearing experts. Hearing specialists should make effort to improve perception of PSAPs.

Background and Objectives: Although the digit-in-noise (DIN) test is simple and quick, little is known about its key factors. This study explored the considerable components of the DIN test through a systematic review and meta-analysis. Materials and Methods: After six electronic journal databases were screened, 14 studies were selected. For the meta-analysis, standardized mean difference was used to calculate effect sizes and 95% confidence intervals.Results: The overall result of the meta-analysis showed an effect size of 2.224. In a subgroup analysis, the patient’s hearing status was found to have the highest effect size, meaning that the DIN test was significantly sensitive to screen for hearing loss. In terms of the length of the presenting digits, triple digits had lower speech recognition thresholds (SRTs) than single or pairs of digits. Among the types of background noise, speech-spectrum noise provided lower SRTs than multi-talker babbling. Regarding language variance, the DIN test showed better performance in the patient’s native language(s) than in other languages.Conclusions: When uniformly developed and well validated, the DIN test can be a universal tool for hearing screening.

Objectives: The present meta-analysis sought to assess further evidence for the efficacy of steroids in vestibular neuritis (VN). Methods: The PubMed, EMBASE and Cochrane Library databases were searched through August 30, 2019. The main outcome measures were 1) complete caloric recovery, 2) improvement of canal paresis (CP) in caloric testing, and 3) dizziness handicap inventory. The follow-up times were divided into short, mid, and long-term. The main outcome measures were 1) complete caloric recovery, 2) improvement of canal paresis (CP) in caloric testing, and 3) dizziness handicap inventory. Results: Among 276 records identified, 5 studies (n = 253) were included in the analysis. The therapeutic effect of steroid on VN was confirmed (Hedges’g = 0.172, 95% CI 0.048 to 0.295, p = .006). This effect was statistically significant on long-term follow-up (Hedges’g = 0.496, 95% CI 0.285 to 0.708, p < .0001). The therapeutic effect of steroids on VN was better than that of non-steroid treatment (Hedges’g = 0.299, 95% CI 0.107 to 0.490, p = .002). However, this effect was obscured by combination of other treatments. The therapeutic effect of steroids on VN was statistically significant regarding complete caloric recovery and improvement in CP (Hedges’g = 0.364, 95% CI 0.181 to 0.547, p < 0.0001; Hedges’g = 0.592, 95% CI 0.315 to 0.5869, p < .0001) Conclusions: The results suggest that corticosteroids are effective at VN recovery, especially in long-term follow-up. More data are required before recommendations can be made regarding management in patients on corticosteroids.