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Background: Many factors are thought to be associated with the development of cholesteatoma, while the mechanisms of its formation remain unclear. This study aimed to identify the potential mechanisms of the proliferation and growth of cholesteatoma by analysis of the differential expressions of proteins in cholesteatoma and retroauricular skin tissue collected from the same patients. Methods: The present study is a retrospective study performed in an academic medical center. Comparative proteomics analyses using two-dimensional gel electrophoresis (2-DE) and liquid chromatography-tandem mass spectrometry (LC-MS/MS), in addition to immunohistochemical analysis, were conducted to identify differentially-expressed proteins in cholesteatoma tissue as compared with retroauricular skin tissue. Western blotting was also employed to verify the expression patterns of the specific proteins identified by 2-DE and to measure the changes in potential modulators related to cholesteatoma proliferation and growth. Results: Calreticulin (CRT) and annexin A2 (AnxA2) were identified as being differentially-expressed in cholesteatoma by 2-DE and LC-MS/MS, the results of which were in agreement with the results of immunohistochemical analysis and western blotting. Downregulation of CRT and AnxA2 were observed in cholesteatoma. Conclusion: Our data suggests that CRT and AnxA2 downregulation are seen in cholesteatoma compared to retroauricular skin. We speculate that the reduced expression of CRT and the persistent inflammatory response play important roles in the epithelial proliferation of cholesteatoma.

To analyze the prevalence and associations of facial canal dehiscence (FCD), dural exposure, and labyrinthine fistula in chronic otitis media (COM) with and without cholesteatoma.This was a retrospective study performed in an academic medical center. Patients who received tympanoplasty with mastoidectomy for COM with and without cholesteatoma were included. The prevalence of FCD, dural exposure, and labyrinthine fistula in COM with and without cholesteatoma (mastoiditis) and their relationships were analyzed.A total of 189 patients, including 107 (56.6%) females and 82 (43.4%) males, with 191 ears were included. There were 149 cases (78.0%) of cholesteatoma and 42 patients (22.0%) with mastoiditis. FCD was noted in 27.5% of patients with cholesteatoma and 9.5% of patients with mastoiditis. Dural exposure was found in 21 patients (14.1%) with cholesteatoma and 4 patients (9.5%) with mastoiditis. Eleven patients (7.4%) with cholesteatoma and 1 patient (2.4%) with mastoiditis had labyrinthine fistula. Patients with a labyrinthine fistula had nearly a fivefold greater chance (OR = 4.924, 95% CI = 1.355-17.896, p = 0.015) of having FCD than those without a fistula. There was a positive correlation between dural exposure and labyrinthine fistula (P = 0.011, Fisher's exact test).FCD, dural exposure, and labyrinthine fistula are common complications in COM. These complications are more frequently observed in patients with cholesteatoma than in patients with mastoiditis. Surgeons should pay more attention to the treatment of COM.

Background Age-related hearing impairment (ARHI) is a major disability among the elderly population. Heat shock proteins (HSPs) were found to be associated with ARHI in animal studies. The aim of this study was to analyze the associations of single nucleotide polymorphisms (SNPs) of HSP genes with ARHI in an elderly population in Taiwan. Methods Participants ≥65 years of age were recruited for audiometric tests and genetic analyses. The pure tone average (PTA) of the better hearing ear was calculated for ARHI evaluation. The associations of HSPA1L (rs2075800 and rs2227956), HSPA1A (rs1043618) and HSPA1B (rs2763979) with ARHI were analyzed in 146 ARHI-susceptible (cases) and 146 ARHI-resistant (controls) participants. Results The “T” allele of HSPA1B rs2763979 showed a decreased risk of ARHI. The “TT” genotype of rs2763979 also showed a decreased risk of ARHI in the dominant hereditary model. For HSPA1L (rs2075800 and rs2227956) and HSPA1A (rs1043618), the haplotype “CAG” was related to a decreased risk of ARHI. Conclusion These findings suggest that HSP70 polymorphisms are associated with susceptibility to ARHI in the elderly population. Graphical abstract

Delayed facial palsy is a complication of otologic surgery. Tympanoplasty is commonly employed in chronic otitis media. We compared the incidence and characteristics of delayed facial palsy and hearing restoration between endoscopic and microscopic tympanoplasty for the treatment of simple chronic otitis media.Retrospective cohort study.Tertiary medical center.We retrospectively analyzed 468 patients who underwent type I tympanoplasty from January 2009 to April 2017. Patients were divided into transcanal endoscopic ear surgery and microscopic ear surgery groups. Their epidemiological profiles were reviewed and the outcomes of tympanoplasty were analyzed. Blood sample tests for herpes simplex virus and varicella-zoster virus immunoglobulin M and immunoglobulin G were arranged in patients with delayed facial palsy.Transcanal endoscopic ear surgery exhibited similar benefits to microscopic ear surgery in graft-taking rate and hearing restoration but had a shorter operation time (Transcanal endoscopic ear surgery is an ideal alternative for simple tympanoplasty. The incidence of delayed facial palsy was not significantly different between the 2 approaches. Because of the favorable prognosis and the absence of direct serological evidence supporting viral reactivation, treatment with antivirals may not be required.

OBJECTIVES: Tinnitus and dizziness are common among the elderly. The conditions may increase depression, and patients may become susceptible to falls, thereby affecting the quality of life of the geriatric population. Investigating the prevalence of persistent tinnitus and chronic/recurrent dizziness in an elderly population and analyzing the association of certain comorbidities with tinnitus and dizziness in southern Taiwan were the main purposes of this study. MATERIALS AND METHODS: This was a cross-sectional study performed in a metropolitan hospital. Hearing tests were conducted in a total of 597 volunteers aged ≥65 years involving 322 (53.9%) men and 275 (46.1%) women recruited in the study. The pure tone average (PTA) and hearing handicap (HH) score were calculated. Patients completed questionnaires regarding the history of hypertension and diabetes and symptoms of tinnitus and dizziness. The association of gender, age, PTA/HH, body mass index (BMI), hypertension, diabetes, and metabolic syndrome (MetS) with tinnitus and dizziness were analyzed. RESULTS: The prevalence of persistent tinnitus and chronic/recurrent dizziness was 32.0% and 24.1%, respectively. Tinnitus or dizziness were not associated with age, BMI, hypertension, diabetes, and MetS but was associated with hearing impairment. Women and those with fasting glucose levels

Hypothesis Whereas autophagy has been linked to various human diseases, whether it also plays a role in cholesteatoma is virtually unknown. This study aimed to investigate the activity and regulation of autophagy in cholesteatoma. Background The treatment of middle ear cholesteatoma has been challenging due to an insufficient understanding of the underlying disease mechanism. Methods Expression of microtubule-associated protein 1A/1B-light chain 3 (LC3), the autophagy protein marker, and phosphorylated Akt (p-Akt), and mammalian target of rapamycin (p-mTOR), the known autophagy regulators, in fresh retroauricular skin and cholesteatoma tissue samples was analyzed by immunoblotting. The results were further confirmed by immunohistochemistry and statistical analyses. Cell proliferation of primary retroauricular skin- and cholesteatoma-derived fibroblasts was evaluated by methyl thiazol tetrazolium (MTT) assay. Ectopic expression of serine proteinase inhibitor, clade B, member 3 (SERPINB3) in the fibroblasts was achieved by electroporation and the expression was detected by immunoblotting. Results LC3 expression was significantly decreased in cholesteatoma in most of the 15 paired retroauricular skin/cholesteatoma tissue samples. However, p-Akt and p-mTOR expression in the cholesteatoma samples was not significantly different from that in the control subjects. Immunohistochemical studies further demonstrated an inverse correlation between LC3 expression and cholesteatoma. The cholesteatoma fibroblasts proliferated faster than the retroauricular skin fibroblasts, and had higher SERPINB3 but lower LC3 expression. Furthermore, overexpression of SERPINB3 in the retroauricular skin fibroblasts enhanced cell proliferation and downregulated LC3 expression. Conclusion Autophagy is significantly suppressed in cholesteatoma tissues, which may not involve the Akt/mTOR signaling pathway. More importantly, SERPINB3 may promote cell proliferation and negatively regulate autophagy in cholesteatoma fibroblasts. Together, these findings warrant further investigation into the pathogenic mechanism of cholesteatoma.

Background Age-related hearing impairment (ARHI) is a major disability among the elder population. Chronic inflammation is an important factor in the development of ARHI. Interleukin-1 (IL-1) plays a key role in inflammation and may be associated with ARHI. The aim of this study is to analyze the associations of single nucleotide polymorphisms (SNPs) of IL-1 receptor genes with ARHI in an elderly population in Taiwan. Method Participants ≥65 years of age were recruited for audiometric tests and genetic analyses. The bilateral pure-tone average (PTA) of high-tone hearing levels was calculated for ARHI evaluation. The associations of SNPs of the IL-1 receptor type 1 gene (IL1R1) (rs3917225 and rs2234650) and type 2 gene (IL1R2) (rs4141134 and rs2071008) with ARHI were analyzed in 182 ARHI-susceptible (case) and 176 ARHI-resistant (control) participants. Results The G allele of IL1R1 rs3917225 showed a decreased risk of ARHI after adjustments for sex, age, and noise exposure. The GG genotype of IL1R1 rs3917225 in all hereditary models and the TT genotype of IL1R2 rs2071008 in the recessive model also showed decreased risks of ARHI after adjustments. Conclusion These findings suggest that IL1R1 and IL1R2 polymorphisms may contribute to the decreased risk of ARHI in the elderly population.

Background: Many factors are thought to be associated with the development of cholesteatoma, while the mechanisms of its formation remain unclear. This study aimed to identify the potential mechanisms of the proliferation and growth of cholesteatoma by analysis of the differential expressions of proteins in cholesteatoma and retroauricular skin tissue collected from patients. Methods: Comparative proteomics analyses using two-dimensional gel electrophoresis (2-DE) and liquid chromatography-tandem mass spectrometry (LC-MS/MS), in addition to immunohistochemical analysis, were conducted to identify differentially-expressed proteins in cholesteatoma tissue as compared with retroauricular skin tissue. Western blotting was also employed to verify the expression patterns of the specific proteins identified by 2-DE and to measure the changes in potential modulators related to cholesteatoma proliferation and growth. Results: Calreticulin (CRT) and annexin A2 (AnxA2) were identified as being differentially-expressed in cholesteatoma by 2-DE and LC-MS/MS, the results of which were in agreement with the results of immunohistochemical analysis and western blotting. Downregulation of CRT and AnxA2 were observed in cholesteatoma. Conclusion: Our data suggested that CRT and AnxA2 were associated with cholesteatoma. We speculated that the reduced expression of CRT and the persistent inflammatory response play important roles in the epithelial proliferation of cholesteatoma.

The glutathione peroxidase 3 gene ( GPX3 ) is reported to be a risk factor for arterial ischaemic stroke and cerebral venous thrombosis. GPX3 may be one of the aetiologies of sudden sensorineural hearing loss (SSNHL), which might be attributed to the genetic effect of GPX3 by influence reactive oxygen species (ROS). Unbalanced ROS have been associated with susceptibility to SSNHL. Therefore, we conducted a case–control study with 416 SSNHL cases and 255 controls. Five single nucleotide polymorphisms (SNPs) were selected. The genotypes were determined using TaqMan genotyping assays. Each SNP was tested using the Hardy–Weinberg equilibrium (HWE), and the genetic effects were evaluated using three inheritance models. All five SNPs were in HWE. As the result, the AG genotype of rs3805435 had an adjusted odds ratio (OR) of 0.54 (95% confidence interval = 0.37–0.79, p = 0.001) compared with the AA genotype in the SSNHL cases. The GG and AG genotypes of the SNP rs3805435 were associated with SSNHL under the dominant model ( p = 0.002, OR = 0.58). In conclusion, these results suggest that GPX3 polymorphisms influence susceptibility to SSNHL in southern Taiwan.

OBJECTIVE Tympanoplasty is a common surgery for chronic otitis media. We analyzed the results of endoscopic and microscopic approaches for type 1 tympanoplasty in patients with simple chronic otitis media. MATERIALS AND METHODS We evaluated the records of 95 patients (100 ears) who underwent type 1 tympanoplasty from 2011 to 2014. Group 1 underwent tympanoplasty with a microscopic approach (50 ears), and Group 2 underwent tympanoplasty with an endoscopic approach (50 ears). The epidemiological profiles and postoperative results, including hearing gain, duration of surgery, perioperative nausea or vomiting, and graft success rate, were reviewed. RESULTS The epidemiological profiles and preoperative hearing status were similar in both groups. Postoperatively, both groups had equal improvements in hearing and air-bone gap as well as equal perforation rates. However, the endoscopic group suffered less perioperative nausea or vomiting and had a shorter operative time. CONCLUSION The endoscopic approach for tympanoplasty offers superior visualization and shorter operative time than conventional surgery, in addition to equal hearing outcomes and perforation rates. Furthermore, observations of fewer tissue injuries, better cosmetic outcomes, and lesser perioperative nausea and vomiting suggest that the endoscopic approach is a better choice for surgery.

To estimate the prevalence and severity of hearing impairment (HI), the self-perception of HI, and the willingness to use a hearing aid (HA) in the elderly population in southern Taiwan.This community-based study was performed in a metropolitan hospital. A questionnaire about the perception of HI and the willingness to use a HA was used. The severity of HI in speech-frequency pure-tone average (PTA) was evaluated. The associations between sex, age, severity of HI, self-perception of HI, and the willingness to use a HA were analysed.A total of 599 volunteers were recruited from the health management center; 324 (54.1%) males and 275 (45.9%) females, who were 65 years of age or older.The prevalence of HI 25 dBHL in the elderly was 78%. The predicted levels for elderly persons to perceive HI and hearing difficulties were 34.38 dBHL and 54.38 dBHL, respectively. Males and younger participants were more willing to use HA. The primary reasons for refusing HA use were discomfort (25.1%) and a self-perception that the HA was unnecessary (19.7%).The prevalence of HI was high among the elderly population in southern Taiwan. Age and sex were the determinants of HA use.

OBJECTIVES: Age-related hearing impairment (ARHI) is a major disability among the elderly. This study aimed to analyze the association of single nucleotide polymorphisms (SNPs) of metabotropic glutamate receptor 7 (GRM7) gene with ARHI in an elderly population in Taiwan. MATERIALS AND METHODS: This was a community-based study performed in a metropolitan hospital. Participants ≥65 years of age were recruited. Participants with a pure tone average (PTA) of speech frequencies in the better ear of >35 decibel hearing level (dBHL) were classified into the case group, whereas those with PTA ≤25 dBHL were classified into the control group. The association of SNPs rs11928865, rs1353828, rs9814809, and rs9880404 with ARHI was analyzed. RESULTS: In 106 cases and 190 controls, alleles of all SNPs were found not to be associated with ARHI. The genotype of rs9880404 was found to be associated with ARHI in a dominant pattern, but the genotypes of rs11928865, rs1353828, and rs9814809 were found not to be associated with ARHI. CONCLUSION: GRM7 SNPs are associated with susceptibility to ARHI, but the significance of this finding in a Taiwanese population differed from that observed in European studies. Further studies may help to determine Taiwanese (Asian)-specific SNPs associated with ARHI.

Objective To describe the clinical manifestations of external auditory canal (EAC) cholesteatoma and evaluate the surgical outcomes of reconstruction using an inferior pedicled soft-tissue periosteum flap. Materials and methods A total of 28 patients were enrolled in this retrospective study conducted at Kaohsiung Medical University Hospital in Taiwan between January 2004 and December 2013. EAC cholesteatoma was classified according to the disease extent. The surgery was performed to reconstruct a smooth contour of EAC. Results The average age of the 28 patients (9 males and 19 females: 30 surgical ears) was 53.7 years. The most common clinical manifestations were unilateral otalgia (63.3%) and otorrhea (46.7%), and the most frequent locations of EAC cholesteatoma with bony invasion were the posterior-inferior (40%), inferior (30%), posterior (20%), and posterior-inferior-anterior (10%) aspects. Based on Naim's staging systems of EAC cholesteatoma, 26 ears (86.7%) were classified as stage III and 4 ears (13.3%) as stage IV. All patients received surgical management via a postauricular approach, and the average length of postoperative follow-up was 61.5 months (range 8-131 months). One patient had recurrence after surgery for 1 year 3 months. Conclusion Bony canaloplasty and obliteration with an inferior pedicled soft-tissue periosteum flap is a reliable procedure for EAC cholesteatoma.

The use of succinylcholine and rocuronium are reportedly feasible during intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN) in thyroid surgery. This study aimed to investigate and compare the recovery profiles of succinylcholine and rocuronium on the laryngeal muscle during IONM of the RLN in a porcine model. Nine male Duroc-Landrace piglets were anesthetized with thiamylal and underwent tracheal intubation without neuromuscular blocking agents (NMBAs). Needle electrodes were inserted into the vocalis muscles through the cricothyroid ligament. The RLN was exposed and stimulated. Electromyographic (EMG) signals were obtained before and after the intravenous administration of a NMBA. The EMG amplitudes were measured before and after (at 1-minute intervals) the administration of the study drug until complete recovery. The study NMBA regimen included succinylcholine (1 mg/kg), low-dose rocuronium (0.3 mg/kg), and standard dose rocuronium (0.6 mg/kg). The maximal neuromuscular blockade and 80% recovery (i.e., duration) of the control responses were recorded and analyzed. The 80% recovery of the control response for succinylcholine (1 mg/kg) was 19.7 ± 1.5 minutes; low-dose rocuronium (0.3 mg/kg), 16.3 ± 2.5 minutes; and standard dose rocuronium (0.6 mg/kg), 29.3 ± 5.7 minutes. Succinylcholine (1 mg/kg) and low-dose rocuronium (0.3 mg/kg) had significantly shorter durations than standard dose rocuronium (0.6 mg/kg). The EMG signal recovery returned to baseline within 30 minutes in the succinylcholine and low-dose rocuronium groups, but it did not return to baseline until 1 hour after surgery in the rocuronium (0.6 mg/kg) group. In this study, succinylcholine (1 mg/kg) and low-dose rocuronium (0.3 mg/kg) had favorable recovery profiles on the laryngeal muscle. It is recommended that low-dose rocuronium may replace succinylcholine for the induction of general anesthesia during IONM of the RLN in thyroid surgery.

Cholesteatoma is a destructive and expanding growth of keratinizing squamous epithelium in the middle ear or petrous apex. The molecular and cellular processes of the pathogenesis of acquired middle ear cholesteatoma have not been fully understood. In this study, comparative proteomic analysis was conducted to investigate the roles of specific proteins in the pathways regarding keratinocyte proliferation in cholesteatoma. The differential proteins were detected by comparing the two-dimension electrophoresis (2-DE) maps of the epithelial tissues of 12 attic cholesteatomas with those of retroauricular skins. There were 14 upregulated proteins in the epithelial tissues of cholesteatoma in comparison with retroauricular skin. The modulation of five crucial proteins, HSP27, PRDX2, GRP75, GRP78 and GRP94, was further determined by RT-PCR, Western blot and immunohistochemistry. Phosphorylation of HSP27 at Ser-82 was identified by mass spectroscopy. The results of this study suggested that phosphorylated HSP27 is the end expression of two potential signal-transduction pathways, and together with PRDX2, they are very likely involved in the proliferation of keratinocytes in cholesteatoma. Upregulations of GRP75, GRP78 and GRP94 in keratinocytes may be able to counter endoplasmic reticulum stress, to inhibit cell apoptosis, to prevent protein unfolding and to promote cholesteatoma growth.

Objectives/Hypothesis: The mechanisms of cholesteatoma proliferation and growth remain unclear. The objective of this study is to discover the potential mechanisms of the proliferation and growth of cholesteatoma by direct experimental assessments on cholesteatoma tissues from patients. Study Design: Retrospective study by the comparisons between cholesteatoma tissues and retroauricular skin tissues from the patients. Methods: Two-dimensional gel electrophoresis, LC-MS/MS analysis and immunohistochemistry were performed to investigate specific protein expression in cholesteatoma tissues compared with retroauricular skin tissues collected from the patients. Western blotting analysis was conducted to verify the regulation of specific proteins found by 2-DE, and to determine the changes of associated potential modulators in cholesteatoma proliferation and growth. Results: Twelve serpin B3 isoforms were found by 2-DE and identified by LC-MS/MS analysis, which is coherent with the results exhibited by immunohistochemistry and western blot. Up-regulation of STAT3 and down-regulations of cathepsin K and cathepsin L were represented using western blot. Conclusions: The data in this study suggested serpin B3, STAT3, cathepsin K, and cathepsin L are associated with the proliferation and growth of cholesteatoma, and these proteins may be influential factors in cholesteatoma growth. Laryngoscope, 2012

Background: Heat shock proteins protect cells and tissues against different types of damage. Previous studies have revealed that the serum level of heat shock protein 70 (HSP70) increases in sudden sensorineural hearing loss (SSNHL) patients. We hypothesized that genetic variants of the HSP70 gene are associated with susceptibility to SSNHL. Methods: We conducted a case-control study with 160 SSNHL cases and 178 controls. Three tagging single nucleotide polymorphisms (SNPs) were selected. The genotypes were determined using TaqMan technology. Hardy-Weinberg equilibrium was tested for each SNP, and genetic effects were evaluated according to three inheritance modes. A haplotype analysis was also performed. Results: All three SNPs were in Hardy-Weinberg equilibrium. The CT genotype of rs2075800 exhibited an adjusted odds ratio of 0.59 (95% confidence interval 0.37–0.94; p = 0.027). The T allele of SNP rs2075800 was associated with SSNHL under the dominant model (p = 0.019; odds ratio 0.59). Haplotype analysis of the three SNPs demonstrated that the haplotype TGC (rs2075800/rs1043618/rs2763979) was statistically significant (p = 0.0137). Conclusions: These results suggest that HSP70 gene polymorphisms influence the susceptibility to the development of SSNHL in the Taiwanese population.

Various parotid gland diseases are seen clinically, including inflammation, sialolithiasis, and benign and malignant tumors. It is important to differentiate between these to make a correct diagnosis and for proper management. Here, we investigated the relationship between tumor characteristics and pathology, and considered whether the former could be used to differentiate malignant from benign parotid gland diseases. We retrospectively reviewed the charts and data of 316 patients who underwent surgery in Kaohsiung Medical University Chung-Ho Memorial Hospital from January 1, 1998 to December 31, 2008. Two hundred and eighty-one patients (88.9%) had benign disease, and 35 (11.1%) had malignant disease. The most common benign disease was pleomorphic adenoma (115 cases, 36.4%), but the most common disease in male patients was Warthin's tumor, a finding which, as far as we aware, has not been previously been reported in the literature. The incidence of Warthin's tumor seems to be increasing. In malignant disease, the most common was acinic cell carcinoma (8 cases, 22.9%). Compared with benign disease, malignant parotid gland disease more often presents as a hard, painful, fixed and large mass (> 3 cm), and more often involves the deep lobe of the parotid gland. Partial parotidectomy was adequate for most tumors, including pleomorphic adenoma. The most common postoperative complication was temporary facial palsy, followed by permanent facial palsy. However, there was no difference in transient facial palsy rate between benign and malignant parotid gland disease, although parotid gland cancer had a higher incidence of permanent facial palsy postoperatively.

Noise-induced hearing loss (NIHL) is the major cause of adult sensorineural hearing loss. It is a complex disease caused by the interaction of environmental and genetic factors. Previous studies found that heat shock proteins (HSPs) were associated with the development of NIHL. Specifically, polymorphisms in the heat shock protein 70 (HSP70) gene family are associated with a susceptibility to NIHL. In this study, three single nucleotide polymorphisms (SNPs) of the HSP70 family (SNP1: rs2075800; SNP2: rs1043618; SNP3: rs2763979) were genotyped in 349 noise-exposed Taiwanese workers. The subjects were categorized into noise-susceptible (NS; n = 27) and general susceptibility (GS; n = 322) groups by the change of a 4K-weighted audiometric average in an interval of 5 years. The G/C genotype of SNP2 was found to be associated with NIHL susceptibility (adjusted OR = 2.634; 95% CI = 1.096–6.328). No significant association was found for SNP1 and SNP3 with NIHL susceptibility. Analysis of haplotypes composed of these three SNPs revealed a significant association between NIHL susceptibility and haplotype CCC (OR = 2.197; 95% CI = 1.110–4.370). In conclusion, the genetic polymorphisms in the HSP70 genes seem to be associated with the individual’s susceptibility to NIHL in the Taiwanese population. These findings could be used as a reference in the understanding and prevention of NIHL.

The success rate (57.5%) in this study is not high for surgical treatment of tympanosclerosis, and therefore lends further evidence that intratympanic tympanosclerosis has been considered intractable for reconstructive surgery.To investigate the clinical findings and surgical results of intratympanic tympanosclerosis.From January 1989 to December 2006, a total of 1523 tympanoplasties were performed. Of these, 84 tailored tympanomastoidectomies were performed for tympanosclerosis in 80 patients.The incidence of intratympanic tympanosclerosis with chronic ear disease was 5.5%. Chronic otitis media was the most common etiologic factor for the tympanosclerosis (79 ears, 94.1%). Tympanosclerosis in the middle ear cavity was most often found around the malleus handle (67 ears, 79.8%), and more than half of the cases of tympanosclerosis (43 ears, 51.2%) had multiple areas affected by the sclerotic tissue. Tympanosclerotic fixation of the stapes was found in 31 ears (36.9%), and an intact ossicular chain was seen in 57 ears (67.9%). There was a postoperative improvement in hearing in 42 ears (57.5%).

Objective Hypoxia may result in increased recruitment of inflammatory cells and release of various inflammatory cytokines. Local hypoxia within the sinus is believed to aggravate sinus inflammation. In this study, we tried to investigate the correlation of hypoxia-inducible factor, which is upregulated under hypoxic condition, and nasal polyposis. Subjects and Methods Forty-four polyps from patients undergoing endoscopic sinus surgery and 38 inferior turbinate mucosa were obtained for immunohistochemical staining. Twenty-three polyps and 22 turbinate mucosa also underwent real-time reverse transcription-polymerase chain reaction for quantification of messenger RNA (mRNA). The severity of the disease was judged by the Lund-Mackay CT scoring. Results Expression of hypoxia-inducible factor protein, but not mRNA, was significantly increased in nasal polyps compared with that in the turbinate mucosa, but it did not correlate with the disease severity. Conclusion We suggest that hypoxia may have a role in the initiation of nasal polyposis.

Background Rupture of internal carotid artery (ICA) pseudoaneurysm is a lethal complication in patients with nasopharyngeal carcinoma (NPC). Angiography is the best diagnostic and treatment method. The aim of embolization is to block the pseudoaneurysm; but sometimes, total occlusion of great vessels is ineludible. We describe a case of NPC post-radiation therapy and with ruptured pseudoaneurysm treated by angio-embolization. Methods The patient had received embolization with numerous tools such as stent grafts, balloons, and bare stents with or without filter protection. Results After failing to pass through the narrow lumen by embolizing tools, the right ICA finally occluded spontaneously by self-thrombosis. Conclusion Although the angio-embolization is a good method to resolve the problems of ruptured pseudoaneurysm, there is still high mortality and morbidity. Being aware of the clinical presentations and the changes of images may alert us to predict the happening earlier. © 2008 Wiley Periodicals, Inc. Head Neck, 2008

Objectives To assess the influence of hyperlipidemia on the development of noise-induced hearing loss (NIHL). Study Design This case-control study analyzed data from the Department of Preventive Medicine at one academic medical center in southern Taiwan. Subjects and Methods We collected the laboratory data from routine health examinations administered to workers who were exposed to noise greater than 85 dBA over a one-year period. We analyzed the relationships of cholesterol and triglyceride levels with NIHL. Results A total of 4071 cases were analyzed. After adjusting for age and gender, hypertriglyceridemia was found to be related to NIHL (aOR = 1.281; 95% CI, 1.088-1.507), but hypercholesterolemia was not (aOR = 0.951; 95% CI, 0.795-1.138). Conclusions This study, one of the largest to date to study the relationship between hyperlipidemia and NIHL, found that individuals with hypertriglyceridemia are at greater risk of NIHL. On the basis of this finding, workers exposed to high noise levels should be educated on control of triglyceride levels to help reduce their risk of NIHL.

The phosphodiesterase 4D (PDE4D) gene has been reported as a risk gene for ischemic stroke. The vascular factors are between the hypothesized etiologies of sudden sensorineural hearing loss (SSNHL), and this genetic effect might be attributed for its role in SSNHL. We hypothesized that genetic variants of the PDE4D gene are associated with susceptibility to SSNHL. We conducted a case-control study with 362 SSNHL cases and 209 controls. Three single nucleotide polymorphisms (SNPs) were selected. The genotypes were determined using TaqMan technology. Hardy-Weinberg equilibrium (HWE) was tested for each SNP, and genetic effects were evaluated according to three inheritance modes. We carried out sex-specific analysis to analyze the overall data. All three SNPs were in HWE. When subjects were stratified by sex, the genetic effect was only evident in females but not in males. The TT genotype of rs702553 exhibited an adjusted odds ratio (OR) of 3.83 (95 % confidence interval = 1.46-11.18) (p = 0.006) in female SSNHL. The TT genotype of SNP rs702553 was associated with female SSNHL under the recessive model (p = 0.004, OR 3.70). In multivariate logistic regression analysis, TT genotype of rs702553 was significantly associated with female SSNHL (p = 0.0043, OR 3.70). These results suggest that PDE4D gene polymorphisms influence the susceptibility for the development of SSNHL in the southern Taiwanese female population.

Thornwaldt's bursa, also known as nasopharyngeal bursa, is a recess in the midline of the nasopharynx that is produced by persistent notochord remnants. If its opening becomes obstructed, possibly due to infection or a complication from adenoidectomy, a Thornwaldt's cyst might develop. Here, we present a 53-year-old man who complained of nasal obstruction that had progressed for 1 year. Nasopharyngoscopy showed a huge nasopharyngeal mass. Thornwaldt's cyst was suspected. Magnetic resonance imaging showed a lesion measuring 3.6 × 3.4 cm, intermediate on T1-weighted and high signal intensity on T2-weighted imaging, neither bony destruction nor connection to the brain. The patient underwent endoscopic surgery for this huge mass. Afterwards, his symptoms improved significantly. We present the treatment and differential diagnosis of a nasopharyngeal cyst.

Objectives To investigate factors affecting the prognosis of sudden sensorineural hearing loss (SSNHL). Study design and setting This is a retrospective study of patients with SSNHL hospitalized at an academic medical center. All patients in this study were treated with prednisolone and dextran. We compared a new 7-pattern classification for audiometric pattern and prognosis analysis with Sheehy classification. Results We analyzed 148 affected ears in 146 patients. Occurrence of SSNHL was associated with changes in season. The best prognosis was with the midtone pattern of the 7-pattern classification and with the low-tone pattern of Sheehy classification. The older patients, those with vertigo, or those treated after 6 days had a poor prognosis. There was no significant association between ESR level and prognosis. Conclusions SSNHL patients with midtone loss have the best prognosis. This study of the audiometric patterns and prognostic factors of SSNHL allow us to better predict its outcome. EBM rating B-2

Chondromas of the nasal septum are rare. Since its first literary description in 1842, only about 140 cases have been reported. We present the case of a 38-year-old female who reported intermittent nasal bleeding and nasal obstruction for 3 months. A reddish mass arising from the nasal septum was found by endoscope. The tumor was removed under endoscopic guidance and histopathologic examination revealed chondroma composed of well-differentiated chondrocytes. No recurrence was noticed after 6 months of follow-up. Despite their rarity, chondromas should be taken into consideration in the differential diagnosis of nasal tumors, especially those arising from the nasal septum.