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Conclusion: Patients with post-lingual deafness should not be excluded from cochlear implantation (CI) on the basis of duration of deafness. We found that the prognosis was favorable in patients who developed deafness after adolescence, even in those with extremely long-term deafness., Objectives: CI is an effective treatment for post-lingual deafness. However, it remains unclear whether CI would benefit patients with extremely long-term deafness. We evaluated the auditory performance after CI of patients who had been deaf for more than 30 years., Methods: The study enrolled 81 adults with post-lingual deafness. Speech perception tests were performed preoperatively and 12 months postoperatively, and factors affecting the postoperative auditory performance were investigated. The subjects were divided into groups according to the duration of deafness and the postoperative speech perception scores were compared., Results: A marked improvement in the open-set speech perception scores (mono/disyllabic words and sentences) after implantation was seen in all groups, and no significant difference in the improvement in speech perception scores was observed among the groups. Age at onset of deafness was closely related to the postoperative performance, and patients who had lost their hearing before adolescence performed poorly.

Conclusion: The study showed that combined repetitive transcranial magnetic stimulation (rTMS) on the auditory cortex and prefrontal cortex has more benefit than rTMS on the auditory cortex alone for tinnitus control in patients with depression. Further studies for the most optimal combination of stimulation on both areas are needed., Objective: Recent studies suggest that the neuronal network changes of chronic tinnitus are beyond the auditory pathway. There is increasing evidences for the application of rTMS on multiple brain cortices in addition to the auditory cortex for the treatment of tinnitus. Sequential rTMS was performed on the auditory cortex alone as well as the auditory cortex combined with prefrontal cortex in patients with both chronic tinnitus and depression., Methods: Patients who presented with chronic tinnitus of more than 1 year were enrolled in the present study (seven males, four females; mean age 54 years). To select the site for the rTMS, PET CT was performed. Patients received the first rTMS on the primary auditory cortex for 5 days and on the primary auditory cortex and prefrontal cortex in the second application after tinnitus relapse. The Tinnitus Handicap Inventory (THI), visual analog scale (VAS), and Beck Depression Inventory (BDI) were evaluated before and after rTMS., Results: The mean THI score of the eight patients with depression changed from 77.5 ± 15 to 61.8 ± 20.1 after the second rTMS. There was statistical significance only for the second rTMS. The VAS score changed from 8.6 ± 1.6 to 6.3 ± 1.8 after the first rTMS and from 7.6 ± 2.4 to 4.6 ± 2.7 after the second rTMS, showing statistically significant changes both times. The THI changes after the second rTMS were greater than after the first rTMS, and the changes in VAS score showed a similar pattern. The changes in BDI score, which indicates the severity of depression, showed a variable pattern after rTMS. Patients with mild depression (10≤ BDI score <16, n = 4) showed significant improvement of THI with the second combined rTMS (ΔTHI = 24.5) as compared with the first rTMS on the auditory area (ΔTHI = 6). In contrast, combined rTMS did not show any better improvement on THI (ΔTHI = 6.5) than the first rTMS on the auditory cortex (ΔTHI = 7) in patients without depression (BDI <10, n = 3) and patients with moderate to severe depression (BDI ≥16, n = 4).

Conclusion: Our technique can decrease the formation of retraction pockets and improve hearing function. The wheel-shaped cartilage-perichondrium composite graft (Wheel CPCG) can be considered a good material for a drum graft, and it is easy to insert a ventilation tube, in case of initial drum retraction., Objective: The purpose of this study was to introduce the novel surgical technique of a Wheel CPCG with one-stage ossiculoplasty to prevent a retraction pocket and subsequent cholesteatoma after intact canal wall tympanomastoidectomy., Patients and Methods: A total of 47 patients were reviewed; 43 cases were selected for audiologic testing. The results of operations were evaluated by comparing preoperative and postoperative hearing results and postoperative drum findings., Results: A retraction pocket was observed in three cases (6.7%). Slight protrusion of partial ossicular replacement prosthesis (PORP) and lateral healing of drum was observed in one case each, and there were two cases of postoperative infection. The number of cases with an air-bone gap (ABG)<20 dB increased from 9 (23%) cases before operation, to 20 cases (51%) after operation. The ABG average statistically decreased from 30.0 dB to 24.0 dB, and the mean air conduction thresholds decreased from a preoperative level of 47.3 dB to a level of 35.7 dB.

Conclusions: Polycel is an effective material to use in ossiculoplasty. Good prognostic factors for hearing improvement after ossiculoplasty were healthy middle ear mucosa and the presence of stapes superstructure., Objective: During the last decade, the surgical use of alloplasts has become increasingly widespread among otologists. This study aimed to evaluate the hearing results after ossiculoplasty using Polycel prosthesis., Materials and Methods: We retrospectively reviewed 188 patients who underwent ossicular chain reconstruction using Polycel prosthesis and were followed up postoperatively for more than 12 months at Severance Eye-ENT Hospital from 1998 to 2002. Postoperative hearing results were assessed by measuring the postoperative air-bone gap (ABG) and closure of the ABG. Successful postoperative ABG criteria were defined as the following three measurements: ABG of

Conclusions: All cost-utility ratios obtained using the various measures of utility except quality well-being (QWB) were below 25,000 dollars per quality-adjusted life year (QALY). Therefore, treatment of post-lingual deaf adults with cochlear implants improves the quality of life at a reasonable direct cost and appears to produce net savings for Korean society., Objectives: To determine the quality of life and the cost consequences of cochlear implants for deaf adults., Patients and Methods: We performed a cost-utility analysis using data from 11 post-lingual deaf adults who had received cochlear implants between 1990 and 2002 in Seoul, Korea. The average age of the participants was 49.6 years. The main outcome was the direct cost per QALY calculated using the visual analog scale (VAS), health utility index (HUI), EuroQol (EQ-5D) measure and QWB measure. Costs and utility were discounted 3% annually., Results: Recipients used implants for an average of 5.6 years. The mean VAS, HUI, EQ-5D, and QWB score increased by 0.33 (from 0.27 before implantation to 0.60 at survey), 0.36 (0.29 to 0.65), 0.26 (0.52 to 0.78), and 0.16 (0.45 to 0.61), respectively. The discounted direct cost was 22,320 dollars, which yielded a cost-utility ratio of 19,223 dollars per QALY using VAS, 17,387 dollars per QALY using HUI, 24,604 dollars per QALY using EQ-5D, and 40,474 dollars per QALY using QWB.

Conclusion: The Na-K-2Cl cotransporter-1 (NKCCl) may be essential for the maintenance and functioning of the vestibular morphology in mice and it is strongly expressed in human vestibular end organs., Objective: NKCCl is a member of the cation-coupled chloride transporter which participates in salt transport and cell volume regulation in diverse tissues. NKCCl-deficient mice exhibit deafness, and show structural alterations in the cochlea. In addition to hearing loss, NKCCl-deficient mice show a shaker-waltzer behavior, which suggests a vestibular system defect. In this study we investigated the morphology of the vestibular system of NKCCl-deficient mice and also evaluated whether NKCCl mRNA and its protein are expressed in human vestibular end organs., Material and Methods: NKCCl-deficient and wild-type mice aged 4-5 weeks were sacrificed. Their heads were cut in the midsagittal plane, fixed and decalcified. For light microscopy, 5-microm sections were cut and stained with hematoxylin-eosin. Human vestibular end organs were harvested during acoustic tumor surgery via a translabyrinthine approach. Some of these end organs were used for total mRNA extraction and the remainder for immunostaining. Reverse transcriptase polymerase chain reaction and immunostaining were performed for NKCCl., Results: The scala media of the cochleae of the NKCCl-deficient mice had collapsed but the bony labyrinth appeared unaffected. However, the semicircular canals (SCCs) were much smaller than those in the wild-type mice. Furthermore, the SCCs were completely missing in some NKCCl-deficient mice. NKCCl mRNA was expressed in both the human macula and crista ampullaris, and its protein was expressed mainly in the transitional and dark cell areas of the human crista ampullaris.

Polyps are believed to be the source of mucus hypersecretion in chronic inflammation of the sinus. However, it is not clear which mucins are responsible for the hypersecretion of mucus by nasal polyps. We describe the over-expression of MUC8 mRNA in nasal polyps and the upregulation of MUC8 mRNA expression and downregulation of MUC5AC mRNA expression by inflammatory mediators. We found that the level of MUC8 mRNA, but not the level of MUC5AC mRNA, increased in nasal polyps. We also found that there was an increase in intracellular mucin in nasal polyps, compared to the normal nasal inferior turbinate. A mixture of inflammatory mediators increased MUC8 mRNA expression and decreased MUC5AC mRNA expression in cultured normal human nasal epithelial cells. Among inflammatory mediators, IL-4 is responsible for the decrease in MUC5AC mRNA and MUC5AC mucin secretion. These results indicate that MUC8 may be one of the major mucins secreted from the polyp epithelium and that it may play an important role in the pathogenesis of mucus hypersecretion in chronic sinusitis with polyps.

Recent technical advances now permit the serial culture of normal human middle ear epithelial (NHMEE) cells. However, the ciliary differentiation of these cells has not been achieved. The purpose of this study was to establish a culture system in order to differentiate serially cultured NHMEE cells into ciliated cells. If ciliated cells developed, the percentages of ciliated cells and secretory cells were measured throughout the duration of culture. We also examined the levels of mucin and lysozyme secretion and their mRNAs in a time-dependent manner. Human middle ear mucosa with a normal appearance was harvested and serially cultured after enzymatic disaggregation. These cells were cultured in an air-liquid interface (ALI) culture system for 2, 7, 14, 21 and 28 days after confluence. Ciliogenesis usually began 16-18 days after confluence. The percentage of ciliated cells detected by means of immunohistochemical staining increased over time up to a maximum of 10.6% but the percentage of secretory cells remained stable at approximately 40% throughout the duration of culture. By Day 14 after confluence, the amounts of mucin and lysozyme secretion, as measured by dot-blotting analysis, had increased significantly and then remained stable. The expression levels of mucin gene 5B (MUC5B), MUC8 and lysozyme increased with the duration of culture. MUC8 in particular showed a dramatic increase on Day 28 after confluence. In contrast, the level of MUC5AC mRNA peaked on Day 14 after confluence, and then decreased. In conclusion, ciliary differentiation of NHMEE cells can be induced using an ALI culture system. Our study also suggests that secretory function develops earlier than ciliogenesis, and that the expressions of MUC5B and MUC8 mRNAs increase as a function of differentiation.